17th Annual Conference Pakistan Society of Neurology 15-16 May, 2010
 
 
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Pakistan Journal of Neurological Sciences
Affiliated with Multiple Sclerosis International Federation
©2009 Multiple Sclerosis
Research & Patient Welfare Trust
 
What is MS
MS is the most common disease of the central nervous system CNS affecting young adults. refers to the scarring or lesions, which occur in the CNS. “Multiple” refer to the sites of damage in the body. The CNS comprises of the brain and spinal cord, which together with the nerves connecting to the rest to the body, form the body’s communication network.

In MS, damage occurs to the myelin sheath that normally protects nerves. This damages alters the way the messages are carried to and from brain and spinal cord , and therefore disrupts some of the functions of the body.

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system. Today over 2,500,000 people around the world have MS.

MS is the result of damage to myelin - a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body

Symptoms vary widely and include blurred vision, weak limbs, tingling sensations, unsteadiness and fatigue. For some people, MS is characterised by periods of relapse and remission while for others it has a progressive pattern. For everyone, it makes life unpredictable.
 
Quick Facts
  • Drugwatch.comMS is a progressive disease of the nervous system, for which there is no cure.
  • An estimated 2,500,000 people in the world have MS.
  • More women than men have MS, with a ratio of 2 men to 3 women affected.
  • MS is the most common diseases of the central nervous system in young adults.
  • There are four types of MS: benign, relapsing remitting, secondary progressive, primary progressive.
  • Sclerosis means scars, these are the plaques or lesions in the brain and spinal cord.
  • In MS, the protective myelin covering of the nerve fibres in the central nervous system is damaged.
  • Inflammation and ultimate loss of myelin causes disruption to nerve transmission and affects many functions of the body.
  • While the exact cause of MS is not known, much is known about its effect on immune system function which may be the ultimate cause of the disease.
  • MS is not directly hereditary, although genetic susceptibility plays a part in its development.
  • MS is not contagious.
  • Diagnosis of MS is generally between 20 and 40 years of age, although onset may be earlier.
  • MS is rarely diagnosed under 12 and over 55 years of age.
  • Life span is not significantly affected by MS.
  • There are a wide range of symptoms. Fatigue is one of the most common.
  • The incidence of MS increases in countries further from the equator.
  • There is no drug that can cure MS, but treatments are now available which can modify the course of the disease.
  • Many of the symptoms of MS can be successfully managed and treated.
Causes of MS
The cause of multiple sclerosis is not yet known, but thousands of researchers all over the world are meticulously putting the pieces of this complicated puzzle together.

The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors.

One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defence mechanisms (i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.
 
Who gets MS?

Women are more likely to develop multiple sclerosis than men, with MS occurring 50% more frequently in women than in men (i.e. 3 women for every 2 men). Multiple sclerosis is a disease of young adults; the mean age of onset is 29-33 years, but the range of onset is extremely broad from approximately 10-59 years.

 
Symptoms of MS

Multiple sclerosis is a very variable condition and the symptoms depend on which areas of the central nervous system have been affected. There is no set pattern to MS and everyone with MS has a different set of symptoms, which vary from time to time and can change in severity and duration, even in the same person.

There is no typical MS. Most people with MS will experience more than one symptom, and though there are symptoms common to many people, no person would have all of them. Common symptoms include:


Visual disturbances

  • blurring of vision
  • double vision (diplopia)
  • optic neuritis
  • involuntary rapid eye movement
  • (rarely) total loss of sight

Balance & co-ordination problems

  • loss of balance
  • tremor
  • unstable walking (ataxia)
  • giddiness (vertigo)
  • clumsiness of a limb
  • lack of co-ordination
  • weakness: this can particularly affect the legs and walking

Spasticity

  • altered muscle tone can and muscle stiffness can affect mobility and walking
  • spasms

Altered sensation

  • tingling
  • ‘pins and needles’
  • numbness (paraesthesia)
  • burning sensations
  • pain may be associated with MS, e.g. facial pain, (such as trigeminal neuralgia), and muscle pains

Abnormal speech

  • slowing of speech
  • slurring of words
  • changes in rhythm of speech
  • difficulty in swallowing (dysphagia)

Fatigue

  • a debilitating kind of general fatigue which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of the most troubling) symptoms of MS

Bladder & bowel problems

  • Bladder problems include the need to pass water frequently and/or urgently, incomplete emptying or emptying at inappropriate times.
  • Bowel problems include constipation and, infrequently, loss of bowel control

Sexuality & intimacy

  • impotence
  • diminished arousal
  • loss of sensation

Sensitivity to heat

  • this symptom very commonly causes a transient worsening of symptoms

Cognitive & emotional disturbances

  • loss of short term memory
  • loss of concentration, judgment or reasoning
 
Types of MS
The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease:


Relapsing-Remitting MS
In this form of MS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years.

  • Frequency - approx 25%

Benign MS After one or two attacks with complete recovery, this form of MS does not worsen with time and there is no permanent disability. Benign MS can only be identified when there is minimal disability 10-15 years after onset and initially would have been categorised as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory).

  • Frequency - approx 20%

Secondary Progressive MS For some individuals who initially have relapsing-remitting MS, there is the development of progressive disability later in the course of the disease often with superimposed relapses.

  • Frequency - approx 40%

Primary Progressive MS This form of MS is characterised by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years.

  • Frequency - approx 15%