Multiple Sclerosis (MS) is an autoimmune disease:
MS occurs when the immune system mistakenly attacks the protective covering of nerve fibres (myelin) in the central nervous system. MS affects an estimated 2.8 million people worldwide, 130,000 in the UK with nearly 7,000 people (130 per week) being newly diagnosed each year. The prevalence varies geographically, with higher rates observed in temperate climates, particularly in North America and Europe. Onset typically occurs in young adulthood: Most individuals are diagnosed with MS between the ages of 20 and 50, although it can develop at any age. Women are more likely to develop MS and the reason for this gender disparity is still unclear.
The exact cause of MS remains unknown. It is believed to involve a complex interplay of genetic and environmental factors, but the precise triggers are not yet fully understood. MS is a highly variable disease: MS can manifest in a wide range of symptoms and progression patterns. It can be mild or severe, with periods of relapses (exacerbations) and remissions, or it can have a progressively worsening course.
MS is not directly hereditary and while there is a slightly increased risk of developing MS if a close family member has the condition, it does not follow a simple inheritance pattern. Multiple genes and environmental factors likely contribute to the risk. Most individuals with MS have a normal life expectancy. However, the disease can affect quality of life and require ongoing management to minimise symptoms and complications.
Prominent symptoms commonly associated with multiple sclerosis (MS) include:
Fatigue: Fatigue is one of the most common and debilitating symptoms of MS. It can be overwhelming and impact daily activities and quality of life.
Motor Dysfunction: MS can cause various motor problems, such as muscle weakness, difficulty with coordination and balance, tremors and spasticity (muscle stiffness).
Sensory Disturbances: Sensory symptoms may include numbness, tingling, pins and needles sensation, burning or itching and altered sensitivity to touch or temperature.
Optic Neuritis: Inflammation of the optic nerve can cause vision problems, including blurred vision, eye pain and temporary loss of vision.
Cognitive Changes: MS can affect cognitive function, leading to difficulties with memory, attention, problem-solving and information processing.
Emotional Changes: Mood swings, depression, anxiety and emotional instability are common in individuals with MS, likely influenced by the physical and psychological impact of the disease.
Bladder and Bowel Dysfunction: MS can disrupt the normal function of the urinary and gastrointestinal systems, resulting in issues such as urinary urgency, frequency, incontinence, constipation or diarrhoea.
Pain and Spasms: MS-related pain can manifest as chronic pain in various parts of the body, while muscle spasms can cause discomfort and involuntary muscle contractions.
Heat Sensitivity: Many individuals with MS experience worsened symptoms when exposed to heat, such as hot weather, hot baths, or fever. This sensitivity is known as Uhthoff’s phenomenon.
Walking Difficulties: Gait abnormalities, problems with balance and coordination issues can significantly impact mobility and walking abilities.
MS can exhibit various patterns of disease progression. Here are four common patterns:
Relapsing-Remitting MS (RRMS): This is the most common pattern, affecting approximately 85% of people with MS at the time of diagnosis. In RRMS individuals experience distinct relapses or exacerbations characterised by new or worsening symptoms that can last for days or weeks. These relapses are followed by periods of remission, during which the symptoms partially or completely resolve.
Secondary Progressive MS (SPMS): Many individuals with RRMS eventually transition to SPMS. In this pattern, the disease progresses more steadily, with a gradual worsening of symptoms and disability over time, even without distinct relapses. However, individuals may still experience intermittent relapses or acute exacerbations during this phase.
Primary Progressive MS (PPMS): Approximately 10-15% of people with MS are diagnosed with PPMS. Unlike RRMS, PPMS does not have distinct relapses and remissions. Instead, individuals experience a steady progression of symptoms and disability from the onset of the disease. Symptoms may fluctuate, but there are no prolonged periods of remission.
Progressive-Relapsing MS (PRMS): This is the least common pattern, affecting around 5% of people with MS. PRMS is characterised by a steady progression of symptoms from the onset, similar to PPMS. However, individuals also experience occasional relapses or acute exacerbations.
It is important to note that these patterns are not definitive categories and individuals may experience a combination or variation of these patterns throughout the course of their disease. Furthermore, treatment and management strategies may differ depending on the specific pattern and individual circumstances.
Treatment approaches may include:
Disease-modifying therapies: These medications aim to reduce the frequency and severity of MS relapses, slow down disease progression and limit the development of new lesions in the central nervous system.
Symptomatic treatments: These therapies target specific symptoms associated with MS, such as muscle spasms, fatigue, pain, bladder or bowel dysfunction and cognitive impairment. Medications, physical therapy, occupational therapy and assistive devices may be used to manage these symptoms.
Rehabilitation therapies: Physical therapy, occupational therapy and speech therapy can help individuals with MS maintain or regain their functional abilities, manage mobility issues and improve overall physical and cognitive function.
Supportive care: MS patients may benefit from psychological support, counselling and education to cope with the emotional and psychological impact of the disease. Support groups and resources can also provide valuable information and a sense of community.
Diagnostic Investigation using Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool and plays a crucial role in diagnosing MS by detecting areas of inflammation, demyelination and lesions in the central nervous system.
While there is currently no cure for MS, disease-modifying therapies can help reduce relapse rates, slow disease progression and manage symptoms. Supportive care, rehabilitation therapies and lifestyle modifications also play a crucial role in managing the condition. Consulting with healthcare professionals who specialise in MS can provide a better understanding of an individual’s specific symptoms and management strategies.
