About Multiple Sclerosis

Multiple Sclerosis or MS is a disease of the central nervous system characterised by inflammation and demyelination, the gradual loss of the insulation material around the nerves known as myelin. Sclerosis is the term given to describe the thickened and scarred small lesions which occur in the nerve tracts. The disease is continually active and forms new lesions regularly leading to gradually increasing levels of disability. The most common form of MS is the relapsing and remitting kind, meaning there are periods of worsening followed by at least partial recoveries.

As the neurological lesions can now be identified on MRI scanning this has greatly improved the accuracy and certainty of diagnosing multiple sclerosis. No specific agent which might trigger MS has been isolated but as it gets better with pregnancy and worse afterwards it may be that hormonal factors are involved. A large number of factors have been considered as potentially important such as infections, but infections have only been shown to be present in one out of every four times the disease presents.

The course of multiple sclerosis varies greatly and the disease can be classified partly by the characteristic pattern of incidence. More frequent in Caucasian peoples, MS increases in frequency as the latitude increases, in other words the risk is greater the further north the person lives. The likelihood of getting MS may be affected by genetic factors but environmental matters are known to be important as moving from a lower risk region to a higher risk region before fifteen years carries within it the risk of the new region.

2.5 multiple sclerosis sufferers are estimated to be presently living in the world and due to the typical age being a younger group this is the cause of important levels of disability and disturbance of family and economic life. Death is not a direct consequence of multiple sclerosis but there is an estimated reduction in life years of between five and seven, possibly due to the consequences of immobility such as urinary infections. Northern Europe shows the highest incidence of this disease and women present from 1.6 to 2.1 times more often than men in general, although in younger (under fifteen) and older (over fifty) women the proportion is three to one.

The primary and progressive form of multiple sclerosis is more likely to occur in male patients and the relapsing form in female patients. When an attack of the condition occurs it shows up in new symptoms of the central nervous system with symptoms typically occurring over a period of time and in different body areas. Loss of feeling in a body part, optic nerve involvement leading to double vision and sudden loss of muscle power in a limb are all examples of typical attacks. However, there may be no specific attacks but rather a steady deterioration in both mental and physical abilities.

If someone has an acute attack and then improves afterwards they are said to have the relapsing and remitting form of multiple sclerosis. However, most people in this group will at some time enter a phase of steady worsening known as secondary progressive disease. The primary progressive form exhibits continuing increase in disability without any remissions, often progressing rapidly to complete paralysis. This type of MS is more disabling and less responsive to therapy than the other forms. If patients do not recover their disability inbetween relapses they can be classified as having relapsing and progressive MS.

Typically multiple sclerosis affects a range of neurological functions in an individual but it can be more concentrated on particular anatomical areas such as involving vision, balance and coordination and mental ability. A threshold is often reached at some juncture in the disease progress where a steadier worsening occurs more redolent of a neurodegenerative process rather than an inflammatory one. As MS is so complex it can affect any number of areas and thereby functions in the nervous system but it can also be limited to a specific area of the system. In the absence of indication that many central lesions are present patients can still exhibit significant mental losses.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about physiotherapy, physiotherapy, Physiotherapy Manchester, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.