WHAT IS IT?
Multiple Sclerosis (MS) is a disease of the central nervous system, (CNS). The CNS acts like a switchboard, sending electrical messages along nerve fibres to various parts of the body. MS is not a fatal illness, nor is it infectious, contagious or hereditary, and at present neither its cause or how to prevent or cure it is known.
The first part of the process of MS is one of inflammation, as parts of the myelin sheaths (a fatty substance which insulates nerve fibres in the CNS) are infected. If the infection ceases and the inflammation dies down there may be no permanent damage.
However, where the disease process continues, the myelin sheath is destroyed at the point of attack and is replaced by Sclerosis (scar tissue). Typically, more than one area of the CNS is affected, thus the name Multiple Sclerosis.
As a result of the above process, the smooth flow of messages along both or either of the sensory or motor nerve pathways is disrupted. Message which control all conscious and unconscious movement, may not get through correctly, may be blocked completely, or alternatively messages may go to the wrong area. Body functions thus become impaired.
WHO GETS IT?
In a given population there is no way of predicting who is most at risk. However, MS is more common in the following groups:
1. Young adults - MS is one of the most common CNS diseases among young adults in Australia.
2. Symptoms usually appear between the ages of 20 - 40. Diagnosis before the age of 15 is very rare and onset is unusual in those over 40.
3. People in cooler climates.
4. Women - there are more women than men in the MS population.
5. MS is much more common in white races than in other racial groups.
6. Near relatives - about ten percent of those with MS have a near relative with MS People appear to inherit the susceptibility to the disease, not MS itself
WHAT CAUSES MS?
The cause is unknown. Likely possibilities are:
1. An uncommon virus which lies dormant for many years before being reactivated.
2. An unusual reaction of the immune system to a common virus.
3. An uncommon virus combined with an over-reaction by, or defect in the body’s immune system.
PATTERNS OF MS
While the course of the disease varies from person to person, there are two major trends -
1. Two thirds of people with MS have a remitting/relapsing form of the disease from the beginning. Symptoms usually temporary, return later. Forty percent of people in this grouping have one significant attack of symptoms which is not repeated, or symptoms may not recur until much later in life. With the other 60 percent significant attacks recur. The period between attacks varies but usually the symptoms become worse over time.
2. One third of people with MS have a progressive form from the beginning.
* The above description greatly over simplifies the nature of MS for the individual and there are many variations on the above patterns.
SYMPTOMS
Depending upon the part of the CNS affected there is a wide variety of physical symptoms. Symptoms may vary from time to time in the same individual.
Symptoms might include:
1. Patches of numbness, tingling feelings similar to pins and needles.
2. Insensitivity to touch, heat and pain.
3. Unawareness of internal signals.
4. Visual difficulties such as double vision, blurred vision and inability to focus.
5. Varying degrees of paralysis.
6. Slowness and/or staggering gait.
7. Loss of balance.
8. Clumsiness.
9. Lack of coordination.
10. Shaking hands or head.
11. Stiffness in body movements.
12. Disturbed bladder and bowel functions.
13. Extreme fatigue.
14. Possible intellectual disability (e.g. problems with short/long term memory, concentration, problem solving and mood swings).
15. Speech impairment.
16. Swallowing difficulties.
Non-medical secondary effects include items such as economic, social and family difficulties which are sometimes worse than the physical difficulties themselves.
DETECTION AND DIAGNOSIS
There is no single, simple test that can diagnose Multiple Sclerosis. Unlike some medical conditions for which a positive result from one laboratory test will confirm diagnosis, MS can only be diagnosed by a combination of the recording of clinical history followed by medical examination and supportive investigations using sophisticated medical technology.
What makes it so difficult is the longitudinal aspect of Multiple Sclerosis where a single episode may raise the suspicion of MS but is not sufficient to constitute a confirmed diagnosis. As well, symptoms can often be similar to those which occur in other diseases. The time of diagnosis can therefore be confusing, challenging and frustrating for the person with Multiple Sclerosis who wants an explanation, and for the doctor who does not want to cause unnecessary anxiety, or fail to exclude an alternate diagnosis.
Diagnosis can take from a few weeks to years because a single initial episode might settle before diagnosis can be confirmed. It is only with subsequent episodes of similar or new symptoms that a diagnosis of clinically definite MS can be made.
If the medical history and physical examination findings raise the possibility of MS, confirmation may be supported by a positive result from magnetic resonance imaging (MRI). The development of MRI techniques has improved the accuracy and diagnosis of MS since it was introduced in the 1980s. Sometimes it is also necessary to examine cerebro-spinal fluid (the fluid surrounding the brain and spinal cord) to exclude other neurological diagnoses. This can only be obtained by a lumbar-puncture.
TREATMENT OF MS
Although there is no cure for MS at present, much can be done to reduce the symptoms. Whilst medication, drugs, diet and surgical techniques have been successful in reducing symptoms, many approaches are still experimental
It should be remembered that not all health problems experienced by a person with MS will be due to the disease, so it is important for the person to remain under the care of his or her own general practitioner for routine health and medical procedures.
RESEARCH
Research into the causes and outcomes of Multiple Sclerosis continues to produce almost as many puzzles as it attempts to solve. This is because MS can have such diverse expression in so many individuals. Nevertheless, scientists and medical researchers across the world continue their efforts to discover why some people are susceptible to MS and other are not. Internationally recognised research related to MS is also proceeding at Australian institutions and universities. Many of the specific MS projects are supported directly by the National Multiple Sclerosis Society of Australia.
*Source: Multiple Sclerosis Association of SA (http://www.ms.asn.au/society/)
