What is multiple sclerosis and how is it treated?
What is multiple sclerosis?
Multiple sclerosis affects approximately 85,000 people in the UK and is usually diagnosed when people are in their late 20s or early 30s. It affects more women than men and is more common in temperate, northern European countries than in hotter places.
Despite its disabling effects, MS does not usually have any significant impact on life expectancy.
The symptoms vary greatly from one patient to another. They may start with numbness, tingling or muscle weakness, and later affect many bodily functions, causing one or more of the following:
- Blurred or double vision
- Loss of balance and coordination
- Movement problems
- Speech difficulties
- Overwhelming fatigue
- Loss of bladder and/or bowel control
- Loss of sexual function
- Increased sensitivity to heat
- Psychological problems such as confusion and forgetfulness.
Dealing with such a disabling condition makes some people anxious and depressed.
The early symptoms of multiple sclerosis may be vague and perhaps last only a few days, so that it can often take some time to make a firm diagnosis.
A specialist will take a detailed medical history to help identify previous symptoms and will carry out a number of neurological tests, including a magnetic resonance imaging (MRI) scan to look for inflammation and damaged nerves.
Multiple sclerosis will only usually be diagnosed after a person has experienced two or more episodes of the symptoms associated with the condition and if evidence of nerve damage shows up on an MRI scan.
Read more: Learn how to overcome anxiety
Types of multiple sclerosis
Benign multiple sclerosis
People with benign multiple sclerosis have a small number of mild attacks, but are not permanently disabled. This type accounts for about 20 per cent of cases.
Relapsing remitting multiple sclerosis
People with relapsing remitting multiple sclerosis suffer attacks that last at least 24–48 hours and are then followed by complete or partial recovery over a few weeks.
The attacks recur but do not grow worse each time. Relapsing remitting multiple sclerosis accounts for about 25 per cent of cases.
Primary progressive multiple sclerosis
In people with primary progressive multiple sclerosis, the symptoms and disability grow progressively worse. The sufferers occasionally reach a plateau on which symptoms and disability no longer worsen but they have no chance of permanent recovery. Primary progressive multiple sclerosis accounts for about 15 per cent of cases.
Secondary progressive multiple sclerosis
The fourth type, secondary progressive multiple sclerosis, at first produces intermittent attacks that do not grow worse (similar to relapsing remitting multiple sclerosis).
But after the initial period, the attacks become more serious. People with secondary progressive disease occasionally enjoy periods of remission in which symptoms ease, but these are few. This type accounts for about 40 per cent of cases.
Living with multiple sclerosis
The key to living as full a life as possible with multiple sclerosis is learning to manage your symptoms. Your GP can offer advice on drugs and help you choose the right combination of medical, nursing and other services.
Being diagnosed with multiple sclerosis can have a heavy emotional impact. Many people feel frustrated or angry as they come to terms with any necessary changes. Psychological therapy and counselling may help. You should try to keep as active as possible – it is important to maintain the function of your nerves and muscles.
- If you can, take exercise and carry on your normal work routine. Discuss this matter with your GP.
- If you are suffering from fatigue, physiotherapy and occupational therapies can help to improve your movement and make everyday activities easier. A physiotherapist will devise appropriate exercises to help you to strengthen and relax your muscles.
- An occupational therapist will advise you on planning your daily routine: you may need to set aside periods of rest or arrange for help with some activities. These therapies will also help you to deal with stiffness and spasms.
- Some people with multiple sclerosis find water exercises (aquatic therapy) helpful.
- Speech therapy will help if you have trouble speaking.
- If you are finding it difficult to eat well, seek advice from a dietitian specializing in multiple sclerosis.
- Small studies have shown that a diet high in polyunsaturated fats (such as those found in sunflower margarine, vegetable oils and fish oils) may help to prevent the progression of multiple sclerosis. The benefits of other supplements are unproven.
The Multiple Sclerosis Society runs short courses on managing your symptoms that cover advice on diet and appropriate exercise, techniques to combat frustration and depression and advice on managing fatigue and pain.
Some people find complementary therapies such as aromatherapy, relaxation techniques and massage helpful. Others advocate cannabis to relieve pain and muscle spasms that do not respond to other therapies, but the drug is not legally available in the UK. Studies are currently being undertaken to investigate further the medical benefits of cannabis use, and it is possible that a licensed cannabis drug may soon be available to people with multiple sclerosis.
Read more: Does cannabis really work as a medicine?
Treatment of multiple sclerosis
A series of studies showed that the drug beta interferon could slow down the progression of some forms of MS, notably relapsing-remitting and secondary progressive disease. The studies suggested that beta interferon reduced the incidence of relapses by about one-third and delayed the progression of the disease and any associated disability.
Exactly how beta interferon works remains unclear. It appears to inhibit the activity of T-lymphocytes – white blood cells whose normal function is to fight infection but which in multiple sclerosis sufferers seem to trigger inflammatory reactions around the myelin sheaths of the nerve fibres in the central nervous system.
Further studies of multiple sclerosis sufferers have revealed that a second drug, glatiramer acetate, can also reduce the incidence of relapses as well as delaying the progression of disability by working to limit the activity of T-lymphocytes.
Both beta interferon and glatiramer acetate are expensive to prescribe. Also, although treatment with these drugs is effective in some cases, others fail to respond to them. In October 2001, the NHS's advisory body, the National Institute for Clinical Excellence, decided that the drugs should not be prescribed on the NHS because of uncertainty over their long-term cost-effectiveness.
However, the four UK health departments subsequently agreed with the drug manufacturers to start a national 'prescribe and monitor' scheme to provide the drugs at prices which will vary according to their long-term results.
The Association of British Neurologists has produced guidelines for prescription. Patients with relapsing-remitting MS are considered for treatment if they can walk independently and have had two attacks in the past three years. Some people with secondary progressive MS are also considered if they are still experiencing relapses.
A recent study in Denmark has suggested that a cannabis extract (dronabil) can reduce pain and give a better quality of life for MS patients.
Multiple Sclerosis Society
MS National Centre, 372 Edgware Road, Cricklewood, London NW2 6ND
Helpline 0808 800 8000
Multiple Sclerosis Trust
Spirella Building,Bridge Road, Letchworth, Herts SG6 4ET
Helpline 01462 476700
Multiple Sclerosis Resource Centre
Helpline 0800 783 0518
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