Multiple Sclerosis

Maddy Snell

About

Multiple sclerosis shortened to MS has mystified scientists ever since the symptoms were first recognised by the French neurologist Charcot in 1868. It affects the central nervous system; it interferes with the travel of nerve impulses throughout the brain, spinal cord and optic nerve. It is the most common chronic disease of the central nervous system for young Australians and effects more women than men. The cause and cure of MS is still unknown. Fortunately MS it is not a contagious disease however it is progressive and unpredictable as symptoms heavily vary between suffers of the disease.

cause

The immune system is there to defend the body from attacks by micro-organisms such as bacteria and viruses. However in someone who has MS their immune system works a lot differently their immune system starts attacking its own myelin which then causes damage and disruption to the nerve transmission throughout the central nervous system and the body. Myelin is the protective layer of the nerve fibres in the CNS (central nervous system) and when inflammation occurs in the myelin it becomes damaged and is replaced by scars of hardened "sclerotic" patches of tissue. Such areas that have suffered damage are called "plaques," and appear in "multiple" places within the CNS, hence the name of the disease, multiple sclerosis. This can be compared to a loss of insulating material around an electrical wire, which restricts with the spread of signals. Even though the cause is still unknown it has been thought that genetic and environmental factors are involved in the cause of MS, however it is not a genetic disease but having a first-degree relative such as parents or siblings with MS increases a person's possibility of developing it later on.

symptoms

There is no one test to determine whether an individual has MS, there are several specialised tests which would be necessary to diagnose a person with MS such as an MRI. The early symptoms for MS are two attacks such as an exacerbation, flare or relapse, this is an unexpected appearance or worsening of an MS symptom, it will last for at least 24 hours. The second early symptoms for MS are if there is more than one area with damage to the CNS myelin. The main symptoms or areas that are affected include:


  • Motor control – muscular spasms and problems with weakness, coordination, balance and functioning of the arms and legs, difficulty in walking this is sometimes done by dragging one foot.
  • Fatigue – including heat sensitivity and headaches
  • Other neurological symptoms – including vertigo, pins and needles, tremors, neuralgia, visual and swallowing troubles
  • Continence problems – including bladder or bowel dysfunction and constipation
  • Neuropsychological symptoms – including memory loss, depression and cognitive difficulties.
  • Other symptoms can include trouble with vision or swallowing, tremors and numbness in some areas.

treatment

There are no proven medications to cure MS, only medication to shorten the length of the attacks, relapse and reduce particular symptoms and slow the progression of the disease by reducing the rate of the attacks. As MS is a very individual disease the types of medications that are used depend on a number of factors including how strong the strength of their immune system. For specific muscle problems physiotherapy is recommended, for fatigue related issues sleep disorder medication is suggested, visual disturbances can be helped with steroids, continence can be helped with medication, specific exercises or changes to the diet, Neuropsychological problems relating to anxiety may include taking medicine or talking to a counsellor. However the main types of medication used include:


  • Immunotherapy - this medication role is to slow the regularity and severity of attacks, which means the myelin sheaths are exposed to less damage. Immunotherapy works by modifying the activity of the immune system. This treatment is prescribed for people with relapsing-remitting MS
  • Corticosteroids – It can be taken in the form of an injection or pill. It is used to reduce the extent of an MS attack by relieving inflammation

long term outcome

As the disorder is very unpredictable for each individual it is hard to anticipate what the outlook will be for them. Most people with MS can expect 95% of the normal life expectancy. MS may lead into severe disability or death. In most cases MS has a tendency to follow one of these four pathways, each of these may be mild, moderate or severe.


  • A relapsing-remitting course (RRMS) – Is regarded as a partial or complete recovery after attacks. This is the most common form of MS. 70-75% of people with MS initially begin with a relapsing-remitting course.
  • Secondary-progressive (SPMS) - A RRMS course which later becomes steadily progressive. Attacks and fractional recoveries may continue to occur. Of the 70-75% who start with RRMS, more than 50% will develop SPMS within 10 years; 90% within 25 years.
  • Primary-progressive (PPMS) - A progressive course from the start. The symptoms generally do not remit. 15% of people with MS are diagnosed with PPMS, however the diagnosis usually needs to be made after the person has been living for a period of time with progressive disability but not acute attacks.
  • Progressive-relapsing (PRMS) - A progressive course from the outset which is also characterized by obvious acute attacks. It is quite rare as only around 6-10% of people with MS appear to have PRMS at diagnosis.

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