What is multiple sclerosis (MS)?
Multiple sclerosis (MS) is a disorder where patches of
inflammation recur from time to time in parts of the brain and/or spinal cord.
Understanding the brain, spinal cord, and nerves
Thousands of nerve fibres transmit tiny electrical
impulses ('messages') between different parts of the brain and spinal cord.
Each nerve fibre in the brain and spinal cord is surrounded by a protective
sheath made from a substance called myelin. The myelin sheath acts like the
insulation around an electrical wire, and is needed for the electrical impulses
to travel correctly along the nerve fibre.
Nerves are made up from many nerve fibres. Nerves come
out of the brain and spinal cord and take messages to and from muscles, the
skin, body organs, and tissues.
What causes multiple sclerosis?
The exact cause of MS is not known. It is thought to
be an auto-immune disease. This means that chemicals and cells of the immune
system, which normally attack bacteria, viruses, etc, attack part of the body.
In people with MS, cells of the immune system called T-cells appear to 'attack'
the myelin sheath which surrounds the nerve fibres in the brain and spinal
cord. This leads to small patches of inflammation.
Something may 'trigger' the immune system to act in
this way. One theory is that a virus, or another factor in the environment,
triggers the immune system in some people with a certain genetic make-up.
The inflammation around the myelin sheath stops the
affected nerve fibres from working properly, and symptoms develop. When the
inflammation clears, the nerve fibres start to work again. However, the
inflammation, or repeated bouts of inflammation, can leave a small scar
('sclerosis') which can permanently damage nerve fibres. In a typical person
with MS, many (multiple) small areas of scarring (sclerosis) develop in the
brain and spinal cord.
Who gets multiple sclerosis?
About 1 in 1000 people in the
MS is not strictly an hereditary disease, but there is
an increased chance of MS developing in close relatives of affected people. For
example, a mother, father, brother, or sister of a person with MS has about a 1
in 100 chance of developing MS (compared to about a 1 in 1000 chance in the
general population).
How does multiple sclerosis progress?
Relapsing-remitting form of MS
About 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 (described
below) and may last days, but usually last 2-6 weeks, and sometimes last
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.
One or two relapses every two years is fairly typical.
But, it varies from case to case, and relapses can occur more or less often
than this. When a relapse occurs, previous symptoms may return, or new ones may
appear.
This 'relapsing-remitting' pattern tends to last for
several years. At first, full recovery from symptoms, or nearly full recovery,
is typical following each relapse. Eventually, often after 5-15 years, some
symptoms usually become permanent. The permanent symptoms tend to accumulate,
and the condition slowly becomes worse over time. This is called 'secondary
progressive MS'.
After 10 years from the first episode of symptoms,
about half of people with MS have developed some form of permanent disability.
After 15 years, about half are unable to walk without assistance. After 25
years, about half are confined to a wheelchair.
Primary progressive MS
In about 1 in 10 cases, 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 a few cases, 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'.
What are the symptoms of multiple sclerosis?
Many different symptoms are possible with MS. The
symptoms that occur during a relapse depend on which part, or parts, of the
brain or spinal cord are affected. You may have just one symptom in one part of
the body, or several symptoms in different parts of your body. The symptoms
occur because the affected nerve fibres stop working properly. The more common symptoms 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. Mobility
may be affected.
·
Partial loss, or blurring of
vision. Double
vision.
·
Problems with balance and
co-ordination.
·
Tremors or spasms of some
muscles.
·
Dizziness.
·
Problems with passing urine.
·
Difficulty with speaking.
·
Constipation.
Tiredness, and psychological symptoms such as mood
swings and depression, are also common in people with MS.
How is multiple sclerosis diagnosed?
Almost all of the symptoms that can occur with MS can
also occur with other diseases. It is often difficult to be sure if a first
episode of symptoms (a first relapse) is due to MS. For example, you may have
an episode of numbness in a leg, or blurring of vision for a few weeks, which
then goes. It may have been the first relapse of MS, or just a 'one-off'
illness that was not MS.
Therefore, most doctors do not make a firm diagnosis
of MS 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.
What are the treatments for multiple sclerosis?
There is no cure for MS, but treatments do help.
Depending on the kind of symptoms that develop, one or
more of the following may be appropriate.
·
Anti-spasm medicines to ease
muscle spasms.
·
Painkillers are sometimes needed.
·
Medicines can help with some
urinary problems that may develop.
·
Antidepressant medicines are
sometimes advised if you develop depression.
·
Medicines 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
A range of therapies may be advised, depending on what problems or disabilities
develop. They include:
·
Physiotherapy
·
Occupational therapy
·
Speech therapy
·
Specialist nurse advice and support
·
Psychological therapies
·
Counselling
More
information about MS in the links section