What is multiple sclerosis?
Multiple Sclerosis (commonly known as M.S.)
is a common chronic,
often disabling condition of the central nervous system (brain and
spinal cord). There are approximately 85,000 people in the U.K.
affected by M.S.
Multiple sclerosis is the result of damage to
the myelin sheath.
The myelin sheath is a protective covering that
surrounds the nerve fibres in the brain and spinal cord. When myelin
is working properly, electrical impulses get through quickly allowing
fast and co-ordinated movement. However, when myelin is damaged
the messages are slower, distorted or even non-existent, causing
many of the symptoms associated with M.S. Damaged areas of myelin
are known as plaques or lesions and these appear as hardened scar areas in the brain and spinal
cord.
The name multiple sclerosis means - ‘multiple’
as it can affect many areas of the brain and spinal cord at different
times, and ‘sclerosis’, which means damaged areas, scars.
There are 4 main types of multiple sclerosis,
they are as follows:
Benign M.S. - starts with a few mild
attacks and is then followed by a complete recovery. There is not
usually permanent disability with this type of M.S. Benign M.S.
can only be diagnosed if after 10-15 years there is minimal disability.
Relapse/ remitting M.S. - this is the
type of M.S. that most people with the condition start with. This
type of M.S. starts with attacks and then periods of remission.
These remissions, when there are no or few symptoms can last for
months or even years. A relapse (attack) is unpredictable the symptoms
may only last a few hours or could go on and last for months and
new symptoms may occur with each attack.
Secondary progressive M.S. - this type
starts in the same way as relapsing/remitting M.S. but after a few
attacks the remission periods stop. This type of M.S. will usually
develop after 15-20 years after the first diagnosis of M.S.
Primary progressive M.S. - this accounts
for about 15% of M.S. cases in the U.K. This type of M.S. never
has periods of remission and people with this type of M.S. experience
steadily worsening symptoms and progressive disability.
What is a relapse?
A relapse is when your symptoms suddenly become
worse. A relapse can last for a few days or a few months. New symptoms
may occur with each relapse.
What causes multiple sclerosis?
The exact cause of M.S. is still unknown. However,
through worldwide scientific research there are a number of factors
thought to be involved with the development of the illness. One
major factor in the damage of myelin is due to an abnormal response
of the body’s immune
system. M.S. is often classified as a 'auto-immune' disease.
The immune system usually defends against invading organisms,
but if you have a auto-immune disease, your body's immune system
attacks its own cells and tissues. In the case of M.S. the body is attacking myelin. It
has not been pinpointed what triggers the immune system to do this,
but the possibility of a virus may play a major role in developing
the illness. It is also possible that perhaps there is not just
one M.S. virus, but many common viruses, such as glandular
fever, measles or herpes,
that lie dormant and then act as a trigger for M.S.
There can be a family link between people with
M.S., though it is not thought to be directly hereditary.
Am I at risk of getting multiple sclerosis?
Figures show, women are much more likely to
develop M.S. than men. In the majority of cases, M.S. tends to be
a young person's disease and is most likely to appear between the
ages of 20 and 40. M.S. is not contagious,
therefore your friends and family cannot catch it from you. Children
can get M.S. but this is very rare.
What are the symptoms of multiple sclerosis?
Multiple sclerosis symptoms can vary from person
to person. The severity of the symptoms depends on the areas of
the central nervous system that are affected. There is no set pattern
to M.S. development, some can experience very mild symptoms, whilst
others can have severe and rapid progression of the disease. Symptoms
you may have include:
- Numbness and ‘pins
and needles’ in the limbs.
- Difficulty in walking/
loss of balance.
- Clumsiness.
- Vision problems and/or
pain at the back of the eye.
- The need to urinate frequently and urgently.
- Impotence.
- Lack of concentration.
- Forgetfulness.
- Slurred speech.
- Fatigue.
- Mood changes/ depression.
How is multiple sclerosis diagnosed?
Diagnosing M.S. can be very frustrating as there
is no single test that is 100% conclusive. There are several tests
and procedures that are needed to establish a diagnosis of M.S.
and these include:
- Medical history - your doctor will require
a detailed report of all the symptoms you have experienced and
will check your present state of health.
- A lumbar puncture - this test looks for the
presence of antibodies in the fluid (known as cerebrospinal fluid),
which flows around the brain and spinal cord. The procedure involves
a thin needle being inserted into the spine, and a small amount
of the fluid is withdrawn. A local anaesthetic will be given to numb the skin. This procedure may be uncomfortable,
but it is not painful as the skin around the area where the fluid
is removed is numb. This test is not totally conclusive to make
a M.S. diagnosis and other tests will be required.
- Evoked potential tests - this test involves
small electrodes being attached to the neck and head, this will
help to indicate how the nervous system is working and if there
is any slowing of the nerve messages in the various parts of the
brain.
- Magnetic Resonance Imaging scan (M.R.I.)
- this is a scan that takes a very detailed picture of the brain
and spinal cord, the scan will show any affected areas.
- Neurological examination - a neurologist
will test for abnormalities in nerve pathways. Common neurological
signs involve changes in eye movements, limb co-ordination, balance,
sensation, speech, weakness and reflexes. Problems in these areas
can be caused by many other illnesses, so once again this test
cannot conclude if M.S. is causing the abnormalities and other
tests will need to be carried out.
As you can see it is not always clear-cut to
make a M.S. diagnosis and therefore a good relationship with your
doctor is essential, to keep a close check on your general health.
Is there a cure for multiple sclerosis?
As yet there is no cure for M.S. sufferers,
but there are many treatments that can help and ease some of the
symptoms. Your doctor will discuss all the options available.
What treatments are available for multiple
sclerosis?
Depending on the severity of your symptoms the
treatment available may include:
- Steroids - these are used to help relapses.
- Injections of interferon beta - interferons
are chemicals found in everyone's body, they play an important
part in the immune system. Interferon beta helps reduce relapses,
increase the time in remission and reduce the progression of disability.
Interferon beta will only be available to M.S. patients who meet
the prescriptions criteria.
- Anti-spasmodic drugs - for muscle spasms caused by the damage of nerves.
- Physiotherapy - to help with balance and walking.
What course may the illness take?
It is very hard to predict accurately what course
M.S. will take for each individual and the majority of people with
M.S. will have symptoms that come and go. However, the way in which
the illness progresses in the first 5 years after the initial diagnosis,
may give some indication of how it will continue. Over time M.S.
may progress and cause disability and poor co-ordination. It is
important to realize that many people with M.S. lead relatively
normal lives and will have manageable disabilities (e.g. a limp
or fatigue).
How can I help myself?
Finding out as much as you can about M.S. is
vital, as it will often reduce the worry of some of the early symptoms.
Always try to get regular rest and relaxation, this is very important
as becoming over tired can cause problems. Stick to a healthy
balanced diet to help maintain good health. Some exercise
such as basic aerobic exercise is recommended as long as you do
not over exhaust yourself.
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