In a healthy body, nerves are insulated by a sheath of protective material known as myelin. This protective sheath allows for nerve impulses to flow freely between the body and the brain. Multiple sclerosis is a potentially debilitating disease that results from the immune system attacking the myelin sheaths around nerves, causing them to deteriorate, interfering with the transmission of nerve signals between the brain and body. Once the myelin sheath has been broken down, the disease can cause permanent damage to the nerves themselves, further impacting normal nerve function. Damage to the nerves causes swelling, lesions or scarring in the brain.
According to MS Research Australia , there are 25,600 people in Australia living with MS and it is far more common in women than men, with three quarters of all cases in Australia affecting women. The average age of diagnosis is between 20 and 40, however multiple sclerosis can affect people of any age. MS is the most common acquired chronic neurological disease in young people.
Symptoms of Multiple Sclerosis
One of the major difficulties with multiple sclerosis is that every case presents and progresses differently. There are common symptoms, but they do not necessarily appear in all cases or with the same progression of symptoms. Often, patients initially present with mixed, non specific symptoms that resolve after a period of time. These periods of symptoms are often termed “attacks” and their features help in the classification of the disease in its early stages. This may assist doctors in developing a treatment plan for your symptoms.
Common symptoms may include:
- Numbness or weakness - This can occur in one or more limbs, typically on one side of the body. The numbness can also affect the legs or trunk.
- Lhermitte’s sign - An electric shock sensation related to movement of the neck. The sensation is especially associated with bending the neck forwards.
- Tremors, unsteady gait, lack of coordination - Physical symptoms such as these that present early after diagnosis tend to indicate a more progressive for of the disease.
- Spasticity and spasms - Spasms cause muscles to stiffen randomly, causing a rapid jerky motion, such as kicking out a leg or flexing and arm. Spasticity refers to stiffness, tension and heaviness in muscles making them hard to move.
- Vision Problems - Partial or complete loss of vision, blurred vision or prolonged double vision. This can be a temporary effect or permanent damage depending on the progression of the disease.
- Speech issues - Neurological damage can lead to difficulty controlling the mouth, but speech difficulties can also be cause by lesions causing memory loss or difficulty forming sentences.
- Fatigue - General fatigue caused by MS can seriously affect your ability to work. The fatigue may also present or be exacerbated by heat sensitivity.
- Difficulty swallowing - Around 50% of people with MS develop difficulty swallowing at some time during the progression of the disease.
- Heat Sensitivity - Many people with MS find that their symptoms are worse when they are hot. The exact symptoms that are worsened vary from person to person and the effect is usually temporary, fading once the person cools down.
- Tingling or pain - Tingling sensations on the skin are quite common, as is a deeper , more prolonged pain. This pain can prove to be quite debilitating.
- Problems with bowel and bladder function - Incontinence is the most common symptom for people living with MS, but other bladder and bowel control issues can occur.
- Depression - Around 50% of people living with MS experience depressive episodes, making them three times more likely to experience depression that the general public. It remains unclear if depression can be a result of neurological damage caused by MS, or as a result of living with the disease, however it is likely that a combination of both exist.
While some of the symptoms can be very serious, people with MS experience nearly the same lifespan as the general public.
Classification of Multiple Sclerosis
Importantly, while symptoms may vary between individuals with the disease, the frequency of attacks and the recovery rate allow the disease to be split into three categories or types.
- Relapsing Remitting (RRMS) - This is the most common form of MS, with 70%-75% of people with MS first presenting with the relapsing remitting form. RMSS is defined by people either partially or fully recovering after an attack.
- Secondary Progressive (SPMS) - A further progression of a relaxing remitting MS course. Within 10 years of diagnosis, 50% of people with relapsing remitting MS will progress to secondary progressive. After 25 years, around 90% of RMSS will progress to SPMS. A progressive form of MS means that the debilitating effects of the disease will steadily become worse over time.
- Primary Progressive (PPMS) - This form of MS is progressive from the outset and accounts for around 15% of diagnosis. Unfortunately, a diagnosis of PPMS can only occur once the disease has progressed to the point that it proves progressive disability and not remitting attacks.
Causes and Risk Factors of Multiple Sclerosis
Multiple sclerosis is classified as an autoimmune disease as it is caused by the body’s own immune system attacking the myelin sheaths around nerve fibres. The exact cause for this is unknown, but there are some suspected risk factors related to the disease that can increase the chances of it developing. These risk factors include:
- Age - MS can occur at any age but it seems to be far more prevalent in people between 16 and 55
- Autoimmune diseases - People with type 1 diabetes, inflammatory bowel disease (IBD) or thyroid disease have a slightly higher chance of developing multiple sclerosis than the general public
- Climate - Multiple Sclerosis is far more common in countries with a temperate climate. Unfortunately this includes Australia and New Zealand. It remains unclear why this temporal association exists.
- Family history - You have a higher chance of developing multiple sclerosis if you have a direct relative (parent or sibling) with the condition.
- Race - Caucasians, especially those of Northern European descent have a much higher chance of developing MS than people of Asian or African descent.
- Sex - Women are much more likely to develop MS than men, especially relapsing remitting subtypes.
- Smoking - While smoking may not be a cause of MS, smokers who have an initial attack of MS symptoms are more likely than non smokers to experience a second event that confirm that they have MS.
- Viral infections - A number of viruses, such as Epstein-Barr (a human herpesvirus responsible for mononucleosis) have been linked to MS.
- Vitamin D deficiency - Low levels of vitamin D due to diet or lack of exposure to sunlight appears to lead to a greater risk of developing MS than the general public
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Treatment for and Living With Multiple Sclerosis
Due to the wide range of symptoms and the different ways that the disease can progress, treatment for multiple sclerosis can vary wildly in terms of specific therapies, however in broad terms treatment is a two part process involving medication and physical therapy, the combination of which is implemented to alleviate individual symptoms and slow the progression of the disease.
Medications are used for both relieving symptoms and for slowing the overall progress of MS , with drugs referred to as “disease modifying therapies” being commonly used. These are medications that work by modifying the body's immune system, decreasing the frequency with which it inappropriately attacks its own cells. Immunosuppressive medications are also used for more severe forms of MS. These types of therapies are common for a range of autoimmune conditions and may be effective in controlling both symptoms and progression.
Steroidal medications are frequently used to reduce the severity of attacks or reduce swelling in affected areas. Other medications may be prescribed for individual symptoms, including muscle relaxants, pain relievers and medications for sexual dysfunction, fatigue, bladder and bowel control, insomnia, depression and more. The exact regimen of medications and their method of administration - pills, injections, IV - will depend on the severity and range of symptoms.
Physical and occupational therapy
Physical and occupational therapy is used to teach exercises to strengthen limbs, regain balance or gait with the end goal being the maintenance of autonomy and normal physical function . These therapies can include training on use of tools or devices intended to optimise fine motor skills and function; the use of mobility aids and training on how to approach tasks in a different way to minimise pain and fatigue.
While medication and physical therapy are the front line treatments for MS, a change in diet and getting regular exercise can help maintain a healthy body and go some way to slowing the progress of the disease. Maintaining a regular exercise regime can strengthen the body, reduce muscle pain and weakness and is generally just good for health. Even if you have limited movement, low impact exercise such as swimming is still an excellent way to maintain health. Always consult a doctor before dieting, however limiting trans fats, saturated fats, highly processed foods, high sugar and high sodium foods is good for overall health.
World Multiple Sclerosis Day
May 30 is World MS Day , and to help spread awareness of the disease, MS Australia is hosting Facebook Live events and free webinars from the 27th May to the 30th. The earlier multiple sclerosis is diagnosed the more more quickly they can be controlled.