June 24, 2004
MULTIPLE sclerosis affects more women than men. But experts still don't know what triggers the disorder, as Dr Miriam explains.
THE most common nervous system disorder affecting young adults is multiple sclerosis.
Nerves in the brain and spinal cord are progressively damaged, affecting balance, sensation, movement and body functions.
Symptoms relate to damaged areas and vary in severity. For example, damage to the optic nerve may cause reduction of vision.
If nerve fibres in the spinal cord are affected, it may cause weakness in legs or arms.
Damage to nerves in the brain stem - the area of the brain that connects to the spinal cord - may affect balance, causing severe vertigo that can be disabling.
Multiple sclerosis (MS) symptoms can be intermittent, with long periods of freedom (remission). However, some people have chronic symptoms that gradually get worse.
In the UK, about one person in 1,000 has MS. Those who have a close relative with MS are more likely to develop the disorder.
The condition is much more common in the northern hemisphere, which suggests environmental factors also play a part.
MS is an autoimmune disorder, in which the body's immune system attacks its own tissues, in this case the nervous system.
Many nerves in the brain and spinal cord are covered by a protective insulating sheath of material called myelin.
In MS, small areas of myelin are damaged, leaving holes in the sheath. Once the myelin sheath has been affected, impulses can't be conducted normally along nerves to and from the brain and spinal cord.
At first, damage may be limited to one nerve, but the myelin covering other nerves may be affected over time. Eventually, damaged patches of myelin insulation are replaced by scar tissue.
It's thought that MS may be triggered by external factors such as a viral infection during childhood in genetically susceptible individuals.
1. RELAPSING-REMITTING - the most common form where symptoms last for days or weeks and then clear up for months or even years. However, some symptoms may eventually persist between the attacks.A person with relapsing- remitting MS may go on to develop chronic-progressive MS.
2. CHRONIC-PROGRESSIVE - about three in 10 people with MS have this type in which there is a gradual worsening of symptoms with no remission.
3. PRIMARY PROGRESSIVE - in which deterioration is seen from the start.
THESE may occur singly in the first stages and group together as MS progresses. They include:
Later in the course of the disease, some people with muscle weakness develop painful muscle spasms.
Nerve damage can lead to urinary incontinence, and men may have more difficulty achieving an erection.
Eventually, damage to myelin covering nerves in the spinal cord may cause partial paralysis, and an affected person may need a wheelchair.
BLURRED VISION IS A CLUE
THERE is no single test to diagnose MS, and, as symptoms are so wide-ranging, a diagnosis is only made once other possible causes of symptoms are excluded.
Quite often, it's possible to make a fairly certain diagnosis from your medical history and a physical examination:
If you're having eye problems, such as blurring vision, you may be referred to an ophthalmologist who will examine the optic nerve, which is commonly affected in the early stages.
Your doctor may arrange tests to find out how quickly your brain receives messages when certain nerves are stimulated. The most common test uses the visual pathways.
You will probably also have an imaging test of the brain to see if there are areas of damaged myelin.
Your doctor may arrange for a lumbar puncture, when a small amount of the fluid that surrounds the spinal cord is removed for analysis to help confirm the diagnosis.
How you can find help
AT the moment, there's no cure for MS, but if you have relapsing-remitting MS, interferon may help lengthen remission periods and shorten the length of attacks.
Your doctor may prescribe corticosteroids to shorten the duration of a relapse. However, at present there's no specific treatment to halt the progression of chronic-progressive MS.
Your doctor may treat muscle spasms with a muscle-relaxant drug.
Incontinence can often be improved by drugs.
Problems in getting an erection may be helped by drug treatments such as Viagra, Cialis or Levitra.
If you have mobility problems, your doctor may arrange for physiotherapy. Occupational therapy may make day-to-day activities easier.
TIME TO COOL OFF
IF you're diagnosed with MS, you and your family will need time and possibly counselling to come to terms with it.
Try to minimise stress and avoid exposure to high temperatures if heat makes symptoms worse.
Regular exercise, such as swimming, will help keep your muscles strong without risk of overstraining them.
THE progression of MS is extremely variable, but people who are older when the disease first develops tend to fare less well. About seven in 10 people with MS have active lives with long periods of remission between relapses.
MANY find cannabis a great help to relieve muscle spasm, tension, bladder problems and vertigo. Herbal cannabis seems to work better than cannabinoid prescription medicines.
Herbal cannabis is sanctioned for medicinal use in some US states and in Canada - and the world's first cannabis-based medicines may be available on prescription in Britain by the end of the year.
First will be an oral spray which limits the high from the drug. In clinical trials, people with multiple sclerosis found it extremely effective in relieving pain and muscle spasms.
A small French study has shown one of the statin drugs used to lower cholesterol might be helpful for people with the relapsing form of MS because it cuts inflammation that damages nerves. But it's early days yet.
FOR further reading, Family Health Guide, by Dr Miriam Stoppard, is
available from Mirror Direct on 0870 07 03 200, price £22.50
including postage and packing.
Copyright © 2004, MGN Ltd