10 multiple sclerosis (MS) facts
Here are 10 facts about MS and what it means.
1. What is multiple sclerosis?
Multiple sclerosis (MS) is an autoimmune disease of the brain and spinal cord (central nervous system).
In the UK, there are over 130,000 patients with MS, and upto 7000 new cases per year. This means one in 500 people have the disease.
What happens? In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibres and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage to the nerves.
Symptoms of MS vary widely and depend on the amount of nerve damage, and which nerves are affected. Some people with severe MS may lose the ability to walk independently, while others may experience long periods of remission without any new symptoms.
There is no cure for multiple sclerosis.
However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.
2. What are the symptoms of MS?
Multiple sclerosis symptoms differ greatly from person to person and over the course of the disease; depending on the location of affected nerve fibres. Symptoms often affect movement, such as:
- Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or your legs and trunk
- Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
- Tremor, lack of coordination or unsteady gait
- Vision problems are also common, including:
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Prolonged double vision
- Blurry vision.
Multiple sclerosis symptoms may also include:
- Slurred speech
- Fatigue
- Dizziness
- Tingling or pain in parts of your body
- Problems with sexual, bowel and bladder function.
3. What is the disease course (and types) of MS?
Most people with MS have a ‘relapsing-remitting’ disease course. This means they experience periods of new symptoms (or relapses) that develop over days or weeks, and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.
At least 50% of those with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, within 10 to 20 years from disease onset. This is known as ‘secondary-progressive MS’.
The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS.
Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses, known as ‘primary-progressive MS’.
4. What is the cause of MS?
The cause of multiple sclerosis is unknown. It is an autoimmune disease in which the body’s immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys the fatty substance that coats and protects nerve fibres in the brain and spinal cord (myelin).
Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and the nerve fibre is exposed, the messages that travel along that nerve fiber may be slowed or blocked.
It isn’t clear why MS develops in some people and not others. A combination of genetics and environmental factors appears to be responsible.
5. What are the risk factors for MS?
These factors increase your risk of developing multiple sclerosis:
- Age. MS can occur at any age, but onset usually occurs around 20 and 40 years of age.
- Sex. Women are more than two to three times as likely as men are to have relapsing-remitting MS.
- Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
- Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis (glandular fever).
- Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. It is far more common in countries with temperate climates.
- Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of MS.
- Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have other autoimmune disorders such as thyroid disease, pernicious anaemia, psoriasis, type 1 diabetes or inflammatory bowel disease.
- Smoking. Smokers who experience an initial attack of MS are more likely than non-smokers to develop a second event (i.e. confirming relapsing-remitting MS).
6. How is MS diagnosed?
How is it diagnosed? There is no specific test for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms.
That doctor will start with a medical history (questions) and an examination. Then after that, the following tests may be done.
- Blood tests – to help rule out other diseases with symptoms similar to MS.
- Lumbar puncture (spinal tap)
- MRI of brain and spinal cord
- Evoked potential test.
Spinal tap (lumbar puncture)
A small sample of cerebrospinal fluid is removed from your spinal canal for laboratory analysis. This sample can show abnormalities in antibodies that are associated with MS. A spinal tap can also help rule out infections and other conditions with symptoms similar to MS.
Magnetic resonance imaging (MRI)
This can reveal areas of MS (lesions) in your brain and spinal cord. You may receive an intravenous injection of a contrast material to highlight lesions that indicate your disease is in an active phase.
Evoked potential test
This records the electrical signals produced by your nervous system in response to stimuli. An evoked potential test uses visual (or electrical) stimuli. In these tests, you watch a moving visual pattern, or short electrical impulses, are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.
7. What is the treatment for MS?
- Corticosteroids (steroids). These include oral prednisone and intravenous methylprednisolone. These are prescribed to reduce nerve inflammation.
- Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body. Plasma exchange may be used if your symptoms are new, severe and haven’t responded to steroids.
Treatments to modify progression
Much of the immune response associated with MS occurs in the early stages of the disease. Aggressive treatment with the medications below as early as possible can lower the relapse rate, slow the formation of new areas of MS, and potentially reduce longterm disability.
Many of the disease-modifying therapies used to treat MS carry significant health risks. Selecting the right therapy for you will depend on careful consideration of many factors, including your age, duration and severity of disease, effectiveness of previous MS treatments, other health issues, and child-bearing status.
Here are treatment options for relapsing-remitting MS.
Injectable treatments
- Interferon beta. This drug is amongst the most commonly prescribed medications to treat MS. It is injected under the skin or into muscle and can reduce the frequency and severity of relapses
- Glatiramer acetate.
Oral treatments
- Fingolimod
- Dimethyl fumarate
- Diroximel fumarate
- Teriflunomide
- Siponimod
- Cladribine.
Infusion treatments (or ‘biological agents’)
- Ocrelizumab
- Natalizumab
- Alemtuzumab
Physiotherapy (and other treatments) for multiple sclerosis
Physiotherapy can build muscle strength and ease some of the symptoms of MS.
- Physiotherapist. A physio (or occupational) therapist can teach you stretching and strengthening exercises; and show you how to use devices to make it easier to perform daily tasks.
- Mobility aids – help manage leg weakness and other gait problems.
- Muscle relaxants. You may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen, tizanidine and cyclobenzaprine may help. Botulinum toxin is another option in those with spasticity.
- Medications to reduce fatigue. Amantadine, modafinil and methylphenidate may be helpful in reducing MS-related fatigue. Some drugs used to treat depression, including selective serotonin reuptake inhibitors (SSRIs), may be recommended.
- Medication to increase walking speed. Dalfampridine may help to slightly increase walking speed in some people.
- Other medications. Medications also may be prescribed for depression, pain, sexual dysfunction, insomnia, and bladder or bowel control problems that are associated with MS.
8. Who should patients be referred to?
Your GP should refer you to a hospital brain specialist (called a neurologist). They will look after you over the years. They will be assisted by specialist nurses, physiotherapists and psychologists. It is good to get to know all members of this multi-disciplinary team (MDT). They have different skills and will help you in different ways.
9. What are the complications of MS?
People with multiple sclerosis may also develop:
- Muscle stiffness or spasms
- Paralysis, typically in the legs
- Problems with bladder, bowel or sexual function
- Mental changes, such as forgetfulness or mood swings
- Depression
- Epilepsy.
10. What is the prognosis (outlook) for MS?
MS itself is rarely fatal, but complications may arise from severe MS, such as chest or bladder infections, or swallowing difficulties.
50% patients can walk unaided 15 years after disease onset. The other 50% will need assistance in walking or will be wheelchair bound.
Frequency of death by suicide is 2 times higher among patients with MS compared to the general population. In suicidal patients, suicide rate does not correlate with disability.
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.
Prognostic indicators
Favourable prognosis
- Female and later onset
- Relapse rate in first 2 years < 5 relapses
- Duration between relapses – long
- Relapse recovery – complete
- Relapse rate after 5 years – no increase
- Number of neural systems involved – one
- Type of systems involved – visual, sensory, brainstem.
Unfavourable prognosis
- Male and earlier onset
- Relapse rate in first 2 years ≥ 5 relapses
- Duration between relapses – short
- Relapse recovery – incomplete
- Relapse rate after 5 years – increasing
- Number of neural systems involved – multiple
- Type of systems involved – motor, cerebellar, bowel or bladder.
Summary
We have described 10 facts about multiple sclerosis (MS). There is a lot you and the NHS can do to give you better care. New advances are happening all the time.
Other resources
The UK’s charities include:
MS Society
MS Trust
Both have alot of useful information on their websites.
And shift.ms is a very good online community.
