What is MS?

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What is MS?

What Causes MS?

Symptoms of MS?

Diagnosis of MS?

What is MS?

Multiple Sclerosis is one of the most common diseases of the central nervous system (brain and spinal cord). MS is an inflammatory demyelinating condition. Myelin is a fatty material that insulates nerves, acting much like the covering of an electric wire and allowing the nerve to transmit its impulses rapidly. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid and co-ordinated movements to be performed with little conscious effort. In Multiple Sclerosis, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in Multiple Sclerosis these scars appear at different times and in different areas of the brain and spinal cord - the term Multiple Sclerosis meaning, literally, many scars.

What causes MS?

The exact cause of Multiple Sclerosis (MS) is unknown. While many theories have been proposed, most researchers believe that MS is caused by a combination of genetic and environmental factors. Thousands of researchers all over the world are meticulously trying to put the pieces of this complicated puzzle together.
The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors. One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defence mechanisms ( i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.

What are the Symptoms of MS?

Symptoms of MS vary greatly. They may include tingling sensations, numbness, slurred speech, dizziness, blurred or double vision, muscle weakness, poor coordination, tremor, unusual fatigue, muscle tightness or spasticity, problems with bladder, bowel or sexual function, and paralysis. Occasionally, there may be mental changes such as forgetfulness or confusion, and, rarely, people have seizures. These symptoms may occur in any combination, may come and go, and may vary from very mild to very severe.

Diagnosing MS

Early MS may present itself as a history of vague symptoms which may have subsided and many of the signs could be attributed to a number of medical conditions. Therefore, a period of time may elapse and a prolonged diagnostic process may be involved before MS is suggested. On the other hand, a possible diagnosis of MS may be more clearcut with classic
symptoms (e.g. optic neuritis) and a distinct chronology of attacks. The neurologist requires
evidence that the types of neurological deficits indicate involvement of at least two different areas of the central nervous system with effects occurring at two separate times.

Multiple Sclerosis is essentially a clinical diagnosis and there are no tests which are specific for the condition and no single test is 100% conclusive. Therefore several tests and procedures are needed to establish a diagnosis of MS and they include the following investigations:

Medical History
The physician will ask for a medical history which will include your past record of signs and symptoms as well as the current status of your health. The type of symptoms, their onset and pattern may suggest MS, but a full physical examination and medical tests will be needed to confirm the diagnosis.

Neurological Examination
The neurologist is testing for abnormalities in nerve pathways. Some of the more common neurologic signs involve changes in eye movements, limb co-ordination, weakness, balance, sensation, speech, and reflexes. However, this examination cannot conclude what is causing the abnormality and so other possible causes of illness which produce similar symptoms to MS must be eliminated.

Testing of Visual and Auditory Evoked Potentials
When demyelination (scarring) occurs the conduction of messages along the nerves may be slowed. Evoked potentials measure the time taken for the brain to receive and intepret messages (nerve conduction velocity). This is done by placing small electrodes on the head which monitor brain waves in response to visual and auditory (hearing) stimuli. Normally, the brain's reaction to such stimuli is almost instantaneous, but if there is demyelination in the central nervous system a delay may occur. This test is not invasive or painful and therefore does not require a stay in hospital.

Magnetic Resonance Imaging (MRI)
The MRI scanner is a more recent diagnostic test and takes very detailed pictures of the brain and spinal cord, showing any existing areas of sclerosis (lesions or plaques). Whilst this is the only test in which the lesions of Multiple Sclerosis can be seen, it cannot be regarded as conclusive, particularly as not all lesions may be picked up by the scanner and because many other conditions can produce identical abnormalities. The MRI clearly shows the size, quantity and distribution of lesions, and together with supporting evidence from medical history and neurologic examination, is very significant indicator toward confirming the diagnosis of MS The MRI is also a very useful tool in clinical trials in assessing the value of new therapies by its ability to measure disease activity in the brain and spinal cord.

Lumbar Puncture
In this test, cerebrospinal fluid (the fluid which flows around the brain and spinal cord) is tested for the presence of antibodies. Antibodies can occur with MS but they can also occur with other neurological conditions. The fluid is taken from the spinal cord by inserting a needle into the back and withdrawing a small amount of fluid. A local anaesthetic is given to numb the skin, and therefore whilst it is uncomfortable it is not usually painful. This test does require the person to lay flat for a number of hours after the test, and may require an overnight stay in hospital. Subsequently for some, a short period of recuperation may be required. This test may indicate MS but is not in itself conclusive.

The diagnosis of MS is not always clear cut. The initial symptoms may be transitory and vague and confusing to both the person and their doctor. Invisible or subjective symptoms are often difficult to communicate to doctors and health professionals and sometimes people are at first dismissed as being neurotic or a hypochondriac.

Following an episode for which you have sought medical advice, your doctor may not have told you that MS is suspected. This delay may be very reasonable because the neurologist may wish to witness at least two distinct episodes with symptoms that are separated by at least a month and persisting for at least 24 hours.

A good relationship with your neurologist and family physician is essential. MS may have times of crisis and acute episodes which require specialist medical attention, but it is a disease that must be lived and managed every day. The time of diagnosis is stressful not only for the person with MS but for the family and carers who should also be fully informed as to the diagnosis, prognosis, treatment, management considerations and lifestyle adjustments associated with MS. The family physician and the local MS Society are important ongoing resources for care and information for those affected by MS.

The diagnosis of MS is a shock and often stereotypes of wheelchairs and disability tend to dominate one's thoughts. Nevertheless, it is most important to realize that many people with MS and their carers have recognized that it is still possible to live life to the full, taking into account any limitations caused by the illness. Thus, it is often unnecessary to give up work, education and social activities. Many people with MS can lead productive, fulfilling and relatively normal lives.

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