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What is multiple sclerosis?

Multiple sclerosis (MS) is a lifelong condition that can affect the brain and spinal cord, causing a wide range of symptoms such as problems with vision, movement of the limbs, sensation and balance. The nerves are predominantly affected in this condition.

Nerves carry messages between the brain and the rest of the body. These have a protective coating made of a substance called myelin. In MS, the myelin coating gets damaged in places. This stops the nerves from working as well as they should.

What causes MS?

The cause of MS is not known. Scientists believe MS is triggered by a combination of factors. To identify the cause, research is ongoing in areas of:

  • Immunology (the study of the body’s immune system)
  • Epidemiology (the study of disease patterns in large groups of people)
  • Genetics (understanding the genes that may not be functioning correctly in people who develop MS)
  • Infectious agents (such as viruses)

More is being learned about environmental factors that contribute to the risk of developing MS.  There is no single risk factor that provokes MS, but several factors such as low vitamin D levels, smoking and obesity are believed to contribute to the overall risk.

Many viruses and bacteria are being investigated to determine if they are involved in the development of MS.  EBV (Epstein Barr virus) that causes glandular fever, has received significant attention in recent years, and a growing number of research findings indicate that previous infection with EBV may contribute to the risk of developing this condition.

MS is not an inherited disease, therefore it cannot be passed down from generation to generation.  However, there is a genetic risk that may be inherited.

How common is MS?

MS is the most common cause of neurological disability among young adults. In Europe and North America the annual incidence is between 2 and 10 cases per 100,000 population. This condition is most commonly diagnosed in those aged between 20 and 40 years, although it can occur at any age. It tends to affect females around 3 times more often than males.

What are the symptoms of MS?

MS can be mild in some cases, but for others it causes serious disability. For many people, the first symptoms are visual disturbances. They include blurring of vision, double vision, or you might see colors less clearly. Vision problems can come and go, but the good news is that your vision will probably go back to normal.

The most common longer-term symptoms are feeling very tired and getting numbness or tingling in parts of your body. The other symptoms depend on which nerves have been damaged.

They include:

  • Problems with movement- some people with MS may notice that their arms or legs shake while they move and some notice muscle spasms or twitches or find their muscles go stiff.
  • Bladder or bowel problems such as needing to go to the toilet urgently or having accidents.
  • Dizziness and having problems with balance.
  • Memory issues or finding it harder to concentrate.
  • Sexual problems, such as erection problems in men or vaginal dryness in women.
  • You may not have symptoms all the time, but it does depend on the type of MS.

The symptoms of MS can sound very frightening, however it is unlikely that you will get all of these symptoms. Also, various aspects of its treatment can help in easing symptoms and delaying the progression of the condition.

The different types of MS

About 80% of people with MS have what is called relapsing-remitting MS at first. This means that you get flare-ups of symptoms that last for a few days or weeks. A flare-up is called a relapse, but after each relapse your symptoms go away completely, known as remission. You may stay in remission for months or even years. However, as the condition progresses, you may find some of the symptoms do not go away completely after each relapse. There may be some residual symptoms which may get worse over time. When this happens, it is called secondary progressive MS.

A less common type is called primary progressive. If you have this type, your symptoms never really go away from the start, instead they slowly deteriorate.

The rarest type of MS is called progressive relapsing. Within this type, the symptoms steadily get worse from the start and relapses can also occur when symptoms suddenly become even more worse.

How can MS by diagnosed?

There is no one gold standard test that can confirm MS after a first episode of symptoms or in the very early stages of the disease. However, some tests are helpful and may indicate that MS is a possible, or a probable, cause of the symptoms.

A magnetic resonance imaging (MRI) scan of the brain is useful as it can detect small areas of inflammation and scarring in the brain which can occur due to MS. However, the results are not always conclusive – especially during the early stages of the disease. A scan result should always be viewed with symptoms and physical examination.

There are other tests that are sometimes carried out which may help diagnose this condition. They include a lumbar puncture and evoked potential tests.

How can MS be treated?

Unfortunately, there is no cure for MS. However, treatments can improve symptoms and slow down the disease as well as improve quality of life. The treatment depends on the type of MS, and it is likely that one will require different treatments over time.

It is hard to say how MS will affect each individual and a lot depends on the type of MS you have as well as its duration. You may start to need more help getting around, however it should not be assumed that you will require a wheelchair. Many people with MS can walk unaided while others can walk short distances but may need walking aids and perhaps a motorised chair or scooter to help them with longer trips. Some people with MS still have very little disability even after 15 to 20 years.

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Sources: Patient.infoBMJ Best PracticeNational MS Society