Multiple sclerosis (MS) is a neurological condition of the central nervous system where the coating around nerve fibres (called myelin) is damaged, causing a range of symptoms.
In MS, the immune system, which normally helps to fight off infections, mistakes the myelin sheath which normally protects nerve cells, for a foreign body and attacks it. This damages the myelin and strips it off the nerve fibres, either partially or completely, leaving scars known as lesions or plaques. This damage disrupts messages travelling along nerve fibres – they can slow down, become distorted, or not get through at all.
As well as myelin loss, there can also sometimes be damage to the actual nerve fibres. It is this nerve damage that causes the accumulation of disability that can occur over time.
No one knows the exact cause of MS, but it is likely that a mixture of genetic and environmental factors including viruses and vitamin D deficiency may play a role.
There are many different types of MS:
- Relapsing Remitting (RRMS) is the most common type of MS, affecting around 85 per cent of everyone diagnosed with MS. It means that symptoms appear (a relapse), and then fade away, either partially or completely (remitting).
- Primary Progressive (PPMS) affects about 10 to 15 per cent of people diagnosed with MS. It has this name because from the first (primary) symptoms and it is progressive. Symptoms gradually get worse over time, rather than appearing as sudden attacks (relapses).
- Secondary Progressive MS (SPMS) is a stage of MS which comes after relapsing remitting MS in many cases. Neurologists generally agree secondary progressive MS is a "sustained build up of disability, independent of any relapses".
Who does it affect?
MS is thought to affect more than 2.3 million people worldwide. Most people are diagnosed between the ages of 20-40, but it can affect younger and older people too. Almost twice as many women have MS as men suggesting that hormones may play a role. While the disease is not contagious or directly inherited, epidemiologists have identified factors in the distribution of MS around the world that may eventually help determine what causes the disease. These factors include gender, genetics, age, geography and ethnic background.
What are the symptoms?
There are wide and varying symptoms experienced by those living with MS, including:
- Mobility issues
- Bladder and Bowel problems in MS
- Eye and sight problems
- Cognitive problems in MS
- Emotional changes
How is it diagnosed?
The diagnosis of MS is a clinical judgement made by a neurologist. There is no one test that will conclusively show a neurologist that someone has MS and diagnosis usually involves a combination of investigations. Similarly, none of the individual symptoms people can experience are unique to the condition, which means that in order to reach a diagnosis a range of other possible explanations has to be ruled out. This can mean that it can take some time to reach a definite diagnosis of MS.
To show that someone has MS, the neurologist is looking for evidence of two or more areas of scarring in different parts of the central nervous system that have occurred at different points in time. Although advances in MRI scanning can sometimes reveal enough evidence to make a diagnosis, it is still unusual to diagnose MS from just a single episode of symptoms.
A number of tests are used to try and find information to support a diagnosis:
- Medical or clinical history
- Neurological examination
- Blood testing
- MRI scan of a person with MS
- Lumbar puncture
- Evoked potentials(measuring the speed of nerve messages)
How is it treated?
Disease modifying treatments
Disease modifying drugs are not a cure for MS, but they can reduce the frequency and severity of relapses. If you experience relapses the drugs may help, but unfortunately they're not effective for primary progressive MS.
Complementary and alternative therapies (CAMs)
CAMs can include:
- And many more
CAMs are an area that is poorly researched, often because these therapies are rarely suited to traditional research techniques. There is not much evidence to show how effective or safe medicines are. Many studies only include a few people, or are not conclusive. However, many people who use CAMs say that they make them feel better, so it is often a case of weighing up the impact on health and wellbeing to find what is right for you.
Exercise & Physiotherapy
- improve the overall health of people with milder MS
- help people with more severe MS to stay as mobile and active as possible
- help some people manage MS symptoms and decrease the risk of heart disease
- improve muscle strength and fitness, helping with mobility or weakness problems
- help manage weight control, especially when combined with a healthy, well-balanced diet
Physiotherapy is often recommended when there is a specific problem or on-going symptoms that affect day-to-day activities, mobility and independence. It can help whatever your level of disability, but can be a particularly valuable when physical symptoms progress or you are recovering from a relapse.
Eating nutritionally balanced meals helps the body work to its full potential, which is particularly important for people living with long-term, unpredictable conditions like MS.
Other treatments may focus on managing and controlling the symptoms of MS and can include a wide range of medical and complimentary interventions.