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Multiple sclerosis - symptoms, diagnosis, treatment

 
Multiple sclerosis (often referred to as 'MS') is a disease of the central nervous system that affects movement, sensation and body functions. 

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

Brain scan 1Multiple sclerosis is an autoimmune disease, where the body’s immune system attacks its own tissues. In multiple sclerosis the autoimmune response damages the myelin sheath that insulates nerve fibres in the brain and spinal cord (central nervous system). The reason that this autoimmune response occurs is unknown. 

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: 

Signs and symptoms

The condition is generally characterised by episodes (attacks or flares) of symptoms that may last for weeks or months and then periods where symptoms diminish or disappear (remissions). 
 
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
  • Paralysis.

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.   
More than 50% of people with multiple sclerosis 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 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

Because the symptoms of multiple sclerosis 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 multiple sclerosis. The nature and distribution of symptoms in the body is also important. If multiple sclerosis is suspected, a referral to a neurologist (a doctor who specialises in the nervous system) will be recommended. 
 
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.

Treatment

Currently there is no cure for the disease but much can be done to help manage symptoms. Treatment will vary depending on the severity of symptoms experienced, and may change over time as the disease progresses.
 
Treatments for attacks
 
Medications such as muscle relaxants (eg: baclofen) can help relieve muscle spasms. For acute attacks, corticosteroid drugs (eg: prednisone, methylprednisolone) may be prescribed to help reduce the severity and duration of the attack. 

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
 
Medications that modify the progression of multiple sclerosis and reduce the number and severity of attacks are known as disease-modifying drugs. A number of these drugs are currently approved for funding by the Government's drug purchasing agency.

Exercise and lifestyle
 
Exercise 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.
 
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 provides support, information, and advocacy for multiple sclerosis sufferers, as well as their family and friends. 
 
Multiple Sclerosis New Zealand 
Freephone: 0800 MS LINE or 0800 675 463
Website: www.msnz.org.nz 
 
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.

References

Alla S, et al. The increasing prevalence of multiple sclerosis in New Zealand. Neuroepidemiology. 2014;42(3):154-60. 
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. 
 
 
Last reviewed — July 2020
 
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