Multiple sclerosis

Multiple Sclerosis

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic disease of the central nervous system, which causes a gradual degeneration of the nerves. This results in a progressive deterioration in various functions controlled by the nervous system – such as vision, speech and movement.

In MS, the body's immune cells attack the covering of the nerves in the brain and spinal cord, known as the myelin sheath. When the myelin is damaged or destroyed, nerve messages are sent more slowly, making them less efficient. Eventually scar tissue (plaques) develops over the affected area, further disrupting nerve communication.

Unfortunately MS has no cure and is characterised by a slow progression of symptoms. There are different types of MS however, so every individual’s experience of the disease may be different.

What causes multiple sclerosis?

MS is an autoimmune disease, which means it is due to an attack by the body's own immune system. However why this happens is not fully understood at present. It is thought that it may be caused by a combination of genetic (hereditary) and environmental factors, and there are theories that it may be triggered by a virus, which causes the body to start attacking its own cells.

Who is most likely to develop multiple sclerosis?

An estimated 6000 people in Ireland have MS. Women are nearly twice as likely to get MS as men. Most people start developing symptoms between the ages of 20 and 40.

People from Northern Europe (including Ireland), America and Canada are more likely to develop MS than Asian people, Eskimos and American Indians.

What are the symptoms of multiple sclerosis?

Since all parts of the nervous system can be attacked, symptoms can differ depending on which part is under attack. Early symptoms can include:

In these more severe cases, later symptoms can include:

Symptoms may be made worse by a rise in body temperature, for example after a hot bath or physical exertion.

What are the different types of multiple sclerosis?

There are several different types of MS.

Most people who develop MS start with relapsing-remitting MS. This means that there are periods of attacks (relapses) followed by periods where there are fewer, or no symptoms (remission). A relapse can last for hours, days, or even months and can vary from mild to severe. The interval between attacks also varies but one individual may not have any further symptoms for several years while another may have a second attack after a much shorter interval.

Around 15% of people with the MS have a form called primary progressive MS, which means that they never have distinct relapses and remissions, but experience steadily worsening symptoms and progressive disability. Some people who initially have relapsing-remitting MS move into a secondary progressive phase, after a number of years.

Other people may have what is known as benign MS. This type of the disease starts with a small number of mild attacks and is followed by complete recovery. There is no permanent disability.

How is multiple sclerosis diagnosed?

Diagnosing MS can be difficult because there is no single, definitive test for the disease. Your doctor will ask you for a history of your symptoms and may then conduct tests to look for signs of MS and to rule out other possible reasons for your symptoms.

Tests may include an examination of your Cerebro Spinal Fluid (CSF) – this requires hospital admission for a day or two; an MRI – a technique used to get detailed images of the inside of your body; a myelogram, to get x-ray images of the spinal cord; and evoked response tests on the eyes, which measure the speed that impulses travel along the optic nerves.

How is multiple sclerosis treated?

Since there can be so many symptoms in this disease, symptoms can often be managed separately, as and when they arise. Treatment can take a number of forms, such as medication, exercise, physiotherapy, occupational therapy and a change in diet.

Specific medications are available for treating relapsing-remitting MS, the most common of which is a group of drugs called beta-interferons. Interferons occur naturally in the body and are involved in regulating the body’s immune system. These drugs seem to have a beneficial effect in reducing severity and frequency of relapses, and in slowing down progression of the disease. A different type of drug also used in relapsing-remitting MS is called glatiramer acetate. This drug appears to work by blocking the autoimmune reaction against the myelin sheath.

A new type of treatment for relapsing-remitting MS called Tysabri (natalizumab) was launched in Ireland in 2006. This drug has been shown to have substantial benefits in slowing the progression of MS and decreasing the number of MS attacks. However, it has also been linked to a rare but very serious infection of the brain called Progressive Multifocal Leukoencephalopathy (PML). This means that it can only be used in patients who have not responded to other treatments and its use has to be monitored by your doctor very carefully.

What is the outlook for multiple sclerosis?

While there is no cure at present for MS, it is not a fatal disease and it does not mean that your life has to come to a stop. It is usually impossible, however to know what course the disease will take until the person has had it for at least five or 10 years.

Learning how to manage the disease and adapt your lifestyle as necessary is the key to coping with your MS. You should feel encouraged to lead as normal a life as circumstances allow.

MS Ireland is the national organisation working on behalf of people in Ireland living with multiple sclerosis. The organisation offers a number of services, including an MS care centre offering short-term respite care and various types of therapy, a helpline (1850 233 233) providing confidential advice and information on living with MS, a counselling service, and various other services throughout the country. Contact MS Ireland on Tel: 01 678 1600, Email: info@ms-society.ie or web: www.ms-society.ie.

Reviewed: November 3, 2006