Understanding Multiple Sclerosis
by Dr John Rees
This month Dr Rees gives us a greater understanding of Multiple Sclerosis, the most common neurological disease causing disability in young people.
Multiple Sclerosis (MS), is the most common neurological disease causing disability in young people. The UK incidence is about 1:1000 and is slightly more common in Scotland, it is more common in women than men, clearly runs in families and typically starts between the ages of 20 and 30. The precise cause is unknown but there is a very strong auto immune basis. It is more common further away from the equator and there is a very definite genetic influence (general incidence 1:1000 but 1:3 in identical twins).
It is part of a group of disorders called demyelinating diseases where the primary event is a breakdown of the fatty, insulating covering of nerves in the brain and spinal cord known as myelin. This seems to be due to the body’s immune system inappropriately attacking the myelin causing demyelination. The patient is only aware of this when they notice that vision, sensation, balance, muscle strength or bladder control is affected, and these symptoms relate to where the demyelination has occurred in the nervous system. Attacks (or relapses as they are called), tend to develop gradually over a few days, last for a few weeks or occasionally longer and then recover, although some are left with some residual disability. Many patients notice that they become temporarily worse if they exercise, develop an acute illness or are exposed to increased temperature e.g. a hot bath.
The commonest form of MS is called Relapse/ Remitting MS. This means that patients have intermittent attacks between which they may be perfectly normal or stable, if they already have a disability from previous attacks. After many years relapses cease and a gradually progressive form takes over.
The next commonest is Primary Progressive disease where the patient gradually becomes a little worse over years, typically with regard to walking. There is a very small group with Benign MS, with little if any progression, over many decades. Most patients can continue work or home life. Life expectancy overall is only a few years less than the general population, but most patients develop some disability varying from mild to severe. Only about 30% of patients need a wheelchair.
Before the advent of Magnetic Resonance (MR) scanning, diagnosis was largely on a clinical basis, now it is a combination of the clinical picture and particular MR abnormalities.
Effective treatment for MS is relatively recent and employs drugs that modify the body’s immune system. They are new, expensive and require detailed supervision since there are many, sometimes serious side effects.
However, these drugs are very effective and can reduce relapse rates by 30-50 % and recently for the first time, one of these drugs has been shown to halt deterioration in the progressive form. The recent success with stem cell transplant is very exciting but more research is required. Other drugs help with stiffness of muscles (spasticity), bladder and other symptoms that may be troublesome.
Physio and occupational therapy are frequently a major part of treatment.
Neurological departments have consultants with special expertise in MS to supervise patients, especially those who are on the immune modifying drugs. They are supported by a team of specialist MS nurses who are trained to deal with the practicalities of drug management and any other problems that may arise.
The national MS Society and its local branches are a beacon for MS patients for their various needs and a major contributor to the extensive research programme into the disease.