Multiple Sclerosis - What is multiple sclerosis?
What is multiple sclerosis?
What is multiple sclerosis
The nervous system is rather like a finely engineered computer. The brain (like the central control chip) is connected to the body (like the moving parts) by nerves (like wiring). Electrical signals are generated in the brain, and travel down the wiring through the bundle that is the spinal cord, out into individual nerves with particular tasks.
Like mechanical electrical wiring, some nerves are insulated from their surroundings by a fatty protein layer (the myelin sheath). In Multiple Sclerosis (MS), the myelin sheath breaks down (demyelination), and the nerves cannot work properly. This happens in many different places (hence "multiple"), and the damaged areas scar (hence "sclerosis").
Who is at risk(1)
- MS is 1.5 times commoner in females than men
- It is more common in northern hemisphere countries: 4/100,000 in Asia, 50-100/100,000 in England and 300/100,000 in Orkney
- In the UK there are about 85,000 people with MS, and 2,500 new diagnoses are made each year
- peak ages for contracting MS are 21-25 and 41-45, though it can occur at any age
How does it occur
- The geographical distribution of MS suggests some kind of environmental influence at work(1,2)
- Viruses are thought to be one possible cause of MS(3), though no one particular virus has been identified as responsible
- It is possible that it can be carried in families. A child of a sufferer has a 1 in 100 risk of developing MS
Current thinking is that either a virus, or some unknown factor within the body triggers a misdirected defence response (autoimmune response) against the body's own myelin. The resulting inflammation and scarring causes interference with the way the nerves work(4,5).
What are the symptoms
There are wide differences in how individuals experience MS, both in the variety of ways and in the level of severity. Almost any nervous system problem can be generated by MS, but the three commonest types of symptoms are:
Vision disturbance in one eye, often with pain (optic neuritis). It can vary from blurred to double vision, or to complete blindness, but the disturbance usually recovers completely.
Numbness, tingling and pins and needles in a hand or leg, sometimes with clumsiness, stiffness and weakness. This is sometimes how the disease starts.
problems with bladder control, impotence, fatigue, recurrent severe pains (neuralgia) and mental changes are common. These include difficulties with memory, attention, thought speed and perception(6). Depression, not surprisingly, is common, and it has many social and family repercussions 7).
In about 90% of patients, MS symptoms wax and wane in periods of relapse and remission, often followed with a full recovery.
As time goes by, the remissions tend to be less complete and about half of patients develop a steadily worsening MS, with increasing amounts of non-recovering symptoms. About a third do not develop progressive disability and remain relatively well for many years (benign MS). About 10% start and continue with steadily worsening symptoms (primary progressive MS). 85% of patients start off with only one symptom. The rest develop several symptoms at once.
What are the risks
MS is not infectious and cannot be caught by family and friends. Modern treatments can help to alter the course of the disease by reducing demyelination and increasing healing. Without treatment therefore, more disability than is necessary may result.
What tests are useful
Blood tests: useful initially to provide a baseline check on general health, and to rule out other causes of similar symptoms.
Lumbar puncture: a thin needle is inserted into the spine under local anaesthetic, and a small amount of the fluid bathing the spinal cord (cerebrospinal fluid, CSF) is withdrawn. This is tested for special proteins. The pattern of these proteins can help diagnose MS.
Electrical tests: by attaching small electrodes to the scalp and neck, it is possible to measure how the nervous system is working, giving more helpful clues.
Brain scans: a CT (Computerised Tomography) scan (using x-rays) and an NMR (Nuclear Magnetic Resonance) or MRI (Magnetic Resonance Imaging) scan (using magnetic fields) give cross-sectional pictures of the brain, and can pinpoint the areas of damage. NMR/MRI is the most sensitive scan, but is less widely available than CT.
What is the treatment
Good doctor-patient communication: A very important part of treatment is a good explanation of the disorder and how symptoms are produced, and what to expect from the investigation and treatment options. This leads on to the importance of counselling and general support to underpin all other treatment.
- Courses of steroids by injection or tablet are used to help relapses. They can be very effective in the short term, but do not alter the long-term progress
- Hyperbaric oxygen (as in a diver's recompression chamber) was thought to be helpful, but the evidence to support this is now considered dubious
- Interferon-beta-1b injection is a new and not yet widely-available treatment which may reduce relapses, and limit new disease activity in the brain (8,9)
- Other drugs still under research include copolymer-1, low-dose methotrexate and cladribine
- Anti-spasmodics may be useful for muscle spasm
- Tricyclic antidepressants can be useful for chronic pains and neuralgia as well as depression
physiotherapy: This may help with balance or walking.
Other treatments: Bone marrow transplantation is under research. Animal studies suggest it may possibly be beneficial in severe progressive MS(10), but it is regarded as a high risk treatment. More research in selected patients is necessary.
What are the treatment side effects
All drug treatment can cause allergic rashes and reactions, though these are rare. A careful assessment of the likelihood and whether the risk is worth taking will be made by the prescribing doctor.
The main side effects of prolonged use of steroids are elevated mood, weight gain, stretch-marks, bruising, bone thinning, diabetes, fluid retention, acne and high blood pressure. Quite a handful, but if the dosage is handled carefully, these need not all appear.
Antispasmodics can cause drowsiness and nausea.
Interferon beta-1b commonly causes injection-site reactions and flu-like symptoms.
What self-help strategies are there
Relaxation: Lifestyle may need review; ensure adequate time for leisure and relaxation, and time with family and friends. Techniques such as yoga or self-hypnosis may be useful.
Time management: Rushing around and meeting deadlines produces adrenaline surges which increase exhaustion. Good planning can reduce the sense of pressure and help restore a feeling of control and calm.
Diet: Stick to a balanced diet with regular meals. Some people have appeared to respond to a diet high in vegetable oils (polyunsaturated fats), and a diet low in animal fats is sensible anyway.
Exercise: It used to be thought that exercise would increase fatigue, and rest was the order of the day. What some people with MS have suspected is now proven: that regular aerobic exercise improves physical function and reduces depression, anger and fatigue (11).
Where can I get further information
Apart from contacting your Gp, the following organisations may be of further help:
Multiple Sclerosis Nerve Centre Level 5
Bristol Royal Infirmary
Telephone: 0117 928 2463 / 0117 928 3022
Multiple Sclerosis Research Trust
Telephone: 01462 484811
Multiple Sclerosis Resource Centre
4a Chapel Hill
Tel: 01279 817101
- THOMpSON, A.J., MCDONALD, W.I., (1996) Multiple Sclerosis. Medicine, 24(6) pp.69-75.
- ROSS, R, CHEANG, M. (1995) Geographic similatrities between varicella and multiple sclerosis: an hypothesis on the environmental factor of multiple sclerosis. Journal of Clinical Epidemiology, 48(6) pp.731-7
- GREENBERG, S.J., (1995) Human retroviruses and demyelinating diseases. Neurology Clinics, 13(1) pp.75-97.
- SOBEL, R.A. (1995) The pathology of multiple sclerosis Neurology Clinics, 13(1) pp.1-21.
- LYNCH, S.G., ROSE, J.W. ( 1996) Multiple sclerosis. Disease Monthly, 42(1) pp.1-55.
- RAO, S.M. (1995) Neuropsychology of multiple sclerosis.Current Opinion in Neurology, 8(3) pp.216-20.
- MURRAY, T.J. (1995) The psychosocial aspects of multiple sclerosis; Neurology Clinics, 13(1) pp.197-223.
- LUBliN, F.D. (1996) Management of patients receiving interferon beta-1b for multiple sclerosis: report of a consensus conference Neurology, 46(1) pp.12-8.
- polMAN, C.H., HARTUNG, H.p. (1995) Treatment of multiple sclerosis: current and future Current Opinion in Neurology, 8(3) pp.200-9.
- BURT, R.K., BURNS, W., HESS, A. (1995) Bone marrow transplantation for multiple sclerosis Bone Marrow Transplantation, 16(1) pp.1-6.
- pETAJAN, J.H. et al (1996) Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology, 39 pp.432-41.