Multiple Sclerosis

Multiple Sclerosis is the most common neurological disorder among young adults. Around 85,000 people in the UK have MS. MS is the result of damage to myelin – a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body. When myelin or nerve fibres are destroyed, the messages from the brain, for example, to move a body part, and messages to the brain, for example, to interpret sensations, are not transmitted effectively. Body movement may be slow or uncoordinated and body sensations may be altered.

While at first there may be healing and return to normal function (remission) later, a scar (called a plaque) may form which permanently interferes with motor and sensory control. Damage to the myelin sheath can occur at any time and affect any part of the brain or spinal cord. The disease is called multiple sclerosis because there are multiple areas of scarring (sclerosis).

Each person with MS has a unique set of symptoms depending on where in the central nervous system the demyelination occurs. Common symptoms include weakness, numbness, lack of co-ordination, loss of balance, visual problems, loss of bladder or bowel control, mood swings, cognitive problems, difficulty speaking, and fatigue. MS is not fatal or contagious. However, a small number of people have a severe type of MS which may shorten life expectancy.

The course may result in relapsing and/or progressive symptoms. The commonest course is a relapsing pattern, characterised by episodes of neurological dysfunction (relapses or attacks), with partial, or complete, recovery. Over time, the individual becomes permanently disabled. The degree and rate of progress of disability varies form individual to individual. A minority of patients with MS has progressive disability from onset.

Because of the heterogeneity of presenting symptoms and signs, clinical diagnosis may take some time. There is no single laboratory test that proves someone does or does not have MS. Tests such as magnetic resonance imaging (MRI), evoked potentials, and analysis of cerebrospinal fluid may strongly suggest MS. A neurologist or other physician will make the diagnosis when there are definite signs of MS in multiple parts of the central nervous system. This usually means that there has been more than one episode of neurologic impairment and more than one symptoms; for example, weakness in one arm and the other leg, weakness and numbness or weakness and bladder problems. Because some people have only a single episode, or mild symptoms that come and go, long periods of uncertainty before the diagnosis is made are not uncommon.

The cause of MS remains obscure. Destruction of myelin seems to be due to an abnormal response of the immune system in which cells that normally protect against illness react against the body’s own tissues (an autoimmune response). A virus or other agent to which someone is exposed in childhood might trigger this abnormal immune response in later life.

Female prevalence exceeds male by a ratio of about 2 to 1. Males are more likely to suffer the progressive form of disease. Females are more likely to be of early age onset. MS normally presents in young adults, onset before the age of 16 years being unusual – 3% of cases. It rarely presents after the age of 60 years. A recent symptom management survey carried out by the Multiple Sclerosis Society suggested that approximately 50% of patients with established disease were aged between 36 and 50 years.

The number of "possible" cases referred for investigation exceeds the number of confirmed cases by a factor of three or four. The incidence of confirmed multiple sclerosis in Scotland is about10 per 100,000 population per year, with a prevalence of about 150 per 100,000. Of these 150, about 60 will be severely disabled, of whom 30 will need special care and five might be in institutional care. A general practitioner can expect to see one new case of definite multiple sclerosis every six years and will have two or three patients with the condition.

Service developments in Glasgow

Epidemiology and needs assessment of multiple sclerosis in Glasgow

Revive Scotland MS Therapy Centre

Multiple Sclerosis Society Scotland