Multiple sclerosis, also known as MS, is a chronic disease that attacks the central nervous system, (brain, spinal cord, and optic nerves). In severe cases, the patient becomes paralyzed or blind while in milder cases, there may be numbness in the limbs.
According to the British National Health Service (NHS), approximately 100,000 people live with multiple sclerosis in the United Kingdom.
Fast facts on multiple sclerosis
Here are some key points about multiple sclerosis. More detail and supporting information is in the main article.
- More than 350,000 Americans have MS
- Multiple sclerosis attacks the central nervous system
- Women are more commonly affected by MS than men
- Month of birth appears to be a factor in the development of MS
- Diagnosis of multiple sclerosis is still a challenging process
What is multiple sclerosis?
MS degrades the nerve's myelin sheaths.
The cause of MS is unknown; however, with multiple sclerosis, the central nervous system (CNS) is attacked by the individual's own immune system. That is why MS is believed to be an autoimmune disease.
Nerve fibers are surrounded by myelin, which protects them. Myelin also helps the nerves conduct electrical signals quickly and efficiently.
The myelin of a patient with MS disappears in multiple areas. This leaves a scar (sclerosis). Multiple sclerosis means "scar tissue in multiple areas." The areas where there is either not enough or no myelin are called plaques or lesions. As the lesions get worse, the nerve fiber can break or become damaged.
When a nerve fiber has less myelin, the electrical impulses received from the brain do not flow smoothly to the target nerve - when there is no myelin, the nerve fibers cannot conduct the electrical impulses at all. Because of this, the messages from the brain to the muscles cannot be transmitted.
Risk factors for multiple sclerosis:
- It is more common among people aged from 20 to 50 years.
- More women develop MS than men.
- People of European descent are more likely to develop MS, compared with other people. However, people of all ancestries can get it.
- A susceptibility for MS can be passed down in our genes.
- Multiple sclerosis rates are higher the further away individuals live from the equator. This leads many to believe that exposure to sunlight impacts on MS risk.
Causes of multiple sclerosis
Although experts are still uncertain, most of them say that the immune system attacks the myelin as if it were an undesirable foreign body - in the same way, our immune system might attack a virus or bacteria.
Why might our immune system attack the myelin? The reasons could be:
Individuals with a parent, sibling, or grandparent who has/had MS, have a greater risk of developing the condition.
Sunlight and Vitamin D appear to play a role in MS.
MS prevalence varies according to geographical area and population groups. Multiple sclerosis is much more common in northern Europe than southern Europe, northern America than southern America.
It seems that the more exposure to sunlight we have, the lower the MS risk.
The more sunlight we are exposed to, the less likely we are to have low levels of vitamin D - therefore, long-term vitamin D levels might play a role in multiple sclerosis risk.
Exposure to a toxic substance, such as a heavy metal or solvent has been suggested, but no clear conclusions have been reached.
It is unlikely there is just one trigger for multiple sclerosis, it is probably triggered by multiple factors.
- Infections - doctors and researchers have often mentioned viruses, such as Epstein-Barr (mononucleosis), varicella zoster, as possible MS triggers; however, this theory has not been backed up scientifically.
- Too much salt - too much salt may trigger the immune system, causing autoimmune diseases, researchers from the Massachusetts Institute of Technology reported in the journal Nature.
Symptoms of multiple sclerosis
MS affects the central nervous system, which controls all the actions in the body. When nerve fibers which carry messages to and from the brain are damaged, symptoms may occur in any part of the body.
For some patients, symptoms are so mild that they do not notice anything until much later in the course of the disease. Others may be aware of them very early on.
The most common symptoms of multiple sclerosis are:
- Bladder problems - patients may have difficulty emptying their bladder completely and need to go to the toilet more frequently. Urge incontinence (suddenly needing to go, or unintentional passing of urine), and Nocturia (needing to go frequently during the night) are also common.
- Bowel problems - constipation is common and can sometimes be serious (fecal impaction). If fecal impaction is not resolved, it can lead to bowel incontinence.
- Cognitive Function - the most commonly reported cognitive changes include problems with memory, abstraction, attention, and word finding.
- Depression - researchers from the University of California, Los Angeles say MS patients have a 50 percent chance of developing depression.
- Emotional Changes - multiple sclerosis may have a profound emotional effect on the individual when a diagnosis is first made. It may be hard to adjust to the diagnosis of such an unpredictable, disabling disorder. Also, demyelination and nerve fiber damage in the brain can cause emotional changes.
Among MS' symptoms are headaches and hearing loss.
- Fatigue - this is one of the most common symptoms of multiple sclerosis, and affects up to 90 percent of patients. The person's ability to function properly at work and at home may be seriously undermined by fatigue.
- Dizziness and Vertigo - people with MS commonly experience dizziness and problems with balance.
- Head movements may cause electric-shock-like sensations.
- Numbness or weakness - usually in one or more limbs, and typically affects just one side of the body at a time, or just the bottom half of the body.
- Pain or tingling in some parts of the body.
- Sexual Dysfunction - loss of interest in sex is common for males and females with multiple sclerosis.
- Spasticity and muscle spasms - damaged nerve fibers in the spinal cord and brain can cause muscles to tightly and painfully contract (spasms). Muscles might get stiff and be resistant to movement (spasticity).
- Tremor - involuntary quivering movements.
- Vision Problems - double vision or blurring vision. There may be partial or total loss of vision, which usually affects one eye at a time. When the eye moves, there is pain (optic neuritis, inflammation of the optic nerve).
- Gait changes - gait refers to the way a person walks. Multiple sclerosis can change the way people walk; because their muscles are weaker, they may have problems with balance and dizziness, plus fatigue.
- Hearing loss
- Respiratory or breathing problems
- Speech disorders
- Swallowing problems
Later symptoms that may occur:
- Alterations in perception and thinking
- Heat sensitivity
- Muscle spasm
- Sexual dysfunction
Multiple sclerosis is an unpredictable disease. Each individual will experience it in different ways. For some, MS starts with a subtle sensation, and it could take months and even years without any MS progression being noticed. For others, however, symptoms worsen much more rapidly - within weeks or months.
Diagnosis of multiple sclerosis
Diagnosing MS can be a complex procedure.
It is still not yet possible to diagnose multiple sclerosis by sending samples to a lab or collecting physical findings.
The doctor needs to use several strategies to decide whether a patient meets the criteria for an MS diagnosis.
To do this, other possible causes of the symptoms need to be ruled out.
The doctor will talk to the patient, carefully look at their medical history, carry out a neurologic exam, order imaging scans, visual evoked potentials (a test to measure the electrical activity of the brain), spinal fluid analysis, and perhaps some further tests.
Treatments for multiple sclerosis
There is no cure for multiple sclerosis yet. Existing treatments focus on suppressing the autoimmune response and managing symptoms. Several disease-modifying drugs are approved for the relapsing forms of MS.
The most common drugs used for treating MS
Corticosteroids are most commonly prescribed to help MS patients.
- Corticosteroids - these drugs reduce inflammation and suppress the immune system. They are most often prescribed for acute flare-up of symptoms. Corticosteroids are the most commonly prescribed drugs for MS patients.
- Interferon Beta 1a or 1b - these medicines seem to slow down the progression of worsening MS symptoms; they must be used with care as they can also cause liver damage.
Interferon Beta has shown effectiveness as a multiple sclerosis treatment in some trials. However, Canadian scientists reported in JAMA in July 2012 that Interferon Beta may not slow long-term progression of MS. They concluded that there was no clear evidence showing that Beta A had any measurable effect on the long-term disability progression of MS.
- Copaxone (Glatiramer) - this drug is aimed at stopping the immune system from attacking myelin. It is injected once a day. The patient may experience flushing and shortness of breath after receiving the injection.
- Tysabri (Natalizumab) -used in patients who either cannot tolerate other treatments or did not experience any benefits from them. It increases the patient's chances of developing multifocal leukoencephalopathy, a fatal brain infection.
- Mitoxantrone (Novantrone) - usually used only for patients with advanced multiple sclerosis. It is an immunosuppressant medication that can damage the heart. For MS patients whose illness is rapidly progressing and getting worse despite other therapies, Novantrone can help slow down the progression of disability.
- Cannabis extract - a Phase III trial found that MS patients who took cannabis extract (tetrahydrocannabinol) had improvements in their symptoms of pain, muscle stiffness, and insomnia.
- Aubagio (teriflunomide) - a once-daily tablet for adults with relapsing forms of MS.
- Do omega-3 fatty acid supplements help MS patients? - according to scientists at Haukeland University Hospital in Bergen, Norway, omega-3 fatty acids do not help MS patients.
Rehabilitation is designed to help the MS patient improve or maintain their ability to perform effectively at home and at work. The focus is on general fitness and energy management, while at the same time dealing with the problems related to mobility and accessibility, speech and swallowing, memory, thinking, and perception.
For an MS patient to achieve good quality healthcare, rehabilitation is usually a crucial component.
Rehabilitation programs generally include:
- Physical therapy - aims to provide people with the skills to maintain and restore maximum movement and functional ability.
- Occupational therapy - The therapeutic use of work, self-care, and play activities to increase development and prevent disability.
- Speech and swallowing therapy - professionals who are trained to assess speech and language development and to treat speech and language disorders are called speech language pathologists, or speech therapists.
- Cognitive rehabilitation - assists in the management of specific problems in thinking and perception.
- Vocational rehabilitation - helps people with disabilities make career plans, learn job skills, get and keep a job.
Plasma exchange (plasmapheresis)
Plasmapheresis involves withdrawing whole blood from the patient. The plasma is removed from the blood and replaced with new plasma. Then the blood, with all its red and white blood cells is transfused back into the patient.
This process is effective in treating patients with autoimmune diseases because it takes out the antibodies in the blood that are attacking parts of the patient's body.
However, whether plasmapheresis is of benefit to MS patients is unclear. Studies using plasmapheresis on patients have had mixed results.
Life expectancy and multiple sclerosis
The lifespan of a person with multiple sclerosis is usually about the same as a healthy person who does not have MS. In rare cases, multiple sclerosis may be so malignant that it is terminal.