Multiple sclerosis (MS) is a disease in which the immune system attacks the protective sheath around the nerves of the central nervous system. Irreversible, progressive damage to the nerves can result. MS is a life-long, potentially disabling condition.The frequency and severity of these attacks are unpredictable. Many MS patients continue to live active, productive lives. For others, however, the disease becomes progressively more severe, causing serious disability.
There is no cure for MS at this time. However, treatment can lessen the effects of attacks, symptoms can be managed and disease progression can be slowed.
CAUSES
The ultimate cause of multiple sclerosis is not known. Researchers believe it is an autoimmune disease: the body’s own immune system attacks the myelin of the CNS (central nervous system: the brain and spinal cord).
Myelin is the protective sheath that covers and insulates the nerves and aids the transmission of electrochemical messages between the CNS and the rest of the body. The attack by the immune system causes plaques or lesions in the myelin, which slows, blocks or distorts the messages sent along the nerves.
Because of complex interacting factors, the disease most often affects young white women in temperate parts of the globe.
These factors may include:
- Age – MS most commonly affects people between 20 and 40.
- Gender – Women have twice the risk of men.
- Infections – Certain viral infections are associated with MS.
- Genetics – If someone in your close family has multiple sclerosis, your risk is increased.
- Ethnicity – People with northern Europe ancestry are at highest risk.
- Geography – There is a higher incidence of MS in certain regions of the world, including south-eastern Australia.
- Autoimmune diseases – If you have other autoimmune diseases (eg. thyroid disease), you may have increased risk.
SYMPTOMS
Initially, most people experience relapsing-remitting MS. In this form of the disease, MS attacks may last days or months, but then the disease goes into remission. Symptoms may improve or completely disappear during these periods. On average, attacks occur every couple of years, although this varies widely. Some may have only one or two attacks. In many people, relapsing-remitting MS develops into a progressive form (gradual deterioration) over time.
In about 10% of people with MS, deterioration starts right from the outset of the disease, with increasing irreversible disability and no relapses. This is called progressive MS.
There are a range of symptoms, which vary widely from person to person, depending on which nerves are damaged and how extensively. Most people with MS will only have a few symptoms over an extended period of time.
Symptoms may include:
- Fatigue – the most common symptom
- Muscle weakness in the extremities; stiffness or spasms; in severe cases, paralysis, usually in the legs
- Trembling, difficulties with co-ordination and balance, unsteady gait
- Temporary, abnormal sensations – numbness or loss of feeling, “pins and needles”, tingling, “electric-shock” feelings, pain
- Vision problems: partial or total sight loss, often in one eye; pain with eye movement, double or blurred vision; red-green colour distortion
- Difficulties with concentration, attention, memory and judgement
- Heat sensitivity
- Slurred speech
- Dizziness
- Bladder, bowel or sexual problems
- Depression
- Epilepsy
DIAGNOSIS
To diagnose multiple sclerosis, doctors will examine you and review your medical history and suggest certain tests:
- Blood tests: These can rule out infectious or inflammatory diseases with similar symptoms.
- Lumbar puncture: A small quantity of spinal fluid is removed for analysis. This may show abnormal levels of white blood cells or proteins, indicating an immune response in the CNS.
- Magnetic resonance imaging (MRI): Scans can show lesions in your brain and spinal cord, possibly due to myelin loss.
- Evoked potential test: This measures electrical signals in the brain and can help detect lesions or nerve damage.
TREATMENT
Multiple sclerosis (MS) has no cure. However, there are various treatments that can slow the course of the disease; reduce attack frequency; shorten relapses and address specific symptoms. Generally, the earlier treatment is started, the more effective it is.
Your neurologist can guide you in your choice of treatment, which will depend on various factors, including the form of MS present.
Immunotherapy: These treatments modify the activity of the immune system. They reduce the frequency and severity of attacks, thus slowing the accumulation of lesions and the development of disability. This can be helpful for people with relapsing-remitting MS.
Medications include:
- Interferon beta: Interferons are proteins that occur naturally in the body. They regulate the immune system and fight viral infections. Different types of interferon beta may be given by injection, intrasmuscularly or into the skin.
- Glatiramer acetate is given daily by injection into the skin and blocks the immune system’s attack on myelin. It can reduce relapse rates by about a third.
- Natalizumab is given intravenously each month. It prevents the white blood cells moving into the brain and spinal cord, thus reducing inflammation.
- Fingolimod is a capsule taken daily. It can help by trapping the immune cells in the lymph nodes.
Immune-suppressant medications may also be used, particularly for people with progressive MS.
Corticosteroids (steroids) are often prescribed to treat MS relapses and can be administered by injection or intravenously. They help to shorten the attack by reducing inflammation and can block the entry of damaging blood cells into the CNS.
Symptomatic therapies are a wide range of treatments that relieve specific MS symptoms.
- Muscle relaxants can help with muscle stiffness and spasms.
- Sleep-disorder medications may be helpful in controlling fatigue.
- Visual disturbances can be improved with medications such as steroids.
- Incontinence can be addressed with medication, as well as exercise, dietary changes and aids such as disposable pads.
- Depression and anxiety can be treated with counselling and medication.
- Pain-relieving medication may also be prescribed.
Many MS medications have problematic side effects, including drowsiness, fluid retention, flu-like symptoms, gastro-intestinal disturbance, mood swings, seizures, weight gain, skin irritation, headaches, muscle aches, depression, hair loss and risk of infection. Other more severe reactions can rarely occur. You should discuss any concerns with your doctor.
MANAGING MS
It is important to manage your disease, with help from doctors, occupational therapists and social workers, to continue living a fulfilling and active life for as long as possible.
These suggestions may help:
- See a physical therapist. Stretching and strengthening exercises can reduce pain and discomfort and improve mobility.
- Learn about devices and techniques for easing daily tasks – an occupational therapist can help.
- Exercise regularly: this improves strength, energy, muscle tone, balance and co-ordination, bladder and bowel control, as well as mood.
- Stay cool. Multiple sclerosis symptoms often worsen or are triggered when body temperature rises.
- Get plenty of rest.
- Eat a healthy, balanced diet.
- Find ways to relieve stress, like yoga, massage, meditation or listening to music.
- As much as you can, keep up with regular activities you enjoy. Spend time with friends and family.
- See a counsellor or therapist if you need help with coping skills, anxiety or depression.
- A support group of people who share your experiences can be very helpful.
- Make practical plans about future employment and living arrangements.
(Prof H. Reuter, University of Stellenbosch. Updated Health24, Oct 2013.)
Sources: The Multiple Sclerosis Society of Western Australia, MS Australia
