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Reviewed by Dr Dan Rutherford, GP
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What is multiple sclerosis?
Multiple sclerosis is a permanent disease that is characterised
by a slowly progressive disablement.
The disease is more common in women than men, and often appears
between the ages of 20 and 45. It is more frequently seen in the temperate
zones, such as northern Europe, than the subtropical and tropical areas of the
World. In Europe and North America multiple sclerosis is the most common cause
of neurological disability in young adults, affecting 1 in 800 of the
population.
The covering of the nerves in the brain and the spinal cord are
repeatedly attacked and their function is reduced.
What are the causes of multiple sclerosis?
Although it is not known why people get MS, research suggests that a combination of genetic and environmental factors may play a role.
The
probable cause is thought to be a combination of hereditary factors, an
environmental trigger like a
virus and a defect in
the immune system.
What are the symptoms of multiple sclerosis?
Multiple sclerosis attacks can develop in a matter of days or
weeks and they may leave the patient more handicapped. Another attack will
follow, often from another part of the nervous system, after a longer or
shorter period.
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Inflammation of the optic nerve is the most usual starting
symptom. There is a reduction of sight and pain behind the eyes. After some
weeks the vision is improved. It may return to normal or there may be a
permanent reduction of sight - often the central vision.
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Paralysis.
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Disruptions in feeling (loss of sensation).
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Problems with urination.
Since all parts of the nervous system can be attacked, the
symptoms may be very different.
How does the doctor make the diagnosis?
Interviewing the patient will often reveal several separate
episodes with different symptoms which have subsided completely or partly. On
examination, the doctor may suspect multiple sclerosis but further tests are
necessary for a confirmed diagnosis.
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MRI scanning of the
brain and the spine will reveal characteristically situated scar
tissue.
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Neurophysiological examinations will show a reduced rate of
conduction of the nerves.
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An examination of the spinal cord will identify the presence of
antibodies.
Taking the patient's history along with the results of the
above tests will allow the doctor to make a diagnosis.
How is multiple sclerosis treated?
Unfortunately, it is not possible to cure the disease at the
present time, or to predict its behaviour in an individual person.
Steroid treatment may shorten the
duration and possibly also the degree of severity of the separate attacks. It
is given in the form of tablets or an injection but has no effect on long-term
outcome.
Symptoms may also be treated with a variety of medicines, such
as
painkillers,
muscle relaxants,
antidepressants and
medicines for preventing urinary
incontinence.
and interferon-beta are both treatments that
are able to modify disease activity, and are now available on the NHS due to a
recent cost-sharing scheme announced by the Government and the manufacturers of
these drugs.
Interferon-beta treatment seems to reduce the number of new
attacks and the extent of the damage. During the last few years special
sub-groups of multiple sclerosis have been treated with
interferon beta-1a
(Avonex or
Rebif)
and
interferon beta-1b (Betaferon).
It is injected either into a muscle or under the skin. A serious concern is the
high expense as the treatment is long term.
Trials are now underway into the effect of cannabinoids
(cannabis-based medication) on MS and early studies are promising. These
suggest that such drugs may be helpful in reducing spasticity in muscles, but
it will be a while yet before any treatment along these lines becomes available
on prescription.
Physiotherapy for the separate attacks is important to help
restore the functions lost.
Active research into potential therapies for multiple sclerosis
is ongoing, and it is hoped that more effective treatments will be found in the
next few years to help people with this condition.
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Based on a text by Dr Per Rochat and Claus Madsen, specialist
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Last updated 02.03.2005
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