MS - The Disease
Multiple sclerosis (MS) is one of the most common diseases of the central nervous system. Today over 2,500,000 people around the world have MS.
MS is the result of damage to myelin - a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body
Symptoms vary widely and include blurred vision, weak limbs, tingling sensations, unsteadiness and fatigue. For some people, MS is characterised by periods of relapse and remission while for others it has a progressive pattern. For everyone, it makes life unpredictable.
MS is the result of damage to myelin - a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body
Symptoms vary widely and include blurred vision, weak limbs, tingling sensations, unsteadiness and fatigue. For some people, MS is characterised by periods of relapse and remission while for others it has a progressive pattern. For everyone, it makes life unpredictable.
What is MS?
Multiple sclerosis is one of the most common diseases of the central nervous system (brain and spinal cord). MS is an inflammatory demyelinating condition. Myelin is a fatty material that insulates nerves, acting much like the covering of an electric wire and allowing the nerve to transmit its impulses rapidly. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid and co-ordinated movements to be performed with little conscious effort.
In multiple sclerosis, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in multiple sclerosis these scars appear at different times and in different areas of the brain and spinal cord. The term multiple sclerosis means, literally, many scars.
In multiple sclerosis, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in multiple sclerosis these scars appear at different times and in different areas of the brain and spinal cord. The term multiple sclerosis means, literally, many scars.
Quick Facts
- MS is a progressive disease of the nervous system, for which there is no cure.
- An estimated 2,500,000 people in the world have MS.
- More women than men have MS, with a ratio of 2 men to 3 women affected.
- MS is the most common diseases of the central nervous system in young adults.
- There are four types of MS: benign, relapsing remitting, secondary progressive, primary progressive.
- Sclerosis means scars, these are the plaques or lesions in the brain and spinal cord.
- In MS, the protective myelin covering of the nerve fibres in the central nervous system is damaged.
- Inflammation and ultimate loss of myelin causes disruption to nerve transmission and affects many functions of the body.
- While the exact cause of MS is not known, much is known about its effect on immune system function which may be the ultimate cause of the disease.
- MS is not directly hereditary, although genetic susceptibility plays a part in its development.
- MS is not contagious.
- Diagnosis of MS is generally between 20 and 40 years of age, although onset may be earlier.
- MS is rarely diagnosed under 12 and over 55 years of age.
- Life span is not significantly affected by MS.
- There are a wide range of symptoms. Fatigue is one of the most common.
- The incidence of MS increases in countries further from the equator.
- There is no drug that can cure MS, but treatments are now available which can modify the course of the disease.
- Many of the symptoms of MS can be successfully managed and treated.
Causes of MS
The cause of multiple sclerosis is not yet known, but thousands of researchers all over the world are meticulously putting the pieces of this complicated puzzle together.
The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors.
One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defence mechanisms (i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.
The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors.
One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defence mechanisms (i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.
Symptoms of MS
Multiple sclerosis is a very variable condition and the symptoms depend on which areas of the central nervous system have been affected. There is no set pattern to MS and everyone with MS has a different set of symptoms, which vary from time to time and can change in severity and duration, even in the same person.
There is no typical MS. Most people with MS will experience more than one symptom, and though there are symptoms common to many people, no person would have all of them. Common symptoms include:
There is no typical MS. Most people with MS will experience more than one symptom, and though there are symptoms common to many people, no person would have all of them. Common symptoms include:
- blurring of vision
- double vision (diplopia)
- optic neuritis
- involuntary rapid eye movement
- (rarely) total loss of sight
- loss of balance
- tremor
- unstable walking (ataxia)
- giddiness (vertigo)
- clumsiness of a limb
- lack of co-ordination
- weakness: this can particularly affect the legs and walking
- altered muscle tone can and muscle stiffness can affect mobility and walking
- spasms
- tingling
- 'pins and needles'
- numbness (paraesthesia)
- burning sensations
- pain may be associated with MS, e.g. facial pain, (such as trigeminal neuralgia), and muscle pains
- slowing of speech
- slurring of words
- changes in rhythm of speech
- difficulty in swallowing (dysphagia)
- a debilitating kind of general fatigue which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of the most troubling) symptoms of MS
- Bladder problems include the need to pass water frequently and/or urgently, incomplete emptying or emptying at inappropriate times.
- Bowel problems include constipation and, infrequently, loss of bowel control
- this symptom very commonly causes a transient worsening of symptoms
- loss of short term memory
- loss of concentration, judgment or reasoning
Whilst some of these symptoms are immediately obvious, others such as fatigue, altered sensation, memory and concentration problems are often hidden symptoms. These can be difficult to describe to others and sometimes family and carers do not appreciate the effects these have on the person with MS and on employment, social activities and quality of life.
The course of MS
It is impossible to predict accurately the course of MS for any individual, but the first five years give some indication of how the disease will continue for that person. This is based upon the course of the disease over that period and the disease type. (i.e relapsing- remitting or progressive ). The level of disability reached at end points such as five and ten years is thought to be a reliable predictor of the future course of the disease.
However, there are many variables in this scenario:
However, there are many variables in this scenario:
- a large percentage of people with MS (approx 45%) are not severely affected by MS and live normal and productive lives.
- there is a significant group (40%) which become progressive after a period of some years as relapsing-remitting.
Who gets MS?
Women are more likely to develop multiple sclerosis than men, with MS occurring 50% more frequently in women than in men (i.e. 3 women for every 2 men). Multiple sclerosis is a disease of young adults; the mean age of onset is 29-33 years, but the range of onset is extremely broad
from approximately 10-59 years.
from approximately 10-59 years.
Before you tell people that you have MS, you need to think about what they need to know. Many people will have no experience with MS or, on the other hand, know of someone with MS whose experience of the disease may be very different to yours. Your community includes people who are intimately connected to you and those whom you know casually. Your relatives, friends and employer naturally will want to know what has happened to you, especially if you have visible symptoms. They may also want to know what they can do to help. If you are honest with those close to you and let them know you will accept help when you need it, you will allay their worries and probably find them very supportive.
You can start with a simple explanation of MS and how it is affecting you at this time, so that people are aware of any practical support which you may need without imagining that your MS is any worse than it is. If you have a standard description which you use, it can help to ensure that you feel confident giving the information and that the details you give are consistent. Certain general issues may need to be quickly refuted - for many people there are stereotypes which surround MS (eg that everyone with MS ends up in a wheelchair) or misunderstandings (eg that MS is contagious). MS societies have pamphlets and brochures that will make the task easier. Casual acquaintances can be told if it comes up in conversation or if you wish. In this case there is probably no need for formal explanation.
You can start with a simple explanation of MS and how it is affecting you at this time, so that people are aware of any practical support which you may need without imagining that your MS is any worse than it is. If you have a standard description which you use, it can help to ensure that you feel confident giving the information and that the details you give are consistent. Certain general issues may need to be quickly refuted - for many people there are stereotypes which surround MS (eg that everyone with MS ends up in a wheelchair) or misunderstandings (eg that MS is contagious). MS societies have pamphlets and brochures that will make the task easier. Casual acquaintances can be told if it comes up in conversation or if you wish. In this case there is probably no need for formal explanation.
Older children and adolescents need to be informed but may require a more careful approach. Although they can appear outwardly calm and possibly even indifferent, they are most likely very concerned. Their anxiety can be helped by information. Their concerns need to be addressed as they arise and they need to know that you are willing to speak with them as issues come up. The opportunity to read selected literature from the national MS society may be helpful.
Adolescents feel that they should be treated as adults, and if they are not allowed to play a responsible part in a family problem they can feel both hurt and resentful, and as a result may start behaving in a destructive way. If, however, their cooperation is encouraged they can become surprisingly mature and a source of strength. Trying to keep your problem to yourself will not spare them any anxiety.
Adolescents feel that they should be treated as adults, and if they are not allowed to play a responsible part in a family problem they can feel both hurt and resentful, and as a result may start behaving in a destructive way. If, however, their cooperation is encouraged they can become surprisingly mature and a source of strength. Trying to keep your problem to yourself will not spare them any anxiety.
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