Multiple sclerosis (MS) is a disease that affects the nerves of the brain and the spinal cord. The symptoms of MS are unpredictable and varied as they depend on which areas of the brain and spinal cord are affected. Because MS affects different people in different ways, it is very difficult to know on an individual basis how the disease will progress.
What causes the symptoms of MS?
The exact cause of MS is unknown, although it is thought to be an autoimmune disease, in which the body's immune system attacks itself, without any real known cause or reason.
In people with MS, something triggers the destruction of myelin – a fatty substance that coats and protects nerve fibers in the brain and spinal cord. The damaged myelin forms scar tissue (sclerosis). Often the nerve fiber is also damaged.
When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted. This causes weakening and deteriorating of a wide range of bodily functions (see symptoms below).
Who gets MS?
In New Zealand, about 1 in every 1,000 to 2,000 people develops MS. It is more common in:
- Young adults: MS can affect anyone at any age, but most people with MS experience their first symptoms and are diagnosed between the ages of 20 and 40 years (usually around the age of 30).
- Women: women are affected about twice as often as men, but men who develop MS will often be more severely affected by disability.
- Caucasians: MS is more common in Caucasians (people with ancestry from Northern Europe), than any other racial group. It is rarely found in Maori and Polynesian people and is uncommon in Asian people.
- Close relatives: MS is not strictly an hereditary disease, but close relatives of those with MS have an increased chance of developing the disease. Having a first-degree relative, (mother, father or sibling) with MS increases the chances of having it from approximately 1 in every 1,000 people to 30 in every 1,000. However, it is important to note that most people with an affected first-degree relative do not develop MS.
- Smokers: Smoking is associated with an increased occurrence of MS. Women who smoke are 1.6 times more likely to develop MS than women who are non-smokers. Also, individuals with MS who smoke appear to be at a much greater risk of experiencing a quicker progression of their disease.
MS is not contagious or infectious, so it is not possible to get it from close contact with a person with MS.
What are the symptoms of MS?
The symptoms of MS are unpredictable and are different in different people. The symptoms may also vary in the same person from time to time as different areas of the brain and spinal cord become affected.
- Some people will only ever experience mild symptoms over their lifetime.
- Others will have relapses followed by incomplete remission, with symptoms gradually worsening after each relapse.
- A number of people experience slowly worsening symptoms over many months or years.
Common early symptoms
Symptoms more likely to occur earlier in the disease include:
- problems with eyesight and vision, such as blurred or double vision, or pain behind the eye
- muscle spasms (spasticity)
- muscle or nerve pain such as tingling, stabbing or burning pains over parts of the skin
- weakness or lack of coordination of the limbs
- extreme tiredness or fatigue which can affect balance and concentration.
People with MS may experience a brief worsening of symptoms due to heat, such as when exercising or bathing. A person with MS will usually experience more than one symptom but not necessarily all of them.
The symptoms of MS can come and go at different times. The times when symptoms worsen are called relapses and the times when symptoms improve (or even disappear altogether) are called remissions.
Other common symptoms
Other common symptoms that progress over time include:
- bladder and bowel problems such as urinary retention and constipation
- problems with sexual performance
- speech and swallowing problems
- mood swings and depression
- thinking, concentration and memory problems.
How is MS diagnosed?
MS is not always easy to diagnose because symptoms may come and go. Also, other diseases of the brain and spinal cord have some of the same symptoms. A complete neurological exam and history of the symptoms are needed to diagnose MS.
There is no single test that can confirm or rule out MS, but the following tests may help with diagnosis:
- Blood tests are helpful to rule out other disease with similar symptoms to MS.
- MRI (magnetic resonance imaging) of the brain and spinal cord helps to clarify the diagnosis but the changes seen are not specific for MS and age-related changes may cause confusion.
- Lumbar puncture, where some of the fluid that surrounds the brain and spinal cord is analysed. Certain protein levels are measured. Some proteins are altered in MS, although they can be altered in other conditions too.
What are the treatment options for MS?
As there is currently no cure for MS, the various treatment options aim to:
- treat relapses (steroid medication)
- prevent relapses (called disease-modifying therapy)
- ease certain symptoms
- minimise disability by rehabilitation.
Read more about the treatment options for MS.
What can I do if I have MS?
It is important to maintain a healthy lifestyle to help your body cope with MS. Maintaining a healthy body gives you the best chance of living well.
There is good evidence that regular exercise improves overall health and energy levels. Keep active but remember to rest when you need to. Do not exert yourself too hard as this may make your symptoms worse, and cause an acute flare.
Eat a balanced diet to stay healthy and keep help keep your energy levels up. There is no scientific evidence that any particular diet changes the course of MS.
Avoid situation where your body can over heat such as saunas, spas, or hot tubs. This could increase tiredness and may make your symptoms worse.
What is the outlook (prognosis)?
Most people with multiple sclerosis have a normal or near-normal lifespan, but MS symptoms can impact your quality of life.
Because MS affects different people in different ways, it is very difficult to guess the outlook for people with MS. There are currently no tests to predict how MS will progress in a person. Most people with MS will be able to continue to walk and function at their work for many years after their diagnosis.
- About 1 in every 5 people with multiple sclerosis have no symptoms or develop only mild symptoms after an initial event. Another 1 in every 5 people experience a rapid progression of symptoms.
- Research has shown that 20 years after diagnosis, about two-thirds of people with MS continue to walk and do not need a wheelchair, although many of them may use a cane or crutches for walking assistance. Some patients use an electric scooter or wheelchair to help cope with fatigue or balance problems.
The following links provide further information on multiple sclerosis. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.