Multiple Sclerosis
Multiple sclerosis is a chronic, often relapsing condition which damages the central nervous system, the brain and spinal cord. About 110 in 100,000 are affected in England and Wales with a ratio of 2 women for each man. Diagnosis is often made between the late twenties to mid forties: mean age is 32, lower in women.
MS arises when an autoimmune reaction damages myelin (insulating covering of nerve fibres) in the white matter. However, the damage might not remain confined to the white matter. Recent studies highlighted widespread involvement of the grey matter in early relapsing-remitting MS suggesting that this may contribute to the pattern of symptoms.
In more than 80 per cent of MS patients, this destruction produces the clinical picture of relapsing–remitting MS. In other words, symptoms appear suddenly within 24 hours and then resolve over weeks or months. In secondary progressive MS, signs of CNS functional impairment persist between exacerbations. In around 20 per cent of patients, the destruction produces to primary progressive MS. In these patients, the symptoms of MS gradually worsen.
The symptoms of MS arise when the demyelination slows or blocks nerve conduction. As a result, patients may suffer a variety of problems including: weakness and loss of feeling in their limbs; sexual dysfunction; fatigue; bladder and bowel problems; sensory, visual and cognitive disturbances; pain; and emotional changes.
Remission occurs when the underling inflammation and oedema resolves. This allows nerves to partially remyelinate. Around the same time, other changes in conduction of impulses occur which are essential for nerve conduction and might aid functional recovery.
Finding the trigger for the first attack of MS and the factors that promote exacerbations presents a challenge. Over the years, researchers suggested numerous culprits including bacterial or viral infections that cause T lymphocytes to mount an autoimmune reaction against myelin. Other studies suggest that bacterial "superantigens," physical injury or stress contribute to the disease. Nevertheless, no single factor has emerged as the main environmental risk factor for MS.
On the other hand, there is little doubt that genetic factors influence individual patients’ susceptibility to MS. For instance, the rates for MS with both affected among monozygotic and dizygotic twins are 31% and 5% respectively. Although only 5% of first degree relatives of a MS patient develop the disease, this risk is still between 20 and 40 times higher than in that in the general population. Uncovering the relative importance of the numerous genetic traits linked to MS offers another challenge.
Certainly, several studies link MS to “a generalised autoimmune diathesis” that arises in genetically susceptible people. In other words, autoimmune diseases are more common in the first-degree relatives of MS patients than expected by chance. A study from Cambridge University, for example, suggests that the increased risk of MS applies to every autoimmune disease. Nevertheless, the association is especially marked with autoimmune thyroid conditions. Such insights could aid diagnosis, risk assessment and identify novel treatment targets.
The course of MS varies widely between sufferers and the condition waxes and wanes within each patient. For example, in one in ten patients MS shows a benign course that lasts more than 20 years. On the other hand, around 70 per cent of MS patients show secondary progression. Patients who suffer frequent relapses in the first two years, show a progressive decline, men, and those with and early, permanent motor or cerebellar findings tend to suffer from more severe MS.
Multiple Sclerosis Society
The Lichfield/Tamworth area has an active branch of the society.
Margaret White (who has MS) is the welfare officer at Sir Robert Peel Hospital on 01827 895719 Wednesday's 2pm-5pm.
The National Centre is in London: Helpline 0808 800 8000.
Website: http://www.mssociety.org.uk/
Summary of NICE guidance beta interferon and glatiramer acetate
http://www.prodigy.nhs.uk/guidance.asp?gt=MS%20-%20drug%20treatments%20(NICE)
The Minster Practice, Lichfield
