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Multiple Sclerosis

Frequently Asked Questions (FAQ)

What is MS?
Who gets MS ?
What are the types of MS ?
What are the signs and symptoms of MS ?
How is a diagnoses made ?
 

What is MS?

MS affects women 50% more than men or, if you prefer ratios, 3 to 2.

The mean age of onset of MS is 29 - 33 years but the range of onset is extremely broad from approximately 10 - 59 years.

MS is more common the farther you go from the equator. Some studies have reported that MS is as much as five times more likely in North America and Europe than in the tropics. There is one slight variation to this statistic, the disease is almost unheard of amongst the Eskimo people, which is one of the reasons that a diet high in fish oils is often recommended to those with MS.

Who Gets MS?
Multiple Sclerosis (MS) is a disease affecting the brain, the spinal cord and the central nervous system (CNS). It is manifested by the destruction of myelin (demyelination) in the central nervous system.

Myelin is a complex substance composed of proteins and lipids (fats) that form a protective coating around nerve cells in much the same way as electrical wires in appliances are covered by material that insulates them. If this covering is destroyed (as occurs in MS), signals travelling through the nerve cells are interrupted or delayed. This results in various neurological symptoms occurring at different locations throughout the body. The symptoms may occur intermittently with periods of complete resolution or they may recur and progress over time (see what are the signs and symptoms of MS).

Repeated injury to different areas of myelin surrounding nerve cells in the brain and spinal cord can eventually result in scar formation (also called plaques). The name Multiple Sclerosis is derived from Latin and means "many scars".
 

What are the signs and symptoms of MS ?

Multiple Sclerosis is a very variable condition and the symptoms depend on which areas of the Central Nervous System have been affected. There is no set pattern to MS and everyone with MS has a differing set of symptoms ,which vary from time to time and can change in severity and duration, even in the same person. The systems commonly affected include:

- vision
 -co-ordination
- strength
- sensation
- speech and swallowing
- bladder control
- sexuality
- cognitive function

There is no typical MS. Most people with MS (PWMS) will experience more than one symptom, and though there are symptoms common to many people, no person would have all of them.

Visual disturbances:
- blurring of vision
- double vision (diplopia)
- optic neuritis
- involuntary rapid eye movement
- (RARELY!) total loss of vision

Balance and co-ordination problems:
- Loss of balance
- tremor
- unstable walking (ataxia)
- giddiness (vertigo)
- clumsiness of limb
- lack of co-ordination

Weakness: this can particularly affect the kegs and walking

Spasticity:altered muscle tone can produce spasticity or muscle stiffness which can affect mobility and walking spasms

Altered sensation: tingling, numbness (par aesthesia), or burning feelings in an area of the body other indefinable sensations

Pain: may be associated with MS, e.g. facial pain (such as trigeminal neuralgia), and muscle pains

Abnormal speech:
- slowing of speech
- slurring of words
- changes in rhythm of speech
- difficulty in swallowing (dysphagia)


Fatigue: A debilitating kind of general fatigue which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of themost troubling) symptoms of MS.
 

Bladder and bowel problems: bladder problems include the need to pass water frequently and/or urgently, incomplete emptying or emptying at inappropriate times. bowel problems include constipation and, infrequently, loss of bowel
control.

Sexuality and intimacy:
- impotence
- diminished arousal
 - loss of sensation

Sensitivity to heat: this symptom very commonly causes a transient worsening of symptoms Cognitive and emotional disturbances:
 

How is a diagnoses made ?

It must be made clear from the outset that there is no single test which can be carried out which will positively diagnose MS with 100% accuracy. For this reason people, with MS often find that they are in the dark as to the nature of their illness for some time, as the symptoms which present will often be vague and could be attributed to a number of other, different conditions. It is therefore fairly common for a period of time to elapse before a diagnoses can be made. The clinical requirement is for there to have been at least two attacks affecting different areas of the central nervous system, occurring attwo different times, at least one month apart.

Several tests and procedures are needed to establish a diagnoses of MS and they will include the following investigations. Medical history Investigation for MS will normally start with a visit to your GP, who will ask for a medical history including
details of past signs and symptoms. Whilst the type ofsymptoms may suggest MS, a full medical examination will be required to confirm the diagnoses.

Neurological examination
The first role of the neurologist is to test for abnormalities in nerve pathways. These normally present themselves by change in eye movements, co-ordination, weakness, balance disturbance, unusual sensations, speech difficulties and reflexes. At this stage, the examination cannot conclude what is causing the abnormality and other possible causes have to be eliminated.  Testing of visual and auditory evoked potentials These are tested by attaching electrodes to the scalp and measure brain waves responding to visual and auditory stimuli. Normally, the brains response to such stimuli is  almost instantaneous, but when demyelisation hasoccurred a, delay in the response is usually apparent.

Lumbar puncture
After a local anaesthetic is given to numb the skin, a needle is inserted into the back to withdraw a small amount of the cerebrospinal fluid (the fluid which flows around the brain and spinal cord). This is then tested for the presence of antibodies, which can occur with MS. This test is not in itself conclusive, as these antibodies can also occur in neurological conditions other than MS. Whilst uncomfortable, this procedure is not normally painful.

Magnetic Resonance Imaging (MRI)
The MRI scanner takes detailed pictures of the brain and spinal cord in which plaques or lesions may be seen. Whilst this is the only test in which the lesions can be seen, it cannot be regarded as conclusive because other conditions can cause identical abnormalities. There are lesions found, in otherwise healthy people particularly the elderly, which are not related to any ongoing disease process. Whilst it is also true that not all lesions will be picked up by the scanner, the evidence provided by the MRI, when taken, in conjunction with the supporting evidence from the medical history and the neurological examination will be a very significant indicator towards confirming the diagnoses of MS.problems with short term memory, concentration, judgment or reasoning. Whilst some of these symptoms are immediately obvious, others such as fatigue, altered sensation, memory and concentration problems are often hidden symptoms. Above are shown some symptoms which may occur. However, it must be remembered that people with MS have a normal life expectancy: eighty per cent will not be totally reliant on a wheelchair. Many people affected with MS canand do experience a full life, including love, marriage, children, work and happiness.