about MS:

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system. Today over 2,000,000 people around the world have MS.

MS is the result of damage to myelin - a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body.

Symptoms vary widely and include blurred vision, weak limbs, tingling sensations, unsteadiness and fatigue. For some people, MS is characterised by periods of relapse and remission while for others it has a progressive pattern. For everyone, it makes life unpredictable.

what is MS:

Multiple sclerosis is one of the most common diseases of the central nervous system (brain and spinal cord). MS is an inflammatory demyelination condition. Myelin is a fatty material that insulates nerves, acting much like the covering of an electric wire and allowing the nerve to transmit its impulses rapidly. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid and co-ordinated movements to be performed with little conscious effort.

In multiple sclerosis, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in multiple sclerosis these scars appear at different times and in different areas of the brain and spinal cord. The term multiple sclerosis means, literally, many scars.

types of MS:

There are four main types of MS:

The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease:

relapsing-remitting MS:

In this form of MS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years. About 85% of people are initially diagnosed with Relapsing Remitting MS.

When deficits always resolve between attacks this is sometimes referred to as Benign MS. Benign MS can only be identified when there is minimal disability 10-15 years after onset and initially would have been categorised as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory).

primary progressive MS:

Approximately 10% of individuals are diagnosed with this form of MS, which is characterised by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years.

secondary progressive MS:

For some individuals who initially have relapsing-remitting MS, there is the development of progressive disability later in the course of the disease often with superimposed relapses and no definite periods of remission.

progressive relapsing MS:

This is the least common subtype (approximately 5%). Individuals show a steady neurologic decline with a clear superimposition of attacks. There may or may not be some form of recovery following these relapses, but the disease continues to progress without remissions.

course of MS:

It is impossible to predict accurately the course of MS for any individual, but the first five years give some indication of how the disease will continue for that person. This is based upon the course of the disease over that period and the disease type. (i.e relapsing- remitting or progressive ). The level of disability reached at end points such as five and ten years is thought to be a reliable predictor of the future course of the disease.

However, there are many variables in this scenario:

• A large percentage of people with MS (approx 45%) are not severely affected by MS and live normal and productive lives
• There is a significant group (40%) which become progressive after a period of some years as relapsing-remitting

Age at onset and gender may also be indicators of the long-term course of the disease. Some research has indicated that younger age at onset [under 16 years of age] implies a more favourable prognosis, but this must be tempered by the knowledge that for a young adult living with MS for 20 or 30 years may result in substantial disability even if the progress towards disability is slow and in the first 10 or 15 years he or she is relatively mildly affected. Other research has indicated that late onset [ie over 55 years of age], particularly in males, may indicate a progressive course of the disease.

The prospect of therapy for MS should be encouraging to those newly diagnosed with MS. Drugs such as interferon beta are possible treatments for those who are relapsing-remitting and ambulatory. The interferon betas may slow the progression of disability as well as reduce the severity and frequency of exacerbations. At this stage it is not known whether interferon beta has any impact on primary progressive MS. The breadth of research currently targeting MS gives hope that therapy which will interfere with the process of MS (even if not curing the disease) is not an unreasonable expectation in the near future.

It should be remembered that many people with MS go through life with a manageable disability (e.g. fatigue, a limp, bladder problems). At least 15% of people with MS, however, will become severely disabled (i.e.having to use a wheelchair on a full-time basis). Life expectancy for persons with MS is near normal.

causes of MS:

The cause of multiple sclerosis is not yet known, but thousands of researchers all over the world are meticulously putting the pieces of this complicated puzzle together.

The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors.

One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defence mechanisms (i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.

diagnosis of MS:

Unlike many other diseases, there is no straightforward ‘positive or negative’ test for MS and none of the range of tests available to help doctors with their diagnosis is 100 percent conclusive on its own.

This means that ultimately a doctor will diagnose MS by a combination of observing a person’s symptoms, and ruling out other possibilities. This is called a 'clinical diagnosis'.

problems with diagnosis:

Unfortunately for a significant minority of people (10–15 percent) a definite diagnosis is still not possible even after all the available tests have been carried out. However, it is possible to rule out other very serious causes of MS type symptoms, and over time with periodic examinations and the monitoring of changes in a person’s condition, diagnosis is possible in the vast majority of cases.

new MS diagnostic criteria:

MSIF’s International Medical and Scientific Board have drawn up new MS diagnostic criteria to help medical professionals distinguish between MS and other conditions that may present similar symptoms. The new criteria allow the results of MRI scanning to included so that it may be possible to diagnose MS when someone has had only one episode of symptoms. When the new criteria are used, a person may be classified as having MS, possible MS or not MS.

Diagnostic Criteria for Multiple Sclerosis:
2005 Revisions to the “McDonald Criteria” (79 kb)

clinical diagnosis:

Early MS may present itself as a history of vague symptoms, which may occur sporadically over a prolonged period of time and could often also be attributed to a number of other medical conditions. Invisible or subjective symptoms are often difficult to communicate to doctors and health professionals and sadly it has not been uncommon for people with MS to be treated unsympathetically in the very early stages of diagnosis.

Even when a person shows a ‘classic’ pattern of MS type symptoms, the symptoms must conform to agreed criteria before a doctor or neurologist can diagnose clinically ‘definite’ MS. These criteria are that:

'Two different areas of the central nervous system are affected, and that these effects have been experienced on at least two separate occasions of at least one month apart and that the person is within the normal age range for the onset of MS.'

So although it is possible to be diagnosed as having ‘definite’ MS on your first visit to a neurologist, it is also quite likely that the diagnosis will be uncertain, and that the person will be referred for further tests.

symptoms of MS:

Multiple sclerosis is a very variable condition and the symptoms depend on which areas of the central nervous system have been affected. There is no set pattern to MS and everyone with MS has a different set of symptoms, which vary from time to time and can change in severity and duration, even in the same person.

There is no typical MS. Most people with MS will experience more than one symptom, and though there are symptoms common to many people, no person would have all of them. Common symptoms include:

visual problems:

• blurring of vision
• double vision (diplopia)
• optic neuritis
• involuntary rapid eye movement
• (rarely) total loss of sight
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balance & co-ordination problems:

• loss of balance
• tremor
• unstable walking (ataxia)
• giddiness (vertigo)
• clumsiness of a limb
• lack of co-ordination
• weakness: this can particularly affect the legs and walking

spasticity:

• altered muscle tone can and muscle stiffness can affect mobility and walking
• spasms
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• Altered sensation
• tingling
• ‘pins and needles’
• numbness (paraesthesia)
• burning sensations

pain:

• muscle pain
• facial pain (such as trigeminal neuralgia)
• stabbing sharp pains
• burning tingling pain

abnormal speech:

• slowing of speech
• slurring of words
• changes in rhythm of speech
• difficulty in swallowing (dysphagia)

fatigue:

• A debilitating kind of general fatigue which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of the most troubling) symptoms of MS.

bladder & bowel problems:

• Bladder problems include the need to pass water frequently and/or urgently, incomplete emptying or emptying at inappropriate times.
• Bowel problems include constipation and, infrequently, loss of bowel control.

sexuality & intimacy:

• impotence
• diminished arousal
• loss of sensation

sensitivity to heat:

• this symptom very commonly causes a transient worsening of symptoms

cognitive & emotional disturbances:

• loss of short term memory
• loss of concentration, judgment or reasoning

Whilst some of these symptoms are immediately obvious, others such as fatigue, altered sensation, memory and concentration problems are often hidden symptoms. These can be difficult to describe to others and sometimes family and careers do not appreciate the effects these have on the person with MS and on employment, social activities and quality of life.