Multiple sclerosis

Multiple sclerosis (MS) is the most widespread disabling neurological disorder affecting young adults In the UK there are more than 100,000 people diagnosed with MS. MS is more common in women than men. MS is a life-long condition, but medication and therapy can help manage the condition and its symptoms.

Sclerosis' means scarring or hardening of tiny patches of tissue. In MS, this occurs at multiple places in the brain and/or spinal cord. Why someone develops MS isn't known. What is known indicates it's caused by a combination of genetic and environmental factors.

In MS, the immune system, which typically helps to fight off infections, misidentifies myelin, which protects nerve fibres, for a foreign body and attacks it. This damages the myelin and strips it off the nerve fibres, leaving scars known as lesions or plaques. This damage interrupts messages travelling along nerve fibres – they can slow down, become distorted, or not get through at all. As well as damaging the myelin, there can sometimes be damage to the actual nerve fibres too. It's this nerve damage that causes the increase in disability that can happen over time.
MS is not a terminal illness, but it is a life-long condition. Most people are diagnosed in their 20’s or 30’s and will live with MS for 40 to 50 years. Usually, people with MS live well into their 70’s. In recent years, disease modifying drugs have been introduced for relapsing MS and they could increase life expectancy in the future as they decrease the number of relapses.

MS can trigger a variety of symptoms and can affect any part of the body. Each person with MS is affected differently. Intervals when symptoms get worse are known as "relapses" and when symptoms improve or disappear are known as "remissions". Some of the most common symptoms include:

• fatigue
• vision problems
• numbness and tingling
• muscle spasms, stiffness and weakness
• mobility problems
• pain
• problems with thinking, learning and planning
• depression and anxiety
• sexual problems and/or bladder problems
• speech and swallowing difficulties
  Note: most people with MS only have a few of these symptoms.

There are four main types of MS:

Relapsing-remitting MS
‘Most people with MS (around 85%) are diagnosed with the relapsing remitting form. This means that they will have periods when symptoms flare up aggressively - known as a relapse, an attack or an exacerbation - followed by periods of good or complete recovery - a remission.

Benign MS
The term benign MS is sometimes used to describe a version of relapsing remitting MS with very mild attacks separated by long periods with no symptoms.

Secondary progressive MS
Many people who are initially diagnosed with relapsing remitting MS find that, over time, their MS changes. They have fewer or no relapses but their disability increases. As this follows an initial (primary) relapsing remitting phase, this is known as secondary progressive MS

Primary progressive MS
Between 10 and 15% of people with MS are diagnosed with primary progressive MS (or less commonly chronic progressive MS). In this type of MS disability increases from the beginning, and it is rare to have any relapses’. (MS Trust. 2018)

Other rare variants of MS do exist these including, Devic's neuromyelitis optica, Balo's concentric Sclerosis, Schilder's disease and Marburg MS. Although rare, the variants are important as they often arise in the differential diagnosis for severe and acute MS presentations.