Multiple Sclerosis (MS)
Introduction to Multiple Sclerosis (MS)
Multiple sclerosis is a ‘demyelinating’ disorder.
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a condition affecting nerves in the brain and spinal cord, resulting in problems with vision and movement. It is relatively common, affecting around 1 in 60 people in the UK, with three times more women than men being affected. Symptoms usually become noticeable in early adulthood, though they can develop at any age. The course of the condition varies between individuals but there are three main patterns. ‘Relapsing-remitting’ MS is the most common form of the disease, involving flare-ups that last anywhere between a few hours to a few months. After several years of diagnosis, this may progress to ‘secondary progressive MS,’ in which symptoms tend to get worse. A minority of patients experience ‘primary progressive MS,’ in which their symptoms worsen immediately from diagnosis. If you think you are experiencing any of the symptoms of MS, see a neurologist or GP as there are several other conditions that manifest with similar symptoms.
What are the causes for Multiple Sclerosis?
Nerve cells are usually wrapped in a fatty, insulating sheath that speeds up neuronal transmission. MS is caused by the destruction of this fatty material, known as myelin. Hence multiple sclerosis is a ‘demyelinating’ disorder.
The condition appears to occur when the body’s own immune system attacks myelin, resulting in inflammation and lesions which can be identified on MRI scans. The exact cause for the immune system’s erroneous destruction of myelin is not known, but it is likely to be due to a combination of genetic and environmental factors. Several genes have been suggested to influence your risk of developing the condition. Environmental factors that have been suggested to increase your risk include smoking, vitamin D intake and sunlight exposure and viral infection. However, the reasons why these factors appear to have a statistical impact are not well understood.
What are the symptoms of Multiple Sclerosis?
MS is characterised by problems with movement and vision. Changes in vision include some loss of vision (usually in one eye), eye pain and flashes of light when moving the eye. Total loss of vision is possible, though uncommon, occurring in 1 in 35 cases. Double vision and involuntary eye movements may also be experienced.
Abnormal sensation, such as pins and needles may be an indicator of multiple sclerosis. In addition, muscle weakness, muscle spasms and pain may be experienced along with tremor and dizziness. Coordination may be reduced. Half of patients experience cognitive dysfunction such as reduced attention span, problems with learning and memory, difficulty understanding speech and difficulty in problem solving.
Depression is experienced in around half cases, with anxiety being another common mental health problem. Sexual health problems, particularly difficulties maintaining an erection and ejaculating in men can be an issue. Often, sufferers find it difficult to empty their bowel or bladder. On the other hand, some may feel the urge to urinate more frequently. Finally, it is common to experience problems with swallowing during the course of the disease.
How is Multiple Sclerosis treated?
There is no cure for MS. Furthermore, there is no single ‘best treatment’ as the symptoms vary amongst individuals and treatment should be personalised towards your needs. In addition to consulting a neurologist, it may be useful to see a physiotherapist, psychologist, continence adviser or speech and language therapist, depending on the symptoms you are experiencing.
There are several useful medications available in the treatment of MS. During a relapse (flare-up), corticosteroids such as prednisolone are often useful, working by suppressing your immune system and alleviating inflammation. However, these drugs have significant side effects associated with long term use. Specific symptoms may also be addressed with specific drugs. For example, gabapentin may be effective for neuropathic pain, problems with eye movements and muscle spasms. Other drugs may be used for bowel incontinence, sexual dysfunction or mental health issues.
The final category of drug used is the ‘disease modifying drugs.’ These may reduce the number of relapses you experience and possibly slow down the deterioration towards ‘progressive MS.’ These include interferon beta, natalizumab and alemtuzumab. Though these treatments can be highly effective in some patients, they carry the risk of several severe side effects. However, depending on the severity of your disease and your own opinion, these risks may be worthwhile.