September 10, 2017

Multiple Sclerosis - Causes, Symptoms, Types, Tests and Treatments

Multiple sclerosis (MS) is a condition which affects the brain and/or spinal cord (otherwise called central nervous system or CNS), marked by weakness, numbness, and loss of muscle coordination resulting in a wide range of potential symptoms, including problems with vision, speech, arm or leg movement, sensation or balance, and bladder control.

Multiple sclerosis is believed to be an autoimmune disease in which the body's immune system destroys myelin in the CNS. It's a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild. In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.

It's estimated that there are more than 100,000 people diagnosed with MS in the UK. The Multiple Sclerosis Foundation estimates that more than 400,000 people in the United States and about 2.5 million people around the world have MS. About 200 new cases are diagnosed each week in the United States. Rates of MS are higher farther from the equator.

Multiple sclerosis (MS) is the most widespread disabling neurological condition of young adults around the world. It's most commonly diagnosed in people in their 20s and 30s, although it can develop at any age. It's about two to three times more common in women than men.

What causes MS?

MS is an autoimmune condition. This is when something goes wrong with the immune system and it mistakenly attacks a healthy part of the body – in this case, the brain or spinal cord of the nervous system.

In MS, the immune system attacks the layer that surrounds and protects the nerves, called the myelin sheath. This damages and scars the sheath, and potentially the underlying nerves, meaning that messages travelling along the nerves become slowed or disrupted. In other words, communication between the brain and other parts of the body is disrupted.

Exactly what causes the immune system to act in this way is unclear, but most medical experts think a combination of genetic and environmental factors is involved.

Symptoms of MS

The symptoms of MS vary widely from person to person (from relatively benign to somewhat disabling to devastating) and can affect any part of the body. Often, the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye.

The main symptoms include:
  • fatigue
  • difficulty walking
  • vision 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
Depending on the type of MS you have (see below), your symptoms may come and go in phases, or get steadily worse over time (progress).

Types of MS

MS starts in one of two general ways: with individual relapses (attacks or exacerbations) or with gradual progression.

1). Relapsing-remitting MS

More than 8 out of every 10 people with MS are diagnosed with the "relapsing remitting" type.

Someone with relapsing remitting MS will have episodes of new or worsening symptoms, known as "relapses". These typically worsen over a few days, last for days to weeks to months, then slowly improve over a similar time period.

Relapses often occur without warning, but are sometimes associated with a period of illness or stress.

The symptoms of a relapse may disappear altogether, with or without treatment, although some symptoms often persist, with repeated attacks happening over several years.

Periods between attacks are known as periods of "remission". These can last for years at a time.

After many years (usually decades), many, but not all people, with relapsing remitting MS go on to develop secondary progressive MS. In this type of MS, symptoms gradually worsen over time without obvious attacks. Some people continue to have infrequent relapses during this stage.

Around half of people with relapsing remitting MS will develop secondary progressive MS within 15-20 years, and the risk of this happening increases the longer you have the condition.

2). Primary progressive MS

Just over 1 in 10 people with the condition start their MS with a gradual worsening of symptoms.

In primary progressive MS, symptoms gradually worsen and accumulate over several years, and there are no periods of remission, though people often have periods where their condition appears to stabilise.

Getting medical advice and tested

See your doctor or GP if you're worried you might have early signs of MS.

The early symptoms often have many other causes, and may just be an MS mimic, so they're not necessarily a sign of MS. Let your doctor or GP know about the specific pattern of symptoms you’re experiencing.

If your doctor or GP thinks you could have MS, you'll be referred to a neurologist (a specialist in conditions of the nervous system), who may suggest tests such as a magnetic resonance imaging (MRI) scan of the head and spine to check for characteristic features of MS.

There is no single test used to diagnose MS. Doctors use a number of tests to rule out or confirm the diagnosis.

Before the MRI, the neurologist may want to get your complete medical history, physical examination, and detailed neurological examination. In addition to the MRI, he may order evoked potential tests, which use electrodes on the skin and painless electric signals to measure how quickly and accurately the nervous system responds to stimulation.

He may also request a lumbar puncture (sometimes called a "spinal tap") to obtain a sample of cerebrospinal fluid (CSF). This allows him to look for proteins and inflammatory cells associated with the disease and to rule out other diseases that may mimic MS, including some infections and other illnesses.

MS is confirmed when positive signs of the disease are found in different parts of the nervous system at more than one time interval and there is no alternative diagnosis.

Treatments for MS

There's currently no cure for MS, but a number of treatments can help control the condition. The treatment you need will depend on the specific symptoms and difficulties you have. It may include:
  • treating relapses with short courses of steroid medication to speed up recovery
  • specific treatments for individual MS symptoms
  • treatment to reduce the number of relapses with medicines called disease-modifying therapies
Disease-modifying therapies may also help to slow or reduce the overall worsening of disability of MS in people with relapsing remitting MS, and in people with secondary progressive MS who are still having relapses.

Unfortunately, there's currently no treatment that can slow the progress of primary progressive MS or secondary progressive MS in the absence of relapses. Many therapies aiming to treat progressive MS are currently being researched.

Outlook

MS can be a challenging condition to live with, but new treatments over the past 20 years have considerably improved the quality of life of people with the condition.

MS itself is rarely fatal, but complications may arise from severe MS, such as chest or bladder infections, or swallowing difficulties.

The average life expectancy for people with MS is around 5 to 10 years lower than average, and this gap appears to be getting smaller all the time.

MS charities and support groups

Speaking with other people who have MS can be one of the most empowering and helpful things for someone with MS. Sharing stories, feelings, and experiences with people in similar situations is not only therapeutic, but also enlightening, and can often improve emotional health. Support groups frequently provide the best available opportunities to have these interactions and below are links you may find helpful depending on where you live.

There are two main MS charities in the UK: the MS Society (contact here) and the MS Trust (contact here). In the United States, the MS Focus Independent Support Group Network has a very large outreach (contact here). There is also the shift.ms website which is an online community for younger people affected by MS.

These organisations offer useful advice, publications, news items about ongoing research, blogs and chatrooms. They can be very useful if you, or someone you know, has just been diagnosed with MS.

Related: Dementia: Key Facts to know

Reference(s)
1). U.S. National Library of Medicine. Multiple Sclerosis. Accessed 10.09.2017. Available here: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024311/
2). NHS Choices. Multiple Sclerosis. Accessed 10.09.2017 Available here: http://www.nhs.uk/Conditions/Multiple-sclerosis/Pages/Introduction.aspx
3). Multiple Sclerosis Foundation. Common Questions. Accessed 10.09.2017. Available here: https://msfocus.org/Get-Educated/Common-Questions

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