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Multiple sclerosis - symptoms, diagnosis, treatment

 
Multiple sclerosis (often referred to as 'MS') is a progressive 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 - a phenomenon that may be due to New Zealand's geographical location, a long way from the equator.  The proportion of New Zealanders that have multiple sclerosis has been estimated at between 50 and 150 cases per 100,000 people (with the higher incidence rates in southern regions of the country).

Causes and risk factors

Multiple sclerosis is an autoimmune disease, where the body’s immune system attacks its own tissues. In multiple sclerosis 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. 
 
Brain scan 1
As well as protecting the nerves, the myelin sheath assists the conduction of electronic signals or messages from the brain along the nerves. With multiple sclerosis, 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 (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.
 

Factors that may influence the development of MS include: 

  • Genetics
  • Environmental factors
  • Viruses.

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).  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.
 
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.
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 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 of the face are also common.

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.
 
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.

Treatment

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 multiple sclerosis is unpredictable, ongoing monitoring of the condition is required. Changes in needs and disability may require treatment changes.
 
Physical and occupational therapy
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.
 
Counselling/Social Support
This will help deal with the depression, anxiety and lifestyle limitations that come with having multiple sclerosis.
 
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 multiple sclerosis.
 
Alternative treatments
Some people report that acupuncture, meditation, yoga, massage, herbal therapy and naturopathy have been beneficial for them.
 
Medications
Medications such as muscle relaxants can help relieve muscle spasms. For acute attacks, corticosteroid drugs may be prescribed to help reduce the severity and duration of the attack.  Medications that modify the progression of multiple sclerosis and reduce the number and severity of attacks are known as disease modifying drugs.  The disease-modifying drugs that are currently approved for funding by the Government's drug purchasing agency Pharmac include interferon beta-1b (Betaferon), interferon beta-1a (Avonex), glatiramer acetate (Copaxone), fingolimod (Gilenya), natalizumab (Tysabri), dimethyl fumarate (Tecfidera) and teriflunomide (Aubagio).

Support and information

The Multiple Sclerosis Society of New Zealand provides support, information and advocacy to multiple sclerosis sufferers, as well as their family and friends.
 
Multiple Sclerosis Society of New Zealand
Freephone: 0800 MS LINE or 0800 675 463
E-mail: info@msnz.org.nz
Website: www.msnz.org.nz
 
Most major towns in New Zealand have an office of the Multiple Sclerosis Society.  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. (2017). Multiple Sclerosis (Web Page). Medscape Reference: Drugs, Diseases & Procedures. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/1146199-overview [Accessed: 13/07/17]
Mayo Clinic (2017). Multiple sclerosis (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/home/ovc-20131882 [Accessed: 13/07/17]
O'Toole, MT. (Ed.) (2013). Multiple sclerosis (MS). Mosby's Dictionary of Medicine, Nursing & Health Professionals. (9th ed.). St. Louis, MI: Elsevier Mosby.
 
Last reviewed – July 2017
 

 

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