Multiple Sclerosis
Posted: Friday, March 19, 2010
by Jonathan Blood Smyth
MS or multiple sclerosis is a central nervous system disease which involves inflammation of the nerve tracts and loss of the insulating myelin sheaths around the nerves, a condition known as demyelination. The small scarrings and thickenings which occur in the MS lesions are known as sclerosis. MS is a very active disease and new nerve lesions are constantly being formed with consequential clinical worsenings and increased disability. The commonest type of MS is one which has regular periods of worsening followed by periods of partial recovery, a disease course known as relapsing and remitting.
Multiple sclerosis presents in a variety of differing clinical courses which vary in severity and pattern of relapses. Caucasian people have a higher incidence and it gets more and more common as the latitude increases, e.g. as we move more towards the northern countries. Genetic factors may well play an important role in susceptibility to MS but we know that environmental factors play a role because moving from a low risk to a high risk area before the age of fifteen means an individual acquires the risk of the high risk area.
The estimated number of patients suffering from multiple sclerosis in the world is two and a half million and as many are younger people this causes significant disability and interference with work and family life. While MS is not the direct cause of death it is estimated that it reduces life expectancy by between five and seven years perhaps secondary to urinary infections and other side effects of immobility. The largest numbers occur in northern European populations with women more commonly presenting than men in proportion of 1.6 to 2.1 times. Under fifteen years old and over fifty years women outnumber men 3 to 1, perhaps due to hormonal differences.
In men the presenting form of multiple sclerosis tends to be the primary progressive type while female patients more often show the relapsing type. Worsenings or exacerbations of the disease show themselves as newly occurring symptoms of dysfunction in the central nervous system. These symptoms may both be spread out anatomically in the body and across a time period. Development of double vision from involvement of the optic nerve, loss of sensibility in a body part and loss of muscle strength in a limb are all examples of attacks. However, attacks may be absent and the patients may just suffer steady worsening.
Undergoing an acute attack of MS and then improving afterwards puts the patient in the relapsing and remitting disease group. This is the commonest group but at some time these patients will move to secondary progressive disease and worsen more steadily. In the primary progressive disease form patients worsen more continuously and dramatically, in some cases to overall paralysis. The typical treatment regimes for multiple sclerosis are less effective against the rapid form and it is much more disabling. If the deterioration acquired during the attacks is not recovered in remissions then the form of disease is relapsing and progressive.
While MS symptoms often spread themselves over a variety of functions in any particular person they can be focussed on more specific areas such as mostly affecting balance, vision or mental abilities. At some point in the course of the disease sufferers seem to reach a threshold where they worsen in a neurodegenerative pattern rather than secondary to inflammation. The complex nature of multiple sclerosis means that virtually any neurological system can be affected in minor ways, or the damage can be concentrated in one particular part of the system. Even without much evidence of nervous system lesions people can lose significant mental ability.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and Manchester Physiotherapists. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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