Multiple Sclerosis (MS)

multiple sclerosisMultiple Sclerosis (MS) is a complex autoimmune disorder which affects the Central Nervous System, resulting in a range of symptoms including complications with muscle movement, vision, balance and extreme fatigue.

What Is MS?

MS describes a condition in which the body’s own immune system mistakenly attacks the myelin (the insulating coating) covering the nerve fibres in the brain and spinal cord.

The brain and the spinal cord are responsible for the relay of messages from the brain to the rest of the body. Each nerve fibre is covered with a layer of insulating protein called the myelin – this serves to protect the nerves and allow the relay of electrical signals from the brain to the rest of the body, as well as helping to keep infections out.

The attack from the immune system damages the myelin causing inflammation, which often leaves scarring to the myelin sheath once the inflammation has subsided. This scarring is referred to as sclerosis – the disorder is known as multiple sclerosis as it typically occurs in more than one place in the body. MS is also associated with axonal damage; the nerve axon, also known as a nerve fibre, is responsible for carrying electrical impulses away from the nerve’s cell body. The nerve axon plays an integral part in cellular communication; some studies suggest that the progressive nature of MS may be due to the axonal damage caused by the immune mediated attack to the myelin.

Types of MS

Relapsing/Remitting MS

Out of the two types of MS, this type is by far the most commonly diagnosed. Relapsing or remitting MS is characterised by intermittent episodes of either new or worsening symptoms which may last from a few days to up to several months. These are typically followed by periods of remission where there are no symptoms – periods of remission may last up to several years in some individuals. This type of MS is more common in women than in men.

Primary Progressive MS

A small number of those with multiple sclerosis are diagnosed with primary progressive MS. This form of MS is characterised by progressive symptoms which gradually get worse, there are no periods of remission, although the disease often appears to stabilise with no noticeable changes in the condition. This type of MS is often diagnosed in the late 40s to 50s, when people are more likely to have other mobility limitations, making it harder to reach an accurate diagnosis. Equal numbers of men and women are diagnosed with primary progressive MS and approximately half of those diagnosed with relapsing/remitting MS develop secondary progressive MS within 15-20 years.

What Causes MS?

The exact cause of MS is currently unknown, however research suggests that it may be a combination of environmental and genetic factors.

Environmental Factors

A lack of sunlight and vitamin D appear to play a role in the development of MS which has a higher prevalence in the countries of the northern hemisphere, than in regions closer to the equator. It still however remains unclear as to whether vitamin D supplements can help to prevent MS.

Genetic Factors

There is no single gene responsible for MS and it is not directly inherited, however those with a sibling or parent with MS have a higher chance of developing the disorder than those without.

Viral Infection

It has been suggested that certain viral infections are involved in the development of MS, in particular Epstein-Barr virus (EBV), a common virus responsible for glandular fever.

Smoking

Smoking is another factor which appears to increase the risk of MS, those who smoke are more likely to develop the disease.

Who Is Affected By MS?

Relapsing/remitting MS affects approximately 100,000 people in the UK and is typically diagnosed between the ages of 20 and 40, it is 2 to 3 times more likely to occur in women than in men. Contrary to common misconception MS is not terminal or fatal, it is however a lifelong condition which may cause serious disability in extreme cases. The average life expectancy is slightly reduced in those suffering from MS.

Common Symptoms of MS

  • Fatigue
  • Visual Disturbances
  • Mobility problems
  • Bladder problems
  • Cognitive difficulties – issues with thinking, learning and planning
  • Muscle stiffness, spasms (spasticity)
  • Numbness, tingling and abnormal sensations
  • Pain
  • Issues with balance and coordination
  • Mental health problems

Fatigue

Extreme fatigue is often described as one of the most troublesome and commonly reported symptoms of MS, transforming the even simple physical and mental tasks and activities into an overwhelming struggle. This can have a significant impact on daily life and routines, interfering with work and relationships as the sufferer is simply too exhausted to carry out even the most basic tasks. Symptoms of fatigue may be worsened during hot weather, after exercising, during illness and at the end of the day.

Visual Disturbances

In approximately 1 out of every 4 cases of MS, one of the first noticeable symptoms are optic disturbances, these typically occur as a result of optic neuritis, inflammation to the optic nerve which transmits visual information to the brain – this usually only ever affects one eye at any one time, rarely both eyes are affected. Common symptoms include pain felt in one or both of the eyes, double vision, involuntary eye movements and in some cases a temporary loss of vision.

Mobility Problems

Many people with MS may experience difficulty with coordination and suffer from clumsiness, dizziness and vertigo as well as tremor.

Bladder Problems

Bladder related problems are common in MS and may include the urge to urinate more frequently, difficulty in completely emptying the bladder, a sudden urge to urinate which may lead to incontinence, as well as recurrent UTIs.

Bowel Problems

A variation in bowel activity is normal, although many people may find this distressing or embarrassing, constipation is the most common bowel disorder associated with MS. Bowel incontinence, although less common, is often linked to constipation, as the body creates excess mucous in attempt to release stools which have become stuck, resulting in leakage.

Cognitive Difficulties

Some people with MS may experience mild cognitive difficulties such as:

  • Problems learning new things and new language
  • Forgetting words
  • Difficulties with problem solving
  • Issues with planning or multi-tasking

Muscle Stiffness and Spasm

Muscles may become stiff and resistant to movement leading to spasticity, MS can also cause muscles to contract tightly or painfully, creating spasms. This may also lead to issues with balance, coordination and gait.

Numbness and Tingling Sensations

Abnormal sensations including tingling or numbness are common during the initial stages of MS, this sometimes manifests in the hands, arms, legs and the body.

Pain

A large number of those suffering from MS experience pain, this may be neuropathic or musculoskeletal. Neuropathic pain is characterised by sharp, stabbing pains caused by damage to the nerves. Musculoskeletal pain in the back, neck and joints can be an indirect result of MS, it may put pressure on the lower back or hips. Stiffness or spasms in the muscles can result in pain and tightness in the chest, also known as the MS hug.

Difficulty Swallowing

Difficulty swallowing also known as dysphagia, is a common symptom of MS – food may feel as though it is stuck in the mouth. Coughing during and after eating, excessive amounts of saliva and difficulty moving food through the mouth may also be present – the condition may also involve problems with speech (dysarthria).

Mental Health Issues

Many of those diagnosed with MS also suffer from bouts of depression or anxiety; it is not clear whether MS causes depression, or if the depression is the result of living with a long term condition, causing a vicious circle effect.

In some rare cases, individuals suffering from MS can experience severe mood swings such as tears, laughter or anger for no apparent reason.

Sexual Problems

MS can lead to a lack of interest in sex for both men and women, it may also interfere with sexual performance in men.

MS Diagnosis

Symptoms of MS may be quite vague or similar to other conditions – there is no single test to diagnose MS, rather a series of tests to investigate suspected symptoms.

In some cases, MS is difficult to diagnose – not having a concrete diagnosis can be frustrating and lead to feelings of self-doubt and uncertainty, individuals may feel as though their symptoms are not believed or taken seriously, and as a result begin to doubt themselves and their symptoms, this can contribute towards feelings of anxiety and depression.

Neurological Examination

A neurologist will perform a physical examination to check for signs of damage to the nerves which may indicate MS.

MRI Scan

One of the most concrete forms of diagnosis, the MRI scan will highlight any damage/scarring to the nerves.

Evoked Potential Test

This type of test measures electrical activity in the brain in response to stimulation of sight, sound and touch, this enables any slowing of electrical communication to be detected.

Cerebrospinal Fluid (CSF)

A sample of CSF is often tested for immune cells and antibodies – changes to the CSF can be an indicator of problems with the nervous system.

Blood Tests

Diagnosis of MS also involves eliminating other possible conditions such as HIV, Lyme disease, vitamin deficiencies or hereditary diseases.

Once a concrete diagnosis has been established, the type of MS will then be determined.

Treatment and Management for MS

There is currently no specific treatment or medication available to treat the condition as a whole, although symptoms can be managed and treated with a range of medications and treatments.

Any type of treatment will very much depend on the type of MS and the specific symptoms experienced by the individual. Due to the varying nature of the symptoms of MS, a multi-disciplinary team of healthcare professionals will typically be involved in the treatment.

Disease Modifying Therapies (DMT) For MS

There are a number of disease modifying therapies available as well as ongoing clinical trials, some of these therapies aim to reduce the amount of damage caused to the myelin sheath, whereas others have been found to reduce the progression of the disease. DMTs are not always suitable for everybody with MS, patients have to meet certain criteria.

Steroid Medication for Relapses

Treatment for relapses often involves a short course of steroids which are either taken in tablet form at home, or administered via injection in the hospital.

Medication

There are various medications available to help manage the symptoms of MS, including visual problems, bladder problems, bowel dysfunction, pain (both neurological and musculoskeletal), muscle stiffness and spasms, gait difficulties and tremor, mental health issues such as depression, sexual problems and extreme fatigue.

Physiotherapy

MS often causes mobility issues as a result of muscular spasms and stiffness, it may also result in significant stresses and strains to the muscles and joints, as well as problems with balance and coordination. A physiotherapist will work with the patient, assessing symptoms to devise a specific exercise programme to help with such issues.

TENS Machine

A TENS machine may be used to alleviate some of the stress to the muscles and joints in the body.

Cognitive Behavioural Therapy (CBT)

CBT is increasingly used to assist individuals suffering from chronic illnesses to help manage their symptoms and improve their quality of life – in the case of MS it is often used in the treatment of depression and the effects of severe fatigue.

Self Care

Maintaining good physical and mental health is highly beneficial in the management of a long term condition such as MS. This typically includes a healthy diet and regular exercise, not smoking, limiting alcohol intake and keeping healthy sleeping patterns. All of this can help to reduce fatigue, improve mobility strength and overall fitness levels, as well as improving bladder and bowel function.

 

The Pain Management Clinic can only offer treatment for cases of MS where there is a clear neurological diagnosis, and where all previous treatment for associated neurological symptoms, has been unsuccessful.

Nerve Pain

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Back Pain

back pain

Treatments

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