Multiple sclerosis - what you need to know

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BPHGRW Man suffering from Parkinson's disease and multiple sclerosis standing near steps

Multiple sclerosis is a neurological condition which causes problems with muscle movement, balance and vision – and for which there is currently no known cure. Affecting around 100,000 people in the UK, the illness is usually diagnosed between the ages of 20 and 40 – but affects older and younger people too. The ratio of women to men affected its roughly 3:1.
Causes and risk factors
An autoimmune condition, MS does not have a precisely identified origin – but it is known that it causes the body to attack its own myelin. This is a substance which helps nerves carry messages through the body.

Genetics are thought to play a strong part in development of MS – with some individuals more susceptible to it if they possess a certain combination of genes. However it is nor directly inherited and is actually unlikely to occur more than once in the same family. The illness is more common away from the equator – and it has been theorised that a lack of Vitamin D could be a trigger. Smoking and childhood viral infections by the likes of the Epstein-Barr virus are also thought to be contributing or correlating factors.

Symptoms
As MS causes the body to attack the myelin in the central nervous system, symptoms can appear in any part of the body. Common symptoms include severe tiredness, numbness, tingling and blurred vision.
Problems with mobility and balance are also often encountered, along with muscle weakness or tight-feeling muscles.Some sufferers have symptoms which get progressively worse over time, while in other cases they come and go.

The first noticeable problem is often a deterioration of the vision in one eye – which can be mild or severe. Colour blindness, eye pain and flashes of light when moving are also all associated with the illness. Muscle spasms and spasticity can also result from the signals between brain and nerves being disrupted. And around 50 per cent of sufferers experience pain – either directly as a result of nerve damage or as a side effect of muscle tightness or spasticity. A similar number of sufferers have problems with thinking, planning or learning as a result of the illness. And the illness can also cause depression, anxiety, sexual issues, bladder or bowel problems and problems with speech and swallowing.

Types of MS
Relapsing remitting MS is by far the most common variety of the illness, affecting eight out of 10 sufferers. Relapses (flare-ups) of the illness last for limited period, from a few days to a few months – but are followed by long periods where the symptoms subside. Secondary progressive MS usually affects sufferers of relapsing remitting MS after 15 years or more. It sees symptoms getting worse over time, without full recovery. The rarest form of the illness is primary progressive MS – which just sees symptoms gradually getting worse with no remission.

Diagnosis
The first step will probably be seeing your GP, who is likely to refer you to a neurologist if he or she suspects you have MS. Because there is no single test which can provide positive confirmation of the illness, doctors usually attempt to rule out other conditions with similar symptoms first. Just one "attack" is not sufficient for a diagnosis – there need to have been at least two instances.

A neurological examination will be carried out, looking for signs of the illness in eye movements, co-ordination, balance and reflexes. This could be followed by an MRI scan looking for evidence of scarring or damage to myelin in the nervous system. If other tests prove inconclusive then a lumbar puncture (spinal tap) may be carried out in an attempt to get a more firm diagnosis.

Treatment
Although not curable, the illness can be treated and symptoms alleviated – with attempts being made to reduce the number of relapses. Heavy duty steroids are administered if it is thought that a relapse of the illness is beginning. This is thought to stop the body's immune system attack its own myelin.
A variety of disease-modifying drugs (DMDs) are also prescribed to patients, hopefully reducing the likelihood of more relapses. Specific medications and treatment are provided for the individual symptoms which come with the illness.

For vision problems that may mean gabapentin, baclofen or clonazepam, while the first two drugs may also be prescribed for muscle spasms- along with tizanidine, diazepam, clonazepam or dantrolene.
Neuropathic pain might be treated with gabapentin or carbamazepine - or with an antidepressant called amitriptyline which has been found to be effective in eliminating nerve pain.

Physiotherapy, painkillers and anti-depressants can also be prescribed for those suffering from chronic pain as a result of muscle problems. If suffering from mobility problems, patients may undergo physiotherapy or be advised to carry out stretching exercises. Botulinum toxin (yes, botox) can also be administered to help de-constrict muscles.

Prognosis
The average life expectancy for MS sufferers is only five or 10 years lower than that of the general population, and big advances have been made in the treatment of the illness in recent decades – resulting in a better quality of life for those living with it.

For more detailed information check out the excellent resources at NHS Choices and the Multiple Sclerosis Society UK.

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