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Multiple Sclerosis

multiple sclerosis


Multiple sclerosis (MS) is a disease where patches of inflammation occur in parts of the brain and/or spinal cord. This can cause damage to parts of the brain and lead to various symptoms.

What causes multiple sclerosis?

MS is thought to be an autoimmune disease. This means that cells of the immune system, which normally attack bacteria, viruses, etc, attack part of the body. When the disease is active, parts of the immune system, mainly cells called T cells, attack the myelin sheath which surrounds the nerve fibers in the brain and spinal cord. This leads to small patches of inflammation.

The inflammation around the myelin sheath stops the affected nerve fibers from working properly, and symptoms develop. When the inflammation clears, the myelin sheath may heal and repair, and nerve fibers start to work again. However, the inflammation, or repeated bouts of inflammation, can leave a small scar (sclerosis) which can permanently damage nerve fibres.

How does multiple sclerosis progress?


Once the disease is triggered, it tends to follow one of the following four patterns.

  • Relapsing-remitting form of MS
    • Nearly 9 in 10 people with MS have the common relapsing-remitting form of the disease. A relapse is when an episode (attack) of symptoms occurs. During a relapse, symptoms develop and may last for days, but usually last for 2-6 weeks. They sometimes last for several months. Symptoms then ease or go away (remit). You are said to be in remission when symptoms have eased or gone away. Further relapses then occur from time to time.
    • Eventually, often after 5-15 years, some symptoms usually become permanent. The permanent symptoms are due to accumulation of scar tissue in the brain and to the gradual nerve damage that occurs. This is called secondary progressive MS. Typically; about two thirds of people with relapsing-remitting MS will have developed secondary progressive MS after 15 years.
  • Secondary progressive form of MS
    • There is a steady worsening of your symptoms (with or without relapses) in this form of MS. Many people with the relapsing-remitting form later develop this type of MS.
  • Primary progressive form of MS
    • In about 1 in 10 people with MS, there is no initial relapsing-remitting course. The symptoms become gradually worse from the outset, and do not recover. This is called primary progressive MS.
  • Benign MS
    • In less than 1 in 10 people with MS, there are only a few relapses in a lifetime, and no symptoms remain permanent. This is the least serious form of the disease and is called benign MS.

Who gets multiple sclerosis?

It can affect anyone at any age, although it is rare in young children. It most commonly first develops around the age of 30. It is twice as common in women as in men. MS is not strictly an hereditary disease. However, there is an increased chance of MS developing in close relatives of affected people.

Multiple sclerosis symptoms

The more common symptoms include:
Visual problems

The first symptom of MS for around one in four people with MS is a disturbance of vision. Inflammation (swelling) of the optic nerve can occur. This is called optic neuritis. This can cause pain behind your eye and also some loss of your vision. This usually only affects one eye.

Muscle spasms and spasticity

Tremors or spasms of some of your muscles may occur. This is usually due to damage to the nerves that supply these muscles.

Pain

Neuropathic pain - this occurs due to damage to the nerve fibres. This can cause stabbing pains or a burning sensation over parts of your skin. Areas of your skin may also become very sensitive.

Musculoskeletal pain - this type of pain can occur in any of your muscles that are affected by spasms or spasticity.

Fatigue

Extreme tiredness or fatigue is one of the most common symptoms of MS. This tiredness is more than the tiredness you would expect after exercising or exertion.

Emotional problems and depression

You may find that you laugh or cry more easily, even for no reason. Also, many people with MS have symptoms of depression or anxiety at some stage.

Other symptoms which may occur include:

  • Numbness or tingling in parts of the skin. This is the most common symptom of a first relapse.
  • Weakness or paralysis of some muscles.
  • Problems with your balance and co-ordination.
  • Problems with concentration and attention.
  • Tremors or spasms of some of your muscles.
  • Dizziness.
  • Problems with passing urine.
  • Inability to have an erection in men.
  • Difficulty with speaking.

Secondary symptoms

They may include: contractures, urine infections, osteoporosis (thinning of bones), muscle wasting and reduced mobility.

How is multiple sclerosis diagnosed?

Almost all of the symptoms that can occur with MS can also occur with other diseases. Therefore, a firm diagnosis of MS is often not made until two or more relapses have occurred. So, you may have months, or years, of uncertainty if you have an episode of symptoms, and the diagnosis is not clear.

Do any tests help?

In most cases, no test can definitely prove that you have MS after a first episode of symptoms or in the very early stages of the disease. However, some tests are helpful and may indicate that MS is a possible diagnosis.

A magnetic resonance imaging (MRI) scan of the brain is the most useful test. This type of scan can detect small areas of inflammation and scarring in the brain which occur in MS.

Lumbar puncture. In this test a needle is inserted, under local anaesthetic, into the lower part of the back. It takes a sample of some of the fluid that surrounds the brain and spinal cord. This is called cerebrospinal fluid (CSF). Certain protein levels are measured. Some proteins are altered in MS.

Evoked potential test. In this test, electrodes measure if there is slowing or any abnormal pattern in the electrical impulses in certain nerves.

Multiple sclerosis treatment

At present, although there is no cure for MS, certain symptoms of MS can often be eased. Treatments generally fall into four categories:

  • Medicines that aim to modify the disease process.
  • Steroid medication to treat relapses.
  • Other medicines to help ease symptoms.
  • Other therapies and general support to minimise disability.

Medicines that aim to modify the disease process

These medicines are known as immunomodulatory agents. They include two forms of interferon beta-1a, one form of interferon beta-1b, glatiramer, natalizumab and fingolimod. These medicines do not cure MS and they are not suitable for everyone with MS. Natalizumab is a fairly new treatment for patients with more advanced and very active MS. Fingolimod is also new. It is the only tablet form of disease-modifying treatment. All the others are given by injection.

Studies have shown that these medicines reduce the number of relapses in some cases. They may also have a small effect on slowing the progression of the disease. The exact way in which they work is not clear, but they all interfere with the immune system in some way.

Steroids
A steroid is often prescribed if you have a relapse which causes disability. A high dose is usually given for a few days. This is often by injection into a vein each day for several days. Sometimes steroid tablets are used. Steroids work by reducing inflammation. A course of steroids will usually shorten the duration of a relapse. However, steroids do not affect the ongoing progression of the disease.

Other treatments to improve symptoms

  • Anti-spasm drugs to ease any muscle spasms.
  • Painkillers which are sometimes needed.
  • Medicines which can help with some urinary problems that may develop.
  • Antidepressant medicines which are sometimes advised if you develop depression.
  • Medicines which can often help with erectile problems which may develop.
  • There is debate as to the benefits of cannabis for people with MS.

Other treatments, therapies and support

  • Physiotherapy.
  • Occupational therapy.
  • Speech therapy.
  • Specialist nurse advice and support.
  • Psychological therapies.
  • Counselling.

What is the outlook?

MS affects different people in many different ways. This means that it is very difficult to predict the outlook for people with MS. There are currently no tests to predict how MS will progress in a person. Most people with MS will be able to continue to walk and function at their work for many years after their diagnosis.


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