Multiple Sclerosis
Multiple sclerosis (MS) is a disease of the central nervous system that affects movement, sensation and body functions. Its symptoms can range from mild and intermittent to severe, constant and disabling.
It is estimated that MS affects approximately 4000 New Zealanders – that is one in every 1000 people. People may inherit a susceptibility to the disease. About 10% of people with MS also have a near relative with the disease.
MS is an autoimmune disease, where the body’s immune system attacks its own tissues. In MS the autoimmune response destroys the myelin sheath that insulates nerve fibres in the brain and spinal cord. The reason that this autoimmune response occurs is unknown.
As well as protecting the nerves, the myelin sheath assists the passage of messages from the brain along the nerves. With MS, the myelin sheath becomes scarred (sclerosis) causing the messages from the brain to become slowed or blocked, producing the symptoms characteristic of the condition.
Symptoms usually appear for the first time between the ages of 20 and 40 years. Diagnosis before the age of 15 years is rare and the disease seldom appears for the first time after the age of 50 years.
Women and people of European descent are more susceptible. Incidence among Maori, PacificIsland and Asian people is very low.
Generally the disease becomes more common the further away from the equator one moves. Therefore, the incidence of MS is higher in regions such as the South Island of New Zealand, Scotland and Canada.
Factors that may influence the development of MS include:
- Genetics
- Environmental factors
- Viruses
The condition is generally characterised by episodes (attacks) of symptoms that may last for weeks or months and then periods where symptoms diminish or disappear (remissions).
There is no "typical" MS but symptoms tend to occur in one of three patterns.
Relapsing-Remitting MS:
Clearly defined symptomatic attacks are followed by complete, or almost complete, improvement. The time frame between attacks may be a year or more. There may be no ongoing disability
Primary Progressive MS:
The disease progresses without remission and symptoms and disability gradually worsen.
Secondary Progressive MS:
After initially following the Relapsing-Remitting pattern, the symptoms and disability steadily progress over a period of several years.
MS has a wide variety of symptoms due to the different ways it can affect the central nervous system. Initial symptoms of MS include vague, non-specific feelings of weakness, fatigue and clumsiness.
The most common general symptoms include:
- Movement, balance and co-ordination problems
- Vision problems such as blurred or double vision
- Problems with bladder or bowel control
- Lack of energy
- Extreme fatigue
- Speech difficulties such as slurred speech
- Lack of concentration and impaired short-term memory
- Mood changes and depression
- Extreme weakness
- Shaking of the hands
- Paralysis.
Symptoms may become more prominent when the body temperature is increased eg: by a hot bath, a fever, being in the sun or by a stressful situation.
More than 50% of people with MS experience pain during the course of the disease and some experience chronic (long term) pain. The pain may be a sharp and stabbing in nature and commonly affects the face, neck or back. Numbness and weakness of the face are also common.
Because the symptoms of MS are so varied the condition may be difficult to diagnose in the initial stages. However, the sequence of an attack, remission and another attack suggests MS. The nature and distribution of symptoms in the body is also important.
If MS is suspected, a referral to a neurologist (a doctor who specialises in the nervous system) will be recommended.
Tests to aid in diagnosis may include blood tests, magnetic resonance imaging (MRI), computerised tomography scan (CT scan) and lumber puncture (to check the concentration of immune cells and proteins in the fluid surrounding the spinal cord and brain). Less commonly, tests to measure electrical conduction through the nerves of the central nervous system may be conducted.
Currently there is no cure for the disease but much can be done to help manage symptoms. Treatment will vary depending on the symptoms experienced.
As the course of MS is unpredictable, ongoing monitoring of the condition is required. Changes in needs and disability may require treatment changes.
Physiotherapy
Exercises programmes can help maintain muscle flexibility, reduce muscle stiffness and aid recovery from attacks. Aids to assist with mobility and daily activity can help maintain independence.
Counselling/Social Support
This will help the person deal with the depression, anxiety and limitations that come with having MS.
Lifestyle Factors
Maintaining a healthy body weight and eating a balanced nutritious diet promotes overall wellbeing. Balancing adequate rest with regular activity and managing stress are also important for people with MS.
Alternative treatments
Some people report that acupuncture, massage, herbal therapy and naturopathy have been beneficial for them.
Medications
Medications such as muscle relaxants can help relieve muscle spasms. For severe attacks, corticosteroid drugs may be prescribed to help reduce the severity and duration of the attack.
Some medications to help suppress the immune response and prevent attacks are available. They are given by injection and include Beta Interferon and Copaxone. They have limited availability in New Zealand due to their expense.
The MS Society of New Zealand provides support, information and advocacy to MS sufferers, as well as their family and friends.
Multiple Sclerosis Society of New Zealand (Inc)
P. O. Box 2627
Wellington
Ph: (04) 499 4677
Fax: (04) 499 4675
Freephone: 0800 MS LINE / 0800 675 463
Website: www.msnz.org.nz
Most major towns in New Zealand have an office of the MS Society. Please refer to the white pages of the local telephone book for contact details.
Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company
Brodsky, R. (2006) Multiple Sclerosis. The Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale.
Multiple Sclerosis Society of New Zealand Inc (2007) The Facts about Multiple Sclerosis. Pamphlet. Multiple Sclerosis Society of New Zealand Inc. Wellington.
Last Reviewed – 28/08/07