Multiple Sclerosis (MS)

Overview

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic (long term) condition of the central nervous system, considered to be an autoimmune disease. In MS, the body’s own immune system attacks the myelin coating or sheath around nerve fibres as well as the nerve fibres themselves in the brain and spinal cord. The individual progress, severity and specific symptoms that develop in an individual cannot be predicted and will depend on the amount of nerve damage and which nerves are affected. Most people with MS experience periods of partial or complete recovery from symptoms (remission) that can last for months or years followed by a relapse where new symptoms develop.

Symptoms

The resulting damage and scarring (sclerosis) caused by MS disrupts the flow of information within the brain and between the brain and body. This can cause symptoms that vary widely from person to person and can affect any part of the body. Most people are diagnosed between the ages of 20-40 with women being about twice as likely as men to develop MS.

The main symptoms include;

• fatigue difficulty walking
• visual problems, such as blurred vision
• problems controlling the bladder
• numbness or tingling in different parts of the body
• muscle stiffness and spasms
• problems with balance and co-ordination
• problems with thinking, learning and planning

Cause

The cause of MS is still unknown but it is thought that genetic and environmental factors are involved. There is no cure for MS however, treatments can help relieve the effects from attacks, slow the course of the disease and manage symptoms.

Types of MS

Relapsing-remitting MS (RRMS) is the most common form of MS experienced by approximately 3 in every 4 people with the condition. Relapses or attacks are followed by periods of remission. During remission all symptoms may improve or some symptoms may continue and become permanent.
Secondary progressive MS (SPMS) develops in most people with RRMS. Relapses and partial recoveries may continue to occur with disability progressively worsening.

Primary progressive MS (PPMS) is a less common type of MS producing symptoms that gradually worsen and accumulate over several years with no periods of remission or acute attacks.

Clinically Isolated Syndrome (CIS) refers to a first episode of neurologic symptoms caused by inflammatory demyelination in the central nervous system that could become MS if additional activity occurs.

Management of MS

As there is no cure for MS, the focus of treatment is to shorten the duration of relapses, ease specific symptoms and slow the progression of the disease by reducing the rate of the attacks. The types of medications and other treatments prescribed depend on a number of factors. These include the MS type, the nature and severity of symptoms and individual considerations such as other medical conditions a person has.

Established treatments

Treatment for MS should be started and supervised by a specialist doctor called a neurologist. Short term sudden worsening or flare-ups (relapses) of MS may be treated with corticosteroids, such as methylprednisolone injection. Longer term prevention of relapses of MS may be treated with immunomodulators. These are medicines that help to suppress the immune system to help slow down the progression and severity of relapses of MS. Immunomodulator medicines include alemtuzumab, daclizum,ab, dimethyl fumarate, fampridine, fingolimod, glatiramer, interferon beta, natalizumab Other symptoms of MS such as muscle spasticity, bladder dysfunction, constipation and fatigue may also require treatment as follows: muscle spasticity, treated with dantrolene, diazepam, botulinum toxins, baclofen, biperiden, trihexiphenidyl or medicinal cannabis bladder dysfunction treated with darifenacin, oxybutynin, solifenacin, tolterodine constipation, treated with laxatives fatigue, treated with stimulants like caffeine.