Multiple sclerosis (MS) is a potentially disabling disease of the brain, spinal cord and optic nerve where your body’s immune system attacks and destroys the fatty protective covering of nerve fibres that is called myelin.
It is a chronic illness that varies in severity but may lead to major disability. There is no cure for it but there is treatment available to manage the symptoms, speed up recovery from attacks and modify the course of the disease. The disease may reduce your life expectancy.
It most commonly starts at the age of between 30 and 40 but can start earlier or later than this. It affects around two to three times as many women as men. However, the prognosis tends to be better for women than men.
Causes
The cause of multiple sclerosis is unknown. It is classified as an autoimmune illness, since it is believed that it is the body’s immune system attacking and destroying the myelin that surrounds the nerves which results in the nerve fibres eventually becoming exposed and hence sending confused messages to the brain.
It is unknown why this happens but it is believed to be the result of a combination of genetic and environmental factors.
The myelin sheath becomes irritated in tiny areas (plaques or lesions) as a result of the assaults, which may be detected on an MRI scan. The messages travelling down the nerves may be disrupted by these inflammatory patches.
They may be slowed down, mixed up and be sent in the wrong direction or be entirely blocked from reaching the brain. MS symptoms are caused by this disturbance.
Something that has been suggested as a possible cause of MS or a contributory factor is an individual’s genetic code. MS is not inherited directly but those who are related to someone who has had it are more likely to get it.
Symptoms
The symptoms of MS and the severity of the disease vary, depending on the nerves affected and the extent of damage of the nerves. Some people may experience long periods of remission whilst others may lose the ability to walk.
Because MS affects the central nervous system, it may affect the functioning of any part of the body.
Some of the earliest symptoms are tingling pins and needles sensations in an individual’s arms, legs, face or body. Painful muscle spasms, including in the legs and vision difficulties are also early symptoms. If the optic nerve is affected by inflammation this may cause an individual’s central vision to be disrupted, resulting in blurry vision, double vision or loss of vision.
Other common symptoms include muscle weakness, typically on one side of the body, an electric shock sensation when moving the neck, bladder or bowel problems, sexual dysfunction, dizziness and balance problems, tremors and fatigue.
When nerves in the spinal column degenerate, chronic fatigue develops. The tiredness usually comes on unexpectedly and lasts for weeks before improving. At first, the weakness is mainly evident in the legs. Because sexual arousal originates in the central nervous system, this may diminish if one has MS.
About half of those with MS experience some sort of cognitive impairment. This can include issues with regard to memory, attention span, language and being well organised.
Progression of disease
Most people with MS experience periods of remission and relapses. New symptoms may occur over days or weeks but then improve completely or partially. Periods of disease remission may last for months or even years.
However, at least 50 percent of those with relapsing-remitting MS eventually develop a steady progression of symptoms, which usually includes problems with walking, within 10 to 20 years. This is known as secondary-progressive MS. The rate at which the symptoms progress varies.
Some people with MS do not experience periods of remission and relapse. They experience a gradual onset and steady progression of signs and symptoms. This is known as primary‑progressive MS.
Risk factors
MS is more frequent in nations distant from the Equator, which might indicate that a lack of sunlight and low vitamin D levels are factors in the disease. However, it is unclear if vitamin D supplementation can help prevent MS.
People who smoke are about twice as likely to develop MS than those who do not. Those who were obese during their teenage years have an increased risk of developing MS.
White people, particularly those of Northern European ancestry, are the most vulnerable to MS. The lowest risk is among those of Asian, African or Native American ancestry.
MS has been associated with a number of viruses, including Epstein-Barr, the virus that causes infectious mononucleosis.
You have a slightly higher risk of developing MS if you have other autoimmune disorders such as thyroid disease, pernicious anaemia, psoriasis, type one diabetes or inflammatory bowel disease.
Treatment
Multiple sclerosis has no known cure. Treatment usually focuses on reducing the time it takes to recover from attacks, delaying the disease’s progression, and managing MS symptoms. Some people’s symptoms are so minimal that no treatment is required.
Managing relapses of MS symptoms with steroid therapy, treating specific MS symptoms and reducing the number of relapses are all possible treatments.
To treat nerve irritation, corticosteroids such as oral prednisone and intravenous methylprednisolone may be administered. Insomnia, high blood pressure, high blood glucose, mood fluctuations, and fluid retention are all possible side effects of this treatment.
Amantadine may be administered for fatigue caused by MS but this may have a limited effect.
Visual issues caused by MS normally recover on their own within a few weeks, so may not need treatment.
Physiotherapy can help with muscle spasms and stiffness (spasticity). If your range of motion is restricted, techniques such as stretching exercises may help. If your muscle spasms are severe, a muscle relaxant may be prescribed.
Muscle spasms and spasticity are the most common causes of mobility issues, although mobility problems may also be caused by muscle weakness, balance issues, or dizziness. If you have mobility issues, you may benefit from a physiotherapist-supervised exercise programme, medication for dizziness or tremors, and mobility aids such as a walking stick or, in some cases, a wheelchair.
