Multiple Sclerosis is a disease that affects the central nervous system (the brain and spinal cord). It affects the cognitive (thinking) aspects as well as the physical aspects of the patient's life. The brain is like a computer that sends messages to your body telling it what to do, while the spinal cord resembles a thick cable of wires attached to the brain¹. Messages travel from the brain, along the spinal cord, to the nerves and muscles throughout your body.

MS occurs worldwide, but is most common in the Northern Hemisphere. It occurs twice as often in females as in males, in as many as 50 to 100 people per 100,000 and is usually diagnosed between the ages of 20 and 40.

When a person has MS, myelin (a covering that protects nerves) in the brain and spinal cord is attacked and destroyed by white blood cells. This slows down, or blocks, nerve messages, and may cause spasms in some cases. Also, sclerosis (scar tissue) on the myelin further disrupts the messages. So, when the brain tells the eye to wink, the message may not be clear, or it may never reach the eye at all.

Diagnosis

There are several ways to diagnose MS. One concept is dissemination in time and space. It is a simple concept, but fairly difficult to put into practice because of the difficulty in satisfying the criteria. Even when the criteria have been satisfied, the evidence must be very critically interpreted. In plain English: if the patient shows enough of the symptoms of MS, within a certain period of time, they are diagnosed with it.

Electrical tests of the central nervous system functions, such as Evoked Potentials (EP), Computed Tomography (CT) scans, and Magnetic Resonance Imaging (MRI), have helped greatly in showing abnormalities in the central nervous system disseminated in space, but this still must be interpreted very carefully. MRI can identify abnormal areas in the spinal cord and brain with great accuracy.

Spinal taps², Myelograms, Evoked Response Tests (ERTs), and radiology are several ways of testing for MS:

• A spinal tap measures the amount of IgG (immunoglobulin G) in the spinal fluid. IgG represents increased antibody formation; an increased level of this suggests the presence of an autoimmune phenomenon. Oligoclonal bands (OB) have also been picked up in the spinal taps of MS patients.

• Myelograms are used to verify that the results of the spinal tap are not a result of compression, such as a slipped disc or tumour.

• ERTs test the response time of different senses. Electrodes are hooked up to an EEG (electroencephalograph) and three common tests are run: visual, auditory, and pain stimulus.

• Radiology, such as CAT scans, MRI, X-rays, and a new technique, NMR (Nuclear Magnetic Resonance) are used to detect any MS lesions that may be present.

Cause

MS affects a number of areas in the brain but its causes are still unknown, despite many years of research. It's not contagious, or directly inherited, although studies do reveal a genetic predisposition. MS is mainly found in northern or southern latitudes, with a very small portion found near the equatorial areas.

Symptoms

Symptoms vary greatly from person to person and from time to time in the same person. They also vary in severity and duration. They might include night-spasms (muscle flexing), numbness or prickly feelings, eye trouble or speech problems, loss of coordination or balance, poor control of bladder or bowel movements, weakening or paralysis of any part of the body, and unusual/extreme fatigue.

Types

Specialists recognise four main types of MS:

• Relapsing-Remitting MS is the most common type of MS at diagnosis. Attacks are followed by partial or complete recovery, succeeded by symptom-free periods.

• Secondary-Progressive MS begins with the initial Relapsing-Remitting form, which later results in a steady worsening of symptoms and disability.

• Primary-Progressive MS is characterised by steady worsening from the onset, usually without remission or a stable period. However, some people may experience temporary minor improvements.

• Progressive-Relapsing MS has clear, acute relapses from the beginning that leave significant disability. There is slow but progressive deterioration.

A doctor or neurologist can give you a diagnosis but cannot give a definite prognosis. In plain English, they cannot predict what course the disease will take.

Treatments

Symptoms may be treated with many different types of drugs. Taking Amantadine may reduce fatigue. Spasms may be treated by a drug called Baclofen. Some experimental drugs change the way the nervous system works and improve neurological function without significant toxicity. Gabapentin and amitriptyline are the two most common drugs for treating peripheral neuropathic pain in MS patients. There are also drugs to treat bladder symptoms.

Acute relapses of MS have been treated with a variety of cortisone drugs, such as ACTH, and corticosteroids. Immunosuppressives such as Asathioprine, Cyclophosphamide, and Cyclosporine are believed to be able to slow down the clinical course of MS, but this has yet to be proven. Interferon is an immunomodulator that has more selective and specific effects on the immune system than immunosuppressives do. Immunostimulators have been shown to make MS worse. Drugs that affect the immune system must be very carefully evaluated.

Early symptoms are often mild and go away without treatment. As time goes on, they may become more numerous and severe. A typical pattern is a short period (24 hours or more) of acute symptoms, followed by an easing or disappearance of symptoms for weeks, months or even years.

Although many people associate MS with being in a wheelchair, some studies show that approximately 70% of those diagnosed with MS will not require wheelchairs on a permanent basis.

There is no known cure for MS yet, but several medications can lessen the frequency and severity of MS attacks, depending on the stage of the sickness you are in at the time of diagnosis. You should seek your doctor's advice on possible helpful medication and treatments.

Exercise is very important for MS patients. Warm-up exercises, back, torso, and limb exercises, as well as head and neck exercises are very beneficial in relieving the symptoms of MS. There are also exercises for bladder control. Yoga, jogging, walking and swimming are the most recommended exercises for patients of MS who are in the relapsing-remitting stage of the disease.

As the years go by and research keeps developing, it is hoped that scientists will eventually come up with a vaccine that will eradicate this horrible disease. Understanding how the immune system causes damage to the nervous system will help the production of specific drugs that can modify the immune reaction to slow down, stop, or prevent MS.