About Multiple Sclerosis
Multiple Sclerosis (MS) is an inflammatory neurological disease affecting the central nervous system which results in loss of myelin, the insulating material around nerves, a process called demyelination. The lesions in MS are scarred, thickened areas, giving rise to the term sclerosis in this disease. MS is an active disease with continual formation of lesions and a steady worsening clinical situation involving increasing disability. Patients who have the commonest form of MS have relapsing (worsening) and remitting (recovering) disease with about five to ten new neurological lesions every year and one or two clinical worsenings.
The ability to image and confirm the diagnosis of MS has been greatly enhanced by the advent of MRI scanning which allows the lesions to be identified. Multiple sclerosis has not been linked with any particular triggering agent although hormonal factors are known to be important as the disease remits in pregnancy and relapses after the child is born. Many different factors could be responsible but it is known that an ongoing infection is only present in one out of four presentations of the disease.
The course of multiple sclerosis varies greatly and the disease can be classified partly by the characteristic pattern of incidence. More frequent in Caucasian peoples, MS increases in frequency as the latitude increases, in other words the risk is greater the further north the person lives. The likelihood of getting MS may be affected by genetic factors but environmental matters are known to be important as moving from a lower risk region to a higher risk region before fifteen years carries within it the risk of the new region.
The estimated number of patients suffering from multiple sclerosis in the world is two and a half million and as many are younger people this causes significant disability and interference with work and family life. While MS is not the direct cause of death it is estimated that it reduces life expectancy by between five and seven years perhaps secondary to urinary infections and other side effects of immobility. The largest numbers occur in northern European populations with women more commonly presenting than men in proportion of 1.6 to 2.1 times. Under fifteen years old and over fifty years women outnumber men 3 to 1, perhaps due to hormonal differences.
The primary and progressive form of multiple sclerosis is more likely to occur in male patients and the relapsing form in female patients. When an attack of the condition occurs it shows up in new symptoms of the central nervous system with symptoms typically occurring over a period of time and in different body areas. Loss of feeling in a body part, optic nerve involvement leading to double vision and sudden loss of muscle power in a limb are all examples of typical attacks. However, there may be no specific attacks but rather a steady deterioration in both mental and physical abilities.
If someone has an acute attack and then improves afterwards they are said to have the relapsing and remitting form of multiple sclerosis. However, most people in this group will at some time enter a phase of steady worsening known as secondary progressive disease. The primary progressive form exhibits continuing increase in disability without any remissions, often progressing rapidly to complete paralysis. This type of MS is more disabling and less responsive to therapy than the other forms. If patients do not recover their disability inbetween relapses they can be classified as having relapsing and progressive MS.
The symptoms of MS tend to cover a wide range of abilities in any individual patients but there can be a concentration of symptoms involving the visual, mental functioning or balance and coordination systems. It is thought that at some point in the disease MS sufferers reach a point where the disease worsens more continuously with an indication of neurodegeneration rather than just inflammation. However, one of the characteristics of MS is that patients can present with almost any combination of symptoms or with severe changes in one particular neurological system. Severe loss of mental ability may be evident without much evidence of central nervous system lesions.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and Physiotherapists in Manchester. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
