Multiple Sclerosis

What it is

Multiple sclerosis is an autoimmune disease that affects nerve cells in the brain, spinal cord and eyes. It attacks the nerve’s protective insulating cover, a fatty material called myelin. When myelin is damaged or inflamed, nerve impulses become distorted or interrupted.

We don’t know what triggers MS, but we do know it is Canada’s disease. One in 340 of us have it, and three more people are diagnosed every day. Women are three times more likely than men to have MS. The disease is more common in those with a northern European background. But no one is immune.

The average age of onset is the prime of life – between the ages of 30 and 35. Yet young children and older adults can get it too.

There are four types of MS.

• 1

  Clinically Isolated Syndrome (CIS) is the first episode of symptoms, lasting for at least 24 hours. People who experience CIS may or may not go on to develop the other three forms of MS.

• 2

  Relapsing-remitting MS (RRMS) is the most common form of the disease, affecting about 85 per cent of those diagnosed. People with RRMS have temporary and unpredictable relapses or flare-ups of symptoms. In between relapses, they may partially or completely recover.

• 3

  Secondary-progressive MS (SPMS) follows RRMS. Over time, distinct relapses and remissions are less obvious and symptoms worsen, although there are sometimes plateaus. About half of people with relapsing-remitting MS move on to this type of multiple sclerosis within 10-20 years of diagnosis.

• 4

  Primary-progressive MS (PPMS) involves a slow accumulation of disability. Symptoms may stabilize for a while, and patients might see minor temporary improvement, but overall, there are no periods of remission. About 15 per cent of people with MS have PPMS.

Symptoms

Fatigue, weakness and tingling are often just the beginning. Impaired sensation, lack of coordination and vision problems can also be symptoms. So too might cognitive impairment and mood changes.

Everyone’s symptoms are different. Some people might lose the ability to walk, but have no cognitive impairment. Others might have trouble with memory and attention, but have no problem with eyesight. Still others might suffer from blurred vision and even temporary blindness.

Diagnosis

MS is a difficult disease to confirm, especially early on, since symptoms can be similar to other illnesses.

Neurologists diagnose MS based on a combination of symptoms and neurological exams. This includes magnetic resonance imaging (MRI) which lets doctors see soft tissues like nerve cells in the brain and spinal cord. MRIs can pinpoint telltale lesions on nerve cells.

There are also tests to measure the speed of nerve impulses. Slowed impulses are a symptom of myelin damage. These tests are called evoked potential (EP) tests and involve stimulating specific nerve pathways and then measuring the responding electrical activity in the brain.

A third test involves a spinal tap to draw cerebrospinal fluid from between two bones in the lower spine. Cerebrospinal fluid is a clear, colourless liquid that bathes the brain and spinal cord. Certain changes in this fluid can indicate an abnormal immune response suggesting MS.

Treatment

There is no cure for MS, but the earlier patients seek treatment for symptoms, the better. The disease often causes more damage in the first year than in later years.

Some treatments are in pill form, some are injectable and some require infusions – a slow drip of drugs delivered intravenously.

Right now, there are more than 14 drugs for treating MS and in some cases, we can put patients into remission for up to eight years. However, there is only one drug for the primary-progressive form of the disease.

There are also treatments for specific symptoms, such as physical therapy, which involves stretching and strenghening exercises to help make it easier to perform daily tasks. Combined with canes or walkers, physical therapy can help manage gait problems. Muscle relaxants can help ease painful stiffness or spasms, especially in the legs. Other medications can reduce the fatigue often associated with MS.