What do you know about multiple sclerosis? Chances are, very little. "Many people aren't aware of the symptoms of multiple sclerosis, or even of the condition itself," says Dr. Emma Gray. Considering that approximately 2.5 million people around the world have multiple sclerosis, it is surprising that there is such lack of awareness, but sadly, this is the case.
Dr. Gray is research communications manager at the Multiple Sclerosis Society - a UK charity that funds multiple sclerosis (MS) research, provides information and support to people with MS, and plays a large role in increasing awareness of the condition.
For the MS society and numerous MS charities worldwide, March and April are the key times of the year for raising awareness. For the US, March is National Multiple Sclerosis Education and Awareness Month, while in the UK, MS awareness week will take place from April 28th - May 4th.
In line with these campaigns, we look at the signs and symptoms associated with MS, how the disease is diagnosed, treatment options and what is being done to increase awareness of the disease.
MS: a disease of the central of nervous system
MS is a condition of the central nervous system (CNS). It is an autoimmune disease, meaning the immune system attacks itself.
It is believed that T cells (immune cells) in the body mistake myelin - the protective coating of the nerve cell fibers - for a foreign invader and attack it, just like they might attack a virus or bacteria.
It is believed that MS is caused by T cells attacking myelin - the protective coating of the nerve cell fibers.
Diagnosis of MS is most common in adults between the ages of 20 and 40, but children and older adults can still develop the condition. The disease is most common in women, who are three times more likely to develop it than men.
MS is not a hereditary condition. However, if a person has a family member with the disease, their risk of developing MS increases from 1 in 1,000 to 1 in 50.
According to the MS society, the condition is more common in people who live further away from the equator.
It is very common in Britain, North America, Canada, Scandinavia, southern Australia and New Zealand, but extremely rare in Malaysia or Equador - suggesting that environmental factors may play a role in disease development.
Past research has suggested other factors may be a cause of MS. Medical News Today recently reported on a study suggesting that obesity and the use of birth control pills may increase MS risk, while other research suggests that a soil-based bacteria called Clostrodium perfringens may be a cause.
The symptoms of MS
When myelin around the nerve fibers is damaged, the electrical impulses sent from the brain to the nerves is disrupted.
This can cause an array of symptoms, which commonly include:
- Vision problems - particularly optic neuritis (inflammation of the optic nerve)
- Balance problems and dizziness
- Bladder problems
- Bowel problems
- Cognitive problems
- Stiffness and/or spasms.
However, Dr. Gray notes that MS is a complex condition. The majority of people will not experience all of these symptoms and will not have all of them at the same time.
But does this variability in symptoms pose a problem in diagnosing the condition?
Diagnosing MS: a complicated process
"Diagnosing multiple sclerosis can be complicated, not least because there is no one test that conclusively indicates the presence of the disease," says Laura Amiss-Smith, MS advice and information supervisor at MS-UK - a UK charity that offers support and information for people affected by MS.
A series of neurological tests are carried out in order to diagnose a patient with MS. The most common is magnetic resonance imaging (MRI), which diagnoses approximately 90% of people with the disease.
MRI scanning is the most common way of diagnosing a patient with MS.
Neurological examination is also a common form of diagnosis. This involves a neurologist asking a series of questions to determine a person's past symptoms and problems, as well as a physical examination to check changes or weaknesses in eye movements, leg or hand coordination, speech, balance, sensation or reflexes.
Evoked Potentials can also diagnose MS. This measures the time it takes for nerves to respond to stimulation and the level of that response.
Lumbar puncture, also know as a spinal tap, is a less common form of MS diagnosis. Under local anesthetic, a needle is inserted into the space around the spinal cord and takes a sample of cerebrospinal fluid. It is then tested for abnormalities, as most people with MS have antibodies in cerebrospinal fluid.
As well as being a complicated process, diagnosing MS can be a lengthy one. Since none of the symptoms of MS are unique to the condition, it can take several months of tests, sometimes longer, before full diagnosis is reached.
"Diagnosis of MS has improved in recent years, but we would still like to see more people experiencing quicker and less invasive diagnosis," says Dr. Gray.
And researchers are certainly on the case to develop a fast, easy and non-invasive diagnostic test for MS. Medical News Today recently reported on a study detailing the discovery of an antibody in MS patients - KIR4.1 - which could be detected through a blood test 10 years before the onset of symptoms.
One of the authors of the study, Dr. Viola Biberacher of the Technical University in Munich, Germany, says:
"If our results can be replicated in larger populations, our findings may help to detect MS earlier in a subgroup of patients. Finding the disease before symptoms appear means we can better prepare to treat and possibly even prevent those symptoms."
Finding new treatments for MS 'a top priority'
Of equal importance is the development of new treatment strategies for individuals who have MS. At present, there are a number of treatment options available.
Many patients with MS undergo physiotherapy and exercise programs to help improve symptoms.
There are many medications available that target specific symptoms of MS, such as Botox for bladder problems, Dantrium or Sativesx for spasticity, and Amprya or Fampyra for walking difficulties.
Steroids are commonly used to treat an attack of symptoms, and they can speed up recovery following MS relapses - defined as "the appearance of new symptoms, or the return of old symptoms, for a period of 24 hours or more in the absence of a change in core body temperature or infection."
Disease modifying drugs (DMDs) in the form of tablets or injections can also be used to reduce frequency and severity of symptoms for people with MS relapses.
"Unfortunately, there are currently no effective disease modifying therapies that people with progressive MS can take to slow, stop or reverse accumulation of disability," says Dr. Gray.
Arney Rosenblat, associate vice president of the National Multiple Sclerosis Society - the US sister organization of the UK MS society - says there needs to be more focus on research to develop new treatments for MS:
"While in just two decades MS has gone from being an untreatable disease to one where there are now 10 disease modifying therapies approved by the FDA (Food and Drug Administration) for relapsing MS, there is deep unmet need for additional therapies, especially to treat progressive forms of disease for which there are few treatment options."
And it seems researchers are gradually getting closer to finding new treatments for the disease. Medical News today recently reported on a study that detailed how a treatment that boosts immunity to Epstein-Barr virus could benefit patients with MS, while another study revealed how a vaccine used to prevent tuberculosis could help prevent MS in people with early symptoms of the disease.
But Rosenblat warns that more investment needs to go into MS research to develop new treatments.
"Although the National MS Society alone will devote nearly $50 million to supporting 380 research projects around the world this year, other research funding has been declining or flat," he adds.
"We are at the beginning of the end of MS and it's time to step up funding as far as we can so that we can make MS just another footnote in history."
Increasing MS awareness
Of course, one of the best ways to increase funding into new MS research projects is to increase awareness of the condition - something MS charities across the globe are set on doing.
But increasing awareness is not all about increasing funding, it is also about ensuring the general public know what symptoms to look out for and have better understanding of the condition.
"If multiple sclerosis was more well known, perhaps it would improve the time it takes for people to be diagnosed. More awareness surrounding the condition in general would also help others to understand the condition more," adds Amiss-Smith.
MS charities play a significant role in increasing awareness of the disease. But Rosenblat says it is also important that the health community is highly involved:
"Building awareness and support for the research underway to stop MS progression, restore function lost to MS and end MS forever requires the commitment of the clinical community, as they are on the front lines when it comes to ensuring that patients receive the best treatment for their MS."
Furthermore, he adds that the MS community itself can increase awareness by connecting through various MS organizations.
As Rosenblat says, "building awareness for multiple sclerosis is an uphill climb and a multi-channel effort."