Multiple sclerosis (MS or wharanga uwhi iaia) is a condition that affects the nerves of your brain and spinal cord. Because MS affects people in different ways, it’s difficult to know how the condition will progress in each person.
- The symptoms of MS are unpredictable and varied as they depend on which areas of your brain and spinal cord are affected.
- About 1 in 1000 New Zealanders develop MS. Young adults, women, Caucasians, close relatives of people with MS, and those in cooler climates are more likely to get the condition.
- Although causes are unclear, it is thought to be an autoimmune condition.
- There is no cure yet for this condition, but treatment options aim to treat or prevent relapses, ease symptoms and minimise disability.
- Maintaining a healthy lifestyle will help your body cope with MS and give you the best chance of living well.
What causes MS?
The exact cause of MS is unknown, although it is thought to be an autoimmune condition, 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 fibres in your brain and spinal cord. The damaged myelin forms scar tissue (sclerosis). Often the nerve fibre is also damaged.
When any part of the myelin sheath or nerve fibre is damaged or destroyed, nerve impulses travelling to and from your brain and spinal cord are distorted or interrupted. This causes weakening and deteriorating of a wide range of bodily functions.
Who gets MS?
In New Zealand, about 1 in every 1,000 develops MS. It is more common in certain groups.
- 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 Māori and Pasifika people and is uncommon in Asian people.
- Close relatives: MS is not strictly an hereditary condition, but close relatives of those with MS have an increased chance of developing it. Having a first-degree relative, (mother, father or sibling) with MS increases the chances of having it to 30 in every 1,000.
- 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, people who smoke appear to be at a much greater risk of a quicker progression of the condition.
- Exposure to the Epstein-Barr virus: This is the virus that causes glandular fever (also known as mononucleosis or mono). Exposure to this virus later in life is associated with an increase incidence of 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.
Common early symptoms
You usually experience more than one symptom but not necessarily all of them. MS typically begins with a sudden episode of neurological symptoms. Symptoms more likely to occur earlier in the disease include:
- problems with vision, such as blurred or double vision, or pain behind your eye
- muscle spasms
- muscle or nerve pain such as tingling, stabbing or burning pains over parts of your skin
- weakness or lack of coordination of your limbs
- extreme tiredness or fatigue that can affect balance and concentration.
You may have a brief worsening of symptoms due to heat, such as when exercising or bathing.
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.
What are the different types of MS?
This is seen in 8.5 out of 10 people with early-stage MS. It involves recurrent acute episodes (relapses), with symptoms suddenly increasing or new symptoms developing. This is followed by periods in which symptoms improve or even disappear altogether (remissions).
Secondary progressive MS
This develops in 2 out of 3 people with relapsing-remitting MS within 15 years of diagnosis. This is a gradual, progressive worsening of neurological functioning regardless of whether you have any acute relapses.
Primary progressive MS
This occurs in 1 out of 10 people with MS. Neurological symptoms develop progressively from the outset, usually with slowly increasing lower limb weakness.
Clinically Isolated Syndrome (CIS)
If you only have one episode or symptom it is hard to predict which category you will fall into. You may or may not go on to one of the other categories.
Progressive Relapsing MS (PRMS)
This is the least common type of MS, with only 5% of people falling into this group. This is when the condition shows clear progression but also acute attacks with or without full recovery.
How is MS diagnosed?
MS is not always easy to diagnose because symptoms may come and go. Also, other brain and spinal cord conditions have some of the same symptoms. A complete neurological exam and history of symptoms are needed to diagnose MS.
There is no single test that can confirm or rule out MS, but your doctor may carry out the following tests:
- blood tests to rule out other conditions with similar symptoms
- MRI (magnetic resonance imaging) of your brain and spinal cord, but changes are not specific for MS and age-related changes may cause confusion
- lumbar puncture, where some of the fluid that surrounds your brain and spinal cord is analysed to see if certain protein levels are altered (although they can be altered in other conditions too)
- Evoked potential (EP) tests – recordings of your nervous system’s electrical responses to the stimulation of specific sensory pathways, such as vision in the case of visual EPs.
What is the treatment 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.
Self-care for MS
Maintaining a healthy lifestyle will help your body cope with MS and give you the best chance of living well.
There is good evidence that regular exercise improves overall health and energy levels. Keep active but rest when you need to. Don’t over-do it as this may make your symptoms worse and cause an acute flare.
Eat a balanced diet to stay healthy and keep your energy levels up. There is no evidence that any particular diet changes the course of MS.
Avoid situations where your body can overheat, such as saunas, spas or hot tubs. This could increase tiredness and may make your symptoms worse.
See also these tips for managing MS
What is the outlook (prognosis) for MS?
Most people with multiple sclerosis have a normal or near-normal lifespan, but MS symptoms can impact your quality of life.
Because MS affects people in different ways, it’s difficult to predict the outlook for each individual. 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 MS 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.
Support for MS
It can be difficult to adjust to a diagnosis of MS, partly because of its unpredictability. Talk to your family, friends and doctor about how you are feeling. You can also get support from a counsellor or therapist
The MS Society can put you in contact with a regional field officer who can offer support and information. The range of services offered varies between regional societies.
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.
- About multiple sclerosis Multiple Sclerosis Society, NZ
- Multiple sclerosis – managing shades of greyBPAC, NZ, 2013
|Dr Helen Kenealy is a geriatrician and general physician working at Counties Manukau DHB. She has a broad range of interests and has worked in a variety of settings including inpatient rehabilitation, orthgeriatrics and community geriatrics.|