Symptoms vary considerably in nature and severity, making the condition difficult to diagnose in some cases. There is no cure but treatment can be effective in managing symptoms.
Multiple sclerosis is more common in New Zealand than many other countries. It is estimated that there are between 50 and 150 cases per 100,000 New Zealanders, with the higher incidence rates in southern regions of the country.
Causes and risk factors
As well as protecting the nerves, the myelin sheath helps carry electronic signals or messages from the brain along the nerves. Multiple sclerosis causes the myelin sheath to become scarred (sclerosis) delaying or blocking signals from the brain, and 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, Pacific Island and Asian people is particularly low.
The disease is more common the further away from the equator one lives (thought to be related to sun exposure and levels of naturally produced vitamin D). Therefore, the incidence of multiple sclerosis is higher in southernmost countries such as New Zealand (especially regions of the South Island) and northernmost countries such as Scotland and Canada.
Other factors that may increase the risk of developing multiple sclerosis include:
- Genetics (family history)
- Environmental factors (including geographical location or climate)
- Certain viral infections, including the Epstein-Barr virus, which causes glandular fever
- Certain autoimmune diseases, including psoriasis, type 1 diabetes, Crohn’s disease, and ulcerative colitis.
Signs and symptoms
Multiple sclerosis has a wide variety of symptoms due to the diverse ways it can affect the central nervous system. Initial symptoms of multiple sclerosis 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
There is no "typical" multiple sclerosis but symptoms tend to occur in one of four patterns.
- Relapsing-remitting multiple sclerosis: 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 multiple sclerosis: Symptoms and disability gradually worsen over time without relapses or remissions.
- Secondary progressive multiple sclerosis: After initially following the relapsing-remitting pattern, the symptoms and disability steadily progress over a period of several years.
- Progressive relapsing multiple sclerosis: Gradual progression of disability from the onset of the disease that is accompanied by occasional relapses and partial recovery.
Numbness and weakness in one or more limbs (usually on one side of the body at a time) and twitching of facial muscles are also common.
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.
Diagnosis may involve blood tests, magnetic resonance imaging (MRI), computerised tomography scan (CT scan), and lumber puncture (to check the levels of immune cells and proteins in the fluid surrounding the spinal cord and brain, cerebrospinal fluid or CSF). Less commonly, tests to measure electrical conduction through the nerves of the central nervous system may be done.
Treatments for attacks
Plasma exchange (plasmapheresis) may be used for severe attacks if use of corticosteroids is not possible or has not helped to control attacks. Plasma exchange involves the liquid part of the blood (plasma) being removed and separated from the blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into the body.
Treatments for disease progression
Exercise and lifestyle
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 multiple sclerosis.
Counselling and support from family and friends will help deal with the depression, anxiety, and lifestyle limitations that come with having multiple sclerosis.
Support and information
Multiple Sclerosis New Zealand
Freephone: 0800 MS LINE or 0800 675 463
Most major towns in New Zealand have a Multiple Sclerosis Society New Zealand office. Please refer to the white pages of the local telephone book or search online for contact details.
Luzzio, C. (2020). Multiple Sclerosis (Web Page). Medscape Reference: Drugs, Diseases & Procedures. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/1146199-overview [Accessed: 29/06/20]
Mayo Clinic (2020). Multiple sclerosis (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269 [Accessed: 29/06/20]
O'Toole, MT. (Ed.) (2017). Multiple sclerosis (MS). Mosby's Dictionary of Medicine, Nursing & Health Professionals. (10th ed.). St. Louis, MI: Elsevier.