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Multiple sclerosisPublished by BUPA's health information team, healthinfo@bupa.com, February 2008. This factsheet is for people who have multiple sclerosis, or who would like information about it. Multiple sclerosis (MS) affects the nerves in your brain and spinal cord, causing problems with muscle control, vision and balance. It may also affect your memory, as well as your moods and emotions. Around 85,000 people in the UK are affected by MS. You are most likely to develop it between the ages of 20 and 40. It affects about twice as many women as men. About MSMS is a condition that affects your nerves. Nerves are made up of many fibres. Thousands of nerve fibres transmit tiny electrical impulses (messages) between your brain and spinal cord to the rest of your body, for example to your muscles, skin or organs (such as your heart and lungs). Your nerves are like tiny wires and are protected by a sheath made of a substance called myelin. This makes sure the messages are transmitted correctly from your brain and spinal cord to the rest of your body. Myelin is the "white matter" in your brain. MS is thought to be an autoimmune disease. This means that your body's immune system, which usually just attacks harmful things like bacteria and viruses, attacks your own healthy body tissue causing inflammation. If you have MS, your immune system attacks the myelin sheaths around the nerves in your brain and spinal cord. This is called demyelination and means that the nerve can't send signals properly. Areas where the myelin has been damaged become scarred and hardened - sclerosis means hardening. SymptomsEverybody with MS is affected differently and your symptoms can vary from day to day. You may find they get worse with heat or exercise. The most common symptoms include:
This may seem a great many symptoms, but you are unlikely to have all of them and not at the same time. Types of MSThere are four types of MS and each progresses differently. Benign MSWith this type you will have a few relapses (times when your symptoms flare up) and then recover. However, you need to have had very few or no symptoms for about 15 years before this diagnosis can be made. You may have a relapse after many years of not having any and it's possible that benign MS will get worse later in life. Relapsing-remitting MSFor about 80 percent of people with MS, it begins as a relapsing and remitting condition. This means you have relapses followed by periods of remission when your symptoms get better. Relapses can come on suddenly and last for between two and six weeks, although some may take a few months to clear. You may find your symptoms get gradually worse with each one or you have new symptoms. Secondary progressive MSAbout half of all people who have relapsing-remitting MS go on to develop secondary progressive MS within 10 years. Your symptoms don't get better once the relapse is over and slowly build up. You are likely to become gradually more disabled even though relapses and remissions may occur less frequently. Primary progressive MSIf you have this type, your symptoms get steadily more severe without any periods of remission. CausesThe exact reasons why you may develop MS aren't fully understood at present. Several factors are thought to be involved.
DiagnosisThere is no single test that can confirm MS. Your GP will ask about your symptoms and medical history. Many of the symptoms of MS are also found in other conditions so these may need to be excluded first. If you have symptoms which get better or go away, your GP is likely to wait and see if you have another relapse before referring you to a neurologist (a doctor specialising in conditions that affect the nervous system). Waiting may cause you some anxiety but this way a more definitive diagnosis can be made - a single episode may not be enough to make a firm diagnosis. Your neurologist may recommend you have other tests including:
TreatmentThere are treatments that can help you manage the symptoms of MS, although there is no cure. Self-helpRegular exercise can be helpful in reducing fatigue and improving mobility. Physiotherapy may help increase muscle strength and balance. No special diets have been shown to improve MS, but aim to eat a healthy, balanced diet. Try to eat lots of fresh fruit and vegetables and limit your intake of saturated fats and sugary foods. MedicinesIf your symptoms are severe, your GP may prescribe you a short course of steroids, often methylprednisolone (eg Depo-Medrone). These reduce inflammation and help to shorten your relapses. Steroids don't have any effect on the long-term progression of MS and you may have side-effects such as weight gain and acne. Disease-modifying drugs may slow down the progression of your disease and help to reduce the frequency or severity of attacks. Those licensed for use in the UK are interferon beta-1a (Avonex or Rebif), interferon beta-1b (Betaferon) and glatiramer acetate (Copaxone) injections. You will only be able to receive these medicines on the NHS if you meet specific criteria and they can only treat certain types of MS. They must be prescribed by a neurologist at a specialist MS centre. A new medicine natalizumab (Tysabri) has recently been licensed for use. You may be eligible for this if you have extremely active relapsing-remitting MS or rapidly evolving severe relapsing-remitting MS. Different types of medicines can be used to treat the various symptoms of MS such as pain, incontinence and impotence. Baclofen can help muscle spasms and stiffness (spasticity). The Medical Research Council funded a large study in the UK into the effects of cannabis on muscle spasticity. Participants reported an improvement in spasticity and sleep quality, as well as reduced pain. However, the reported study results found that cannabis had no considerable effect on muscle spasticity. There is a medicine called Sativex that contains an extract of cannabis. This isn't licensed in the UK but your GP may legally prescribe it on a named patient basis if he or she thinks it will help your symptoms more than conventional treatments. It's important to remember that cannabis is classed as an illegal drug in the UK. For any medicine, follow the instructions in the patient information leaflet that comes with it and ask your doctor for advice. Complementary therapyBetween two-thirds and three-quarters of people with MS use a complementary therapy such as aromatherapy or homeopathy. Although there is little scientific evidence to show that these are effective, many people find them helpful. Speak to your doctor before trying any complementary therapy. Living with MSGood practical and emotional support is important. Your neurologist will usually refer you to specialist services that aim to help you carry on living independently and continue your daily activities. As well as your GP and neurologist, some of the health professionals who can help include:
You may need to make changes at work to help you carry on doing your job. Your employer is expected to make reasonable adjustments to help with this. You may eventually need special equipment to help you carry out everyday tasks such as eating and getting around. Further information
Sources
This information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett, BscMB ChB MRCGP DRCOG DFFP, General Practitioner (GP) and GP Appraiser, Gloucestershire, Dr Richard Orrell BSc MD FRCP, Senior Lecturer in clinical neurosciences at the Institute of Neurology, Consultant Neurologist at the Royal Free Hospital and by BUPA doctors. It has been patient reviewed by the Multiple Sclerosis Society and the Multiple Sclerosis Trust. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: February 2008. Expected review date: February 2010.
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