Understanding multiple sclerosis
Overview
Multiple sclerosis or MS is a chronic disease affecting the central nervous system.
Around the world, over 2.3 million people have the condition while in Australia there are over 25,000 living with multiple sclerosis.
This article has been developed to provide the answers to some of the most commonly asked questions and help explain multiple sclerosis and define MS. What are the symptoms of MS? How is MS diagnosed? What causes MS and how is it treated? Discover more about common early signs, the different types of MS, how does MS affect the central nervous system… and more.
What is multiple sclerosis?
Multiple sclerosis is a complex disease in which the body’s immune system mistakenly attacks and damages nerves of the central nervous system.
Nerves in the brain, spinal cord and optic nerve are normally protected by a fatty material called myelin. Myelin insulates these nerves and allows them to efficiently transmit ‘messages’ between the brain and other parts of the body that are essential to a wide range of functions. Sclerosis is a Greek word for scars and multiple sclerosis, or ‘many scars’ describes the effect when myelin is attacked and damaged. The process that results in scarring, also known as plaques or lesions, is called demyelination.
Demyelination can happen anywhere through the central nervous system and this is why everyone’s experience of MS is different. While the brain works to repair damaged nerve tissues, some nerves are irreversibly destroyed or damaged which leads to diminished function throughout the central nervous system. A wide range of largely unpredictable symptoms and effects can be experienced at various stages of this progressive disorder.
What are the symptoms of MS?
While the symptoms of MS are varied and unpredictable, they can manifest as a combination of problems within five key areas of health:
Motor control – this is all about the regulation of movement through the nervous system and can cover difficulties with walking, balance or coordination, muscle spasms or tremors and general muscle weakness. Especially as the disease progresses, it may also include slurring or slowing of speech, difficulties with swallowing or breathing, heart problems and dizziness or vertigo.
Fatigue – extreme tiredness is often experienced in combination with heat sensitivity which can also make other symptoms worse.
Other neurological symptoms – this covers a wide range of functions and disorders of nervous system including sensations such as sensitivity to heat and cold, pins and needles, numbness and pain as well as visual disturbances such as blurred or double vision, changes in depth perception and even partial or complete sight loss.
Bladder and bowel function – symptoms may include including incontinence, frequent and urgent urination, constipation or diarrhoea.
Neuropsychological symptoms – these also cover a very wide range of symptoms including impaired memory and concentration, changes in processing speed and ability, impaired cognitive function, emotional and personal changes, anxiety, depression and difficulties sleeping.
What causes multiple sclerosis?
No single cause of MS has been identified. Studies have found a complex interaction between a range of factors including genetics, environment and lifestyle. While MS isn’t hereditary, the American National MS Society has identified a higher chance of developing MS when a parent or sibling has been diagnosed.
It’s the most common acquired neurological disease affecting young adults and is most commonly diagnosed between the ages of 20 to 40, children have also been diagnosed. In Australia, it affects three times more women than men.
Various studies have linked MS to autoimmune diseases caused by environmental factors or viruses while others show a correlation to vitamin D deficiency, smoking or exposure to second hand smoke. And while the reasons are still unclear, MS is more common in areas further away from the equator.
What are the early signs of MS?
Because every individual’s experience of multiple sclerosis is different, there is no single test for MS. Diagnosis can also be challenging as some of the common early signs of the disease can be caused by a number of other health conditions. This is why it can sometimes take years to reach a diagnosis.
While there is no ‘typical’ pathway to MS, early signs that may lead to further testing include:
- vision problems
- tingling and numbness
- pains and spasms
- weakness or fatigue
- balance problems or dizziness
- bladder issues
- sexual dysfunction
- cognitive problems
How MS diagnosed?
If a GP or treating specialist suspects a patient may have MS, the patient will be referred to a specialist MS neurologist who has access to the latest diagnostic tools and facilities and the support of an experienced MS healthcare team.
A diagnosis of MS will only be made when specialists have evidence of lesions or sclerosis in different parts of the central nervous system that can only have occurred at different points in time and have no other explanation.
To reach these conclusions, the process of diagnosis is likely to include:
Physical examinations – to check reflexes and review coordination, motor skills, vision, balance, sensory, language and emotional function.
Neurological examination – to assess the passage of impulses along pathways of the central nervous system.
Blood tests – to rule out other causes.
MRI (Magnetic Resonance Imaging) – to look for scarring in the brain and spinal cord.
Lumbar puncture – also known as a spinal tap to test cerebrospinal fluid and help rule out other diseases.
What are the different types of MS?
Multiple sclerosis can progress in different ways and these pathways or clinical courses define three different types of MS, each of which can be classified as mild, moderate or severe:
Relapsing-remitting MS (RRMS) – this is the most common type of MS and around 70–75% of people will initially be diagnosed with RRMS. It is characterised by clearly defined attacks followed by periods of complete or partial recovery. During these remission periods symptoms might disappear (non-worsening), or some might continue or become permanent (worsening).
Secondary progressive MS (SPMS) – this type of MS is diagnosed when an initial relapsing-remitting (RRMS) phase is followed by a ‘progressive’ phase in which the disease progresses and continually worsens. 50% of people diagnosed with RRMS will develop SPMS within 10 years and 90% within 25 years.
Primary progressive MS (PPMS) – this type of MS is diagnosed when the condition follows a progressive (continually worsening) course from the beginning. It is characterised by increasing disability, usually without periods of remission or acute attacks. Around 15% of people with MS are diagnosed with PPMS.
How is MS treated?
Following diagnosis of MS, patients will generally be supported by their GP working closely with a specialist MS team consisting of a neurologist, an MS specialist nurse and other allied health practitioners as needed, such as a physiotherapist or occupational therapist.
Just as the symptoms and progression of MS are different for every person, so too are the types of treatment and the level of care that may be required.
While there is no known cure for MS, there are many options for treatment that may slow its progression and help to manage symptoms. At all stages of the disease, the treatments aim to:
- minimise relapses
- eliminate inflammation
- prevent the formation of new lesions
- minimise brain atrophy
- restore function
- minimise the impact of symptoms on day to day life
Specialist MS health teams help patients develop customised plans that provide ways of coping, adapting to and managing MS. Research shows that a collaborative decision-making process between patient and healthcare providers leads to the best health outcomes. Specialists will take the time to discuss the aims of treatment and the pros and cons of different treatments available.
Tailored to individual needs, treatments may include:
Medicines including immunotherapies – used to ease symptoms, slow progression and reduce the risk and severity of attacks or relapses.
Regular exercise, physiotherapy and occupational therapy – to strengthen muscles, improve heart health and improve mood.
Dietary advice – diets low in fat and high in fibre may be helpful.
Brain health – weight management, keeping mind and body active, avoiding smoking and alcohol, managing stress.
It is generally difficult to predict the course of MS as the condition varies greatly in each individual, but most people living with MS can expect 95% of the normal life expectancy.
MS and Forsight homes
If and when the condition progresses, people with MS may have an increased need for hands-on care and support. To find out more about the support available through Forsight click here.
Information for this article is drawn from a number of online resources. While we take care to include accurate and up to date facts and figures, we always recommend that you undertake your own research into the medical conditions we might write about.
Some of our sources:
www.healthdirect.gov.au/multiple-sclerosis-ms
www.brainfoundation.org.au/disorders/multiple-sclerosis/