Multiple Sclerosis (MS) is the most common acquired chronic neurological disease affecting young adults. It is most commonly diagnosed between the ages of 20 and 40, and in Australia every three out four people diagnosed are women. Over 2.3 million people around the world have MS.
In MS, the body’s own immune system mistakenly attacks and damages the fatty material – called myelin – that surrounds nerve cells. Myelin is important for protecting and insulating nerves so that the electrical messages that the brain sends to the rest of the body travel quickly and efficiently. During an MS attack myelin is damaged and destroyed – a process called demyelination – and patches of nerve cells become exposed and then scarred (sclerosis). This renders the nerve cells unable to communicate messages properly and leaves them open to attacks from the immune system. This means that the brain cannot talk to the other parts of the body properly, resulting in a range of symptoms that can include a loss of motor function (e.g. walking and hand and arm function, loss of sensation, pain, vision changes and changes to thinking and memory).
Some MS symptoms include:
- Loss of coordination/clumsiness
- Speech difficulties
- Hand shaking/tremor
- Loss of bladder/bowel control
- Extreme fatigue
- Sight impairments
- Memory lapses
- Loss of sensation or changed sensation including pain and tingling
Myelin can be repaired by the body and individuals can recover well from MS attacks. However, for some, recovery can sometimes by incomplete or symptoms can worsen over time.
The effects and symptoms of MS vary greatly from patient to patient, but MS is typically classified into one of several common forms of MS.
- Relapse-Remitting MS (RRMS) - is the most common form of MS; it is characterised by flare-ups of the neurological symptoms of MS, also known as relapses or attacks, followed by periods of recovery or remission.
- Secondary Progressive MS (SPMS) – is a secondary phase of relapsing remitting MS that can develop years, to decades following the initial onset of relapsing symptoms. SPMS is characterised by a progressive worsening of symptoms (accumulation of disability) over time, with no obvious signs of remission.
- Primary Progressive MS (PPMS) – is diagnosed in approximately 10-15% of people with MS. PPMS is characterised by a progressive worsening of symptoms and disability right from the beginning, without periods of recovery or remission.
- A definite diagnosis of MS requires evidence for at least two attacks separated by an interval of time and/or lesions in the brain and spinal cord that indicate previous attacks. If there is only evidence for the current attack, then an individual may receive a diagnosis of clinically isolated syndrome (CIS). Some people with CIS may later go on to develop MS.
The cause of MS is not known but a range of environmental and genetic risk factors have been identified as playing a role. These include:
- Having a close relative with MS or another autoimmune disease, however, MS is not a hereditary disease.
- Living further away from the equator.
- Having a previous viral infection.
You can read more about the potential triggers for MS on the MS Research Australia website https://msra.org.au/news/unravelling-causes-ms/
Diagnosing MS can be difficult as patients exhibit similar symptoms to other diseases that affect the central nervous system. As yet, there is no single test to diagnose MS. If your doctor suspects MS they will order a MRI (magnetic resonance imaging) scan of your brain and/or spinal cord to check for areas of scarring and inflammation. This will be done in conjunction with a clinical exam to review coordination, motor skills, vision, balance, sensory, language and emotional function. Other tests your doctor may order can include an eye examination by an ophthalmologist and a lumbar puncture (spinal tap) and electrophysiological tests to assess the conduction of nerve impulses.
MS is diagnosed if:
- There have been at least two attacks, at least one month apart, which last a minimum of 24 hours.
- More than one area of the central nervous system is damaged. The areas of damage may be evident on clinical testing, shown by MRI scanning, or electrophysiological testing.
- Other criteria, such as the presence of oligoclonal bands, are present in the spinal fluid.
For more information please see MS Research Australia’s article on the 2017 [McDonald criteria] https://msra.org.au/news/refining-diagnosis-people-ms/ for diagnosing MS.
Currently there is no cure for MS. There are two broad groups of treatment for people with MS. There is treatment to prevent relapses and slow disease progression or treatment to alleviate specific symptoms of MS. The types of drugs used depend on a number of factors, including the type of MS a person has.
Some of the disease modifying treatments available are:
- Immunotherapy medications reduce the frequency and severity of attacks, which means the myelin sheaths are subjected to less damage; works by modifying the activity of the immune system; most often prescribed for people with relapsing-remitting MS – these may be injections, infusions or tablets
- Methylprednisolone, taken as pills or an infusion; steroid medication is used to control the severity of an MS attack, by easing inflammation at the affected site
- Immune suppressive treatments such as methotrexate or mitozantrone, may sometimes be used, especially for people with very severe forms of MS
- Treatments in development: a large number of new therapies being trialled in the treatment of MS and there is a significant focus on developing treatments for the progressive forms of MS
For more information about treatments, please see MS Australia’s page https://www.msaustralia.org.au/about-ms/medications-treatments.
As with any medication, people with MS may experience drug-related side effects and these should be discussed with your treating physician.
Some treatments for specific symptoms include:
- Muscle problems:a combination of medication may ease muscle problems, including stiffness and tremors. Physiotherapy is also recommended.
- Fatigue:some studies have found that medication used to treat the sleep disorder narcolepsy is helpful in controlling MS-related fatigue.
- Neurological symptoms:in some cases visual disturbances and walking difficulties can be helped with medication,
- Continencetreatment for continence problems may include special exercises, medications, continence aids (such as disposable pads) and certain dietary changes.
- Neuropsychological problems:treatment for depression or anxiety may include counselling or medication; memory problems and other cognitive difficulties can be better managed with professional help from a neuropsychologist.
While there is no cure for MS, most people with MS live near-normal life spans. Several studies have suggested that a person with MS lives around seven years less than people without MS. Most people with MS tend to die from the same conditions that people without MS tend to die from, such as cancer and heart disease.
Most people with MS will not become severely disabled, but many experience pain, discomfort and other difficulties that can have an impact on quality of life. Medical research continues into the cause, treatments and a possible cure for MS.
Donate Your Brain
It is now possible to make a fruit fly with Parkinsons Disease and a mouse with the features of Alzheimers Disease, but unless you can relate what you find back to the human brain, you don’t really know if you’re on the right track. Since brain tissue is not generally available for research use during life, this means research must be done on post mortem tissue.
People with MS in Australia can choose to donate their brain and other tissues of the nervous system for the purposes of MS research after their death. Where people have provided their consent before death, tissue is retrieved and preserved as rapidly as possible (within 24 hours) after death and stored together with the donor’s medical history.
The MS Research Australia Brain Bank facilitates MS research by distributing high quality and well-characterised MS tissue to researchers for investigating the cause of and developing a cure for MS. Registered MS Brain Donors and their families are kept up to date on the latest progress in MS research.
Researchers need to study the brain and spinal cord tissue from people with different MS subtypes and disease stages to find out how and why demyelination occurs. Researchers also need to study brain and spinal cord tissue to develop ways of repairing and preventing tissue damage.
Donating your brain to the MS Research Australia Brain Bank after your death will:
- Help researchers find diagnostic markers for early detection
- Help researchers develop better treatments
- Help researchers discover possible cures and prevention measures for MS
See also Australian Brain Bank Network
Further information and support
Read more at Virtual Medical Centre
Australian MS organisations:
MS Research Australia – is the largest national not-for-profit organisation dedicated to funding, coordinating and advocating for multiple sclerosis research as part of the worldwide effort to solve MS. Its goal is to accelerate research into the cause, better treatments and prevention, with the aim of ultimately finding a cure for MS.
MS Australia is the national peak advocacy body representing people with MS in Australia. MSA campaigns about important issues by working closely with its state organisations, national advocates and MS Research Australia, to ensure submissions and work is based on the latest evidence.
There are also several organisations in Australia that can provide information, resources and services.
The Australian MS state societies offer a range of support services including counselling, assessment, employer liaison, work simplification strategies, support groups, respite accommodation and much more. Services vary across organisations and locations;
International MS organisations:
There are also several organisations globally that can provide information and resources for people living with MS.
- MS Trust
- MS International Federation
- International Progressive MS Alliance
- National MS Society
- MS Society of Canada
- Multiple Sclerosis Society UK
Reviewed February 2018 by MS Research Australia, https://msra.org.au/