What is Multiple Sclerosis?Multiple Sclerosis (or MS) is an inflammatory disease of the Central Nervous System (CNS) and there are estimated to be about 130,000 people with MS in the UK. The nerve fibres of the CNS are protected by a fatty tissue known as myelin. A Person with MS (PwMS) has areas of damage (lesions) where myelin is lost or damaged (demyelination) which in turn causes nerve cells to become exposed or damaged. A PwMS may lose myelin in various (multiple) areas leaving scar tissue called sclerosis giving the condition its name, Multiple Sclerosis. Diagram showing the effect of MS on the nervous system Symptoms may include mobility problems, spasticity, pain, impaired vision, incontinence, impaired sexual function, slurred speech, fatigue or cognitive dysfunction (memory and reasoning difficulties). MS is unpredictable and variable between people, depending on which areas of the CNS are affected and how badly they are damaged. It is important to point out that very few people will experience most of these symptoms, the majority of PwMS will experience lesser and/or fewer symptoms and will still have a good quality of life. About 75% – 80% of PwMS do not need to use wheelchairs. MS is not hereditary, contagious or terminal, but people with MS will live for the rest of their life with the symptoms of the condition.
Types Of MSThere are four main types of MS:
- Relapsing/Remitting MS: Characterised by “good turns and bad turns”, relapses (an attack of MS) are followed by periods of remission, when a person may make a complete or almost complete recovery. Most people with Multiple Sclerosis are first diagnosed with relapsing/remitting MS.
- Secondary Progressive MS: About 50% of people with Relapsing/Remitting MS develop Secondary Progressive MS, where the condition gradually worsens. People with Secondary Progressive MS may experience some good and bad periods, but no real recovery.
- Primary Progressive MS: In this type there is a rapid progression of the disease from its onset with no remissions at all. There may be periods of a levelling off of the symptoms, but no periods of remission. Surprisingly, people with this severe form of MS are less likely to develop cognitive problems.
- Clinically Isolated Syndrome (CIS) is a first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system. The episode, which by definition must last for at least 24 hours, is characteristic of multiple sclerosis but does not yet meet the criteria for a diagnosis of MS because people who experience CIS may or may not go on to develop MS. When CIS is accompanied by lesions on a brain magnetic resonance imaging (MRI) that are similar to those seen in MS, the person has a high likelihood of a second episode of neurologic symptoms and diagnosis of relapsing-remitting MS.
Causes of MSThere are several theories as to the cause of MS but still no definitive explanation.
- Genetic: Although there is no sole gene linked to MS, some PwMS do seem to have a gene that makes them predisposed to develop the condition.
- Family Links: MS is not hereditary but it occasionally affects more than one member of the same family. The chances of more than one person in the same family developing MS are still relatively small compared to other chronic illnesses that may have family links, i.e. heart disease or cancer.
- Climate: MS is more common in temperate countries, and the incidence of MS seems to rise as we move North. In the UK, Scotland has a higher incidence per capita than England.
- Auto Immune System: Research suggests a virus may be involved in the onset of MS, and an adverse reaction to the virus may contribute towards the body’s immune system turning on itself.
DiagnosisDiagnosing MS is not easy and is confirmed through referral to a neurologist. As there is no specific test for MS, a diagnosis is made by a neurologist who will carry out a physical examination, look at the person’s medical history and consider the results of several diagnostic tests. Although other tests may be used to support a diagnosis of MS, the following diagnostic techniques are the most common:
- Neurological Examination is the starting point and can aid diagnosis of MS. This includes tests for poor co-ordination; tests that involve walking heel to toe; standing with the eyes closed; finger to nose tests and sensory tests using tuning forks, pins, feathers etc. Other tests of the eyes, hearing, walking ability, etc may be carried out. These tests alone can’t confirm MS but can contribute towards a diagnosis.
- Lumbar Puncture: involves drawing fluid from the spine, and although the procedure is not necessarily painful, some people do find it uncomfortable. The results of a Lumbar Puncture won’t positively diagnose MS but can exclude other conditions and point to MS when supported by other tests.
- MRI (Magnetic Resonance Imaging) Scan: with other evidence, an MRI scan is perhaps the most useful means of diagnosing MS. The procedure is completely harmless as long as simple precautions are taken. An MRI scan can provide detailed images of the brain and the spinal cord, and can indicate areas of damage or lesions and, more importantly, where they are and the possible resulting signs and symptoms of MS.
- Evoked Potential Tests: are tests that measure the time it takes for the brain to receive, understand and act upon messages. The procedure involves attaching electrodes to the head to monitor brainwaves and is completely painless. When myelin is damaged it takes longer for the brain to receive messages, so these tests can indicate MS.
Drug Treatments For MSUnfortunately there is still no cure for MS, but some drugs can act upon the condition itself or upon the individual symptoms. Research is ongoing and new treatments are constantly undergoing trials. The MS Trust lists Disease Modifying Drugs that have been approved for use by the NHS in the UK. Their list, which includes detailed information about each drug, can be found here. Symptoms including spasms, urinary problems, pain, sexual dysfunction, fatigue, etc, can all be treated by different drugs that act directly on the symptom itself rather than the MS.
Physical Treatments for MS
- Physiotherapy: Research and experience has shown that Physiotherapy can help alleviate mobility problems which arise from muscle weakness, spasticity or spasms, and may help with all round fitness and wellbeing. Physiotherapy is aimed at helping to maintain and improve mobility, fitness levels, balance, co-ordination, and improve “normal” activities.
- Complementary Therapies: Whilst never being able to cure MS or replace conventional medical treatment, some therapies, as their name suggests, may be able to complement the work of conventional medicine. Complementary therapies, such as Yoga or Reflexology, may help with stress or relaxation, which may in turn improve a person’s general wellbeing.