MS

What is MS?
Multiple sclerosis (MS), is an auto-immune disease where the body's own immune system incorrectly attacks the central nervous system (CNS).  Nerve conductors are surrounded by cells called myelin, similar to the outer sheath on an electrical cable. The immune system attacks and breaks down the myelin around the nerves.  The resulting scar tissue around the nerve and inflammation during an attack then interferes with the nerve performance, resulting in a breakdown of communication around the body.

This can result in a wide range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may disappear completely; however, permanent neurological problems often occur, especially as the disease advances.


What are the main symptoms of MS?

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 of MS include:

• 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.
• Visual problems: blurring of vision, double vision (diplopia), optic neuritis, involuntary rapid eye movement, (rarely) total loss of sight.
• Balance and coordination problems: loss of balance, tremors, 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: muscle pains, facial pain (such as trigeminal neuralgia), stabbing sharp pains, burning tingling pain.
• Abnormal speech: slowing of speech, slurring of words, changes in rhythm of speech, difficulty in swallowing (dysphagia).
• Bladder and 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 and intimacy: impotence, diminished arousal, loss of sensation.
• Sensitivity to heat: this symptom very commonly causes a transient worsening of symptoms.
• Cognitive and emotional disturbances: loss of short-term memory, loss of concentration, judgment or reasoning.

Are there different types of MS?
People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe.

• Relapsing-Remitting MS: People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks—which are called relapse or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS. 

• Primary-Progressive MS: This disease course is characterised by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS. 

• Secondary-Progressive MS: Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data is not yet available but we hope that current treatments significantly delay this transition. 

• Progressive-Relapsing MS: In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions. Since no two people have exactly the same experience of MS, the disease course may look very different from one person to another. And, it may not always be clear to the physician — at least right away — which course a person is experiencing.