This factor has never been identified but some form of virus or viral like particle remains a prime candidate. It seems likely that to develop MS one needs both the genetic make-up and the environmental trigger.
We do not know what the actual cause of MS is but we do know what happens to the nervous system when the disease develops. Each nerve in the body is surrounded by a protective coating called a myelin sheath. In MS the bodies own immune system attacks the myelin sheath around a particular nerve. This lack of the protective coating to the nerve then causes the nerve to malfunction or even stop working altogether.
The symptoms that result from this process will depend on the function of the affected nerve. If, for example, the nerve affected is responsible for sensation to part of the hand then the relevant part of the hand may develop symptoms such as tingling or numbness. The damage to the nerves can occur anywhere in the central nervous system (the brain or the spinal cord) and thus there are a wide variety of symptoms that can follow from MS nerve damage.
Q. Is there any evidence of a genetic component, in other words, are the brothers and sisters of children of people with MS at increased risk?
A. (I have partly answered this above). Yes, there is thought to be a genetic component in MS. We have known for some years that certain white cell blood groups are more common in people with MS than in those without the disorder. About 10% of people will confirm that a close or distant family member also has the disorder. There is certainly an increased risk in identical twins. If one twin has the disorder then there is about a 25% risk of the other identical twin getting the disorder.
The risk is also increased for non-identical twins. However, the disease is not "genetic" in the normal sense of the word and often there is no clear family pattern. Close family members of someone with MS are at a slightly increased risk of getting the disorder but the risks are still small.
Q. How important is early diagnosis? Does it matter if the diagnosis is missed to start with?
A. Early diagnosis is important for a number of reasons. First, people developing MS will often be worried and anxious about the cause of their symptoms. Most people appreciate early investigation and then appreciate being told the exact cause of their problems. In past years neurologists used to avoid telling people the diagnosis until the it was absolutely certain.
Often in the early months or years of MS it is not possible to say with absolute certainty that the symptoms are caused by MS. However, in recent years the situation has changed with wider availability of MRI scanning. An MRI (magnetic resonance imaging) scanner detects subtle damage to the brain or spinal cord and this scan, along with clinical examination and sometimes other tests, can usually confirm the diagnosis. However, although early diagnosis is important it probably makes little difference from the point of view of long term outlook.
Until recently there was no treatment that could slow down disease progression. However, interferon therapy has now been shown to slow the progression of the disease. Thus, the earlier the diagnosis is made the earlier interferon treatment can be started
Q. Who is likely to benefit most from interferon treatment? What does it involve and how can it change the course of the disease?
A. Interferons are treatments that affect the body's immune system. Early studies showed that interferon had a very positive effect on people with relapsing/remitting MS. These are people who have sudden deterioration in their condition followed by a reasonably quick recovery without any or little residual disability. In these people interferon reduces the number of relapses. MRI scans were also done on these people and these showed less MS activity in those on the interferon therapy.
More recently other studies have been conducted which have now shown that an effect on the disease even in those with the progressive form of the disorder. Those on treatment were less disabled than those without treatment over two or three years. In the UK the National Institute for Clinical Excellence (NICE) is currently assessing the evidence and later this year will make a recommendation to the UK government regarding the use of interferon.
There are currently three manufacturers of interferon. Interferon is administered by injection but the frequency of the injections varies according to the type of interferon. Injection is usually administered by a MS specialist nurse or sometimes by the person themselves. Interferon is not without problems and overall about a third of people on treatment eventually have to stop it because of unacceptable side effects.
Q. Complementary therapies seem popular with people who have MS. What sort of things do they try? Is there any evidence to back their use? Aand last but, not least, could any be harmful?
A. Certainly many people with MS use a variety of complementary therapies. Perhaps the most common are acupuncture, reflexology, aromatherapy and various relaxation techniques including yoga. Many people also use cannabis to help with relaxation and muscle spasms. Many people find these techniques helpful.
The therapies can either make people more relaxed and less stressed or alternatively some can help specific symptoms such as muscle spasm or tingling sensations. Often the benefit is relatively short lived just lasting for some hours or a few days. However, some people do find long term benefit from these therapies. There is no hard evidence that any of these techniques have a long term effect on progression of the disease.
The therapies should be looked upon as a potential assistance with a variety of troublesome symptoms. Personally I encourage people to try out various complementary therapies to see which suits them best. However, I always recommend that people find practitioners who are fully qualified in their field. A drawback is that most of these therapies are not available on the NHS and have to be purchased privately - often at some expense. Thus, I also recommend that people should not persevere with a particular therapy if it has not been of assistance in the first few sessions.
Q. Are there any exciting developments in the pipeline?
A. The main development is the forthcoming publication of the NICE guidelines regarding interferon. We hope that interferon will be made more widely available and we will avoid the unfair system of "postcode prescribing" that happens at the moment. A newer drug, Copaxone, is also soon to be released and there is evidence that this helps in the same way as interferon therapy.
There are many other treatments currently in research and hopefully over the next few years some of these will confirm their initial promise and become more widely available. However, at this moment the interferons and Copaxone seem the most hopeful and promising developments.
The UK government has recently approved a high quality study of the use of cannabis in people with muscle spasm and the government has indicated that it may be prepared to licence cannabis for medicinal use. Many people are likely to benefit form this development. People with MS and their carers should also not forget that there are many MS symptoms that can now be effectively treated. Spasticity is one example with a number of useful anti-spastic drugs now available and the new technique of injecting the muscles with a relaxant, botulinum toxin, can also be helpful for people with troublesome and painful muscle spasms.
A whole variety of other symptoms can now be helped such as problems with continence and sexual difficulties. There are an increasing number of specialist MS nurses available around the country and slowly but surely comprehensive multidisciplinary MS teams are emerging. These developments are firmly supported by the MS (Research) Charitable Trust and the MS Society. We hope that the development of these networks will enable high quality and up to date information to be available to all people with MS and their families.
About the author
Professor Mike Barnes is Professor of Neurological Rehabilitation at the University of Newcastle upon Tyne. He runs the Regional Neurorehabilitation Centre at Hunters Moor Hospital. This centre specialises in rehabilitation of people with complex physical disabilities including multiple sclerosis, traumatic brain injury and stroke. He has a long standing and special interest in multiple sclerosis and some years ago conducted research into hyperbaric oxygen. He now has a special interest in neurological rehabilitation, particularly the management of troublesome symptoms such as spasticity. He is a trustee of the MS (Research) Charitable Trust.
We are indebted to the MS Trust for their help in compiling this section.
