A B C D E F G H I J K L M N O P R S T U V W

MULTIPLE SCLEROSIS

What is Multiple Sclerosis ?

Multiple sclerosis (MS) is a disease of the brain and spinal cord components of the nervous system. These organs are made up of a variety of tissues, among which are nerve cells (grey matter), and connecting nerve fibres (white matter). In MS, there is damage predominantly affecting the white matter. Parts of the nervous system become swollen and invaded by the body’s immune or defence cells. This inflammation of MS usually starts causing problems to people in their twenties and thirties. The inflammation leads to symptoms such as weakness, loss of vision or numbness. After a week or so, the symptoms may settle as the inflammation dies down and in several weeks, the symptoms may have gone altogether. The attack is termed a relapse, and after recovery the patient is said to be in remission. Relapses like this may occur once or twice in every two-three year period, but the disease may be active in between relapses, causing fatigue or some restriction of activity. After a while, many patients report that they are not recovering properly from relapses or that they are getting gradually weaker or unsteady. This can lead to progressive disability. Some people never have relapses but progress steadily right from the start. Some never seem to progress. Eventually most people stop having relapses. Over many years, about a third of patients do become disabled and require help with walking or a wheelchair. Most of the others are restricted in what they can manage, but some are remarkably spared permanent disability. It is very difficult to predict the future pattern the disease will take or whether disability will result. Almost any part of the brain or spinal cord can be affected and a great variety of symptoms can result. This can mean that healthy young people with sensory symptoms such as pins and needles can become concerned that they may have MS.

How does Multiple Sclerosis occur ?

The cause of the initial inflammation is not known. Over the years, a variety of forms of attack, by viruses, by chemicals, or by the body’s own defence systems have been found to damage the white matter. However, whether any of these is the cause of MS has not been established. There is also a mystery concerning why some people develop severe disability while others recover from relapses and remain reasonably well. In severe cases, the process probably starts to affect grey matter as well: this damage is permanent.

Why does Multiple Sclerosis occur ?

This too is a mystery. There is a genetic link because relatives of people with MS do have a greater than average risk of getting the disease. However, this is not the whole story as certain areas of the world have a much higher level or incidence of the disease. This may be as a result of local viruses or other environmental agents. The condition is more common in women than in men, and may start up in the body many years before the first symptoms are felt.

Treatment Involved for Multiple Sclerosis

It is very important that the disease is correctly diagnosed, and although this may involve tests, it really depends on the patient having more than one episode of illness affecting more than one area of the nervous system. After the initial attack therefore, MS may be suspected but not confirmed until another episode some months or years later. To rule out other diseases, blood tests, X-rays or scans may be required and a lumbar puncture is sometimes performed to analyse the contents of the cerebrospinal fluid which bathes the spinal cord and brain. A lumbar puncture is done by passing a small needle through the skin over the lower spine so that it goes between the bones of the spine to reach the cavity within. A magnetic resonance scan (MRI), will almost always show some abnormalities of the brain in people with MS but it does not indicate how severe the condition is or whether it will progress. When an acute relapse is severe or disabling, steroids (cortisone-like drugs) by mouth or in a drip into the arm are often given for a short period. This accelerates the immediate recovery but the eventual improvement is likely to be just as good without steroids. Steroids are also sometimes used when the patient has noticed a definite progression, particularly affecting walking. The results in these cases are difficult to predict but can be worthwhile. Other drugs are used for particular symptoms such as stiffness in the legs and a healthy diet and lifestyle is encouraged. If a pattern of regular and disabling relapses is established, drugs such as beta-interferon or glatiramer acetate can be given to reduce the number and severity of relapses. They are very expensive and do not seem to have real benefit in terms of stopping any worsening of the condition. Many other treatments including a variety of alternative remedies and physical treatments such as hyperbaric oxygen, are used even though solid evidence of benefit in most cases of MS has not been proven.

During Treatment for Multiple Sclerosis

The pattern of the disease is so variable that almost anything can happen. A knowledgeable nurse or doctor, or contact with a self-help group can be very reassuring. Treatments such as steroids and interferon can have side-effects in some patients, and the MS can relapse even while on treatment. If steady deterioration occurs, physiotherapists and occupational therapists can give expert help and treatment, and social workers can advice on benefits and housing problems.

After Treatment for Multiple Sclerosis

The disease is unpredictable and a relapse or sustained symptoms may develop at any time. Relapses are probably more likely when there are many viruses around causing colds and coughs, so it is best to stay away from illness of this kind. Hot baths or very hot weather worsen the symptoms of some, but not all, MS patients.

If Multiple Sclerosis is Left Untreated

Treatment does not seem to alter the course of the disease except in the case of beta-interferon and glatiramer acetate. Without these treatments, a small proportion of MS patients would have more frequent and more severe relapses. If relapses were not treated, they would still be expected to settle down but this may take longer than if steroids are given.

Effects on Family of Multiple Sclerosis

MS is not infectious but there is a small increase in the risk of getting MS if you are a blood relative of a person with the disease. The family and friends of someone with MS may have to provide extra help during relapses and may well find that the person is easily fatigued. Some patients become depressed or show a personality change with MS Pregnancy is often a good time when relapses are much less likely to occur and pregnant women may feel quite well.