What is MS?
How is it caused?
What is Demyelination?
Is it easily diagnosed?
Can MS be treated?
What are the types of MS?
Who gets MS?
Is MS fatal ?
Does MS always cause paralysis?
Is MS contagious or inherited?
Can MS be cured?
What medications and treatments are available for MS?
Why is MS so difficult to diagnose?

Multiple Sclerosis, often referred to as ‘MS’, is widely considered to be an autoimmune disease that mistakenly attacks the central nervous system. In people with Multiple Sclerosis (MS), the layer that protects nerves in the brain is damaged by their own immune system and this causes a lack of protection for the central nervous system and a loss in the ability to properly transmit nerve signals.

Doctors call multiple sclerosis a ‘chronic’ condition, but we do not know everything about it. It is often difficult for a specialist to properly predict what path the MS disease may take in separate patients. Multiple sclerosis is not contagious and therefore cannot be transmitted from one person to another. MS is also not an inherited disease, in the direct sense but some research has suggested that a disposition to developing the problem can exist in certain genes. Most people who have multiple sclerosis can expect to live to a normal, or nearly normal age. Only a minority of sufferers actually develop any serious disability as a result of having the disease. Typically multiple sclerosis is first diagnosed in people between the ages of twenty and forty five, although there have been cases of very young children and very old people also developing the disorder. MS is a debilitating disease which often causes people to steadily encounter more problems with day to day life as the time goes on.

The early symptoms of multiple sclerosis can vary greatly, anywhere from eye sight problems to slurred speech to pins and needles. Multiple sclerosis symptoms vary greatly between sufferers but characteristically, the symptoms tend to occur, then go away and then come back again. Over time some people may develop paralysis or severe motor disabilities, whilst in others the symptoms may go away completely.

There is no known cure for multiple sclerosis. However, several types of multiple sclerosis treatments have proven to be helpful. MS treatment is aimed at returning bodily functions after an attack, preventing new attacks, and preventing disability with drugs and physiotherapy.

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Specialists who have dedicated their working careers to researching multiple sclerosis still cannot answer this question. While MS itself is neither inheritable nor contagious, it is widely considered that multiple sclerosis develops in those who have a predisposition to these types of autoimmune disorders. A certain type of genetic makeup can make one person more or less able to develop this kind of problem.

What is missing is the trigger – something external to the individual physiology which triggers the development of multiple sclerosis. Many consider this unidentified ‘trigger’ in MS to be some form of toxin or virus, which in most people does little harm. The scientific thinking speculates that when someone who is already susceptible to developing multiple sclerosis comes into contact with this type of toxin or virus they then develop the autoimmune disease.

Scientists can be much more specific about what causes the symptoms of multiple sclerosis, however. Sometimes our immune systems work in reverse and health tissue and cells can be attacked thanks to a disease. This is of course what the term ‘autoimmune’ refers to in the case of multiple sclerosis.

In particular one type of tissue is affected in cases of MS – Myelin. Myelin is a protecting form of tissue which is typically found in the sensitive areas of the central nervous system. These areas include the brain, the spinal cord and the optic nerves. Myelin is essentially the protective layer that surrounds the nerve endings in these important parts of the body. This layer of tissue also helps the electrical impulses travel from the brain to the nerves and muscles. With multiple sclerosis, myelin is removed from these areas and replaced by internal scars which are called ‘sclerotic tissue’. It is the lack of myelin which causes the symptoms of MS. When any part of this myelin sheathing is destroyed, nerve impulses to the brain are interrupted and distorted.

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Demyelination is the term used for a loss of myelin, a substance in the white matter that insulates nerve endings. Myelin helps the nerves receive and interpret messages from the brain at maximum speed. When nerve endings lose this substance they cannot function properly, leading to patches of scarring, or ‘sclerosis’, occurring where nerve endings have lost myelin. It is these areas of scarring that give multiple sclerosis its name.

Demyelination is the root cause of the symptoms that people with MS experience. When it occurs, the speed at which messages pass along the nerves is slower than normal. Even when the patches of scarring caused by demyelination have healed and re-myelination has occurred, the response time of the nerve endings tends to remain slower.

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MS is not always easy to detect or diagnose because early symptoms can be so spotty, because other diseases of the central nervous system have some of the same warning signs and because we do not yet have a definitive neurological or laboratory test that can confirm or rule out MS. With the increase in awareness of MS amongst people and medical personnel, and wider availability of investigations like the MRI scan are helping rapid and accurate diagnosis of MS in India. Continued efforts for community awareness are vital in progress in this direction.

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Yes, to a degree. Much can be done to help MS persons’ function at their best level on a day-to-day basis.

Although there is no known cure for multiple sclerosis, there are several types of multiple sclerosis treatments that have proven to be helpful. There are medications, which can provide symptomatic relief for acute attack and for more chronic disease. Muscle relaxers aid in reducing spasms. Bowel and urinary distress, pain and other manifestations of the disease can also be eased by judicious use of medication, taken under a physician’s direction.

Different MS treatments are used for patients experiencing acute attacks and it depends on what phase of the multiple sclerosis the patient is in. MS treatment is aimed at returning function after an attack, preventing new attacks, and preventing disability.

During symptomatic MS attacks, patients may be hospitalized and are usually given high doses of corticosteroids, such as methylprednisolone, to help stop attack sooner and leave fewer lasting effects. For relapsing-remitting MS, there are 5 approved drugs available for treatment including three interferons: Interferon beta-1a (Avonex and Rebif) or beta-1b (Betaseron / Betaferon). A fourth multiple sclerosis medication is glatiramer acetate (Copaxone), a mixture of polypeptides which may protect important myelin proteins by substituting itself as the target of immune system attack. The final multiple sclerosis medication, mitoxantrone is effective but has side effects of cardiac toxicity.

Alongside the multiple sclerosis drugs that are available there are a number of therapies that can help offer relief from the symptoms of multiple sclerosis and some patients have found them to also help reduce the problems associated with the disorder. In particular the MS symptoms such as bladder weakness, pain, spasticity, sexual problems and reasoning issues have associated therapies available. There are other treatments that help. Counseling, to decrease emotional stress; physio and Occupational therapy; attention to diet and adequate rest – all of these are extremely valuable in helping a person remain independent and be able to lead a full and productive life.

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The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease:

1.Relapsing-Remitting MS
In this form of MS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years. Frequency - approx 25%

2.Benign MS
After one or two attacks with complete recovery, this form of MS does not worsen with time and there is no permanent disability. Benign MS can only be identified when there is minimal disability 10-15 years after onset and initially would have been categorised as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory). Frequency - approx 20%

3.Secondary Progressive MS
For some individuals who initially have relapsing-remitting MS, there is the development of progressive disability later in the course of the disease often with superimposed relapses. Frequency - approx 40%

4.Primary Progressive MS
This form of MS is characterised by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years. Frequency - approx 15%

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Anyone may develop MS but there are some patterns. Twice as many women as men have MS. Studies suggest that genetic factors make certain individuals more susceptible than others, but there is no evidence that MS is directly inherited. It was considered to occur more commonly among people with northern European ancestry. Now with newer diagnostic tools like MRI available, people of African, Asian, and Hispanic backgrounds are also diagnosed with MS.

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In rare cases MS is so malignantly progressive it is terminal, but most people with MS have a normal or near-normal life expectancy. Severe MS can shorten life in the same way as smoking or hypertension may increase the risk factor.

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No. Moreover, the majority of people with MS do not become severely disabled. Two-thirds of people who have MS remain able to walk, though many will need an aid, such as a cane or crutches, and some will use a scooter or wheelchair, because of fatigue, weakness, balance problems, or to assist with conserving energy.

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No. MS is not contagious and is not directly inherited. Studies do indicate that genetic factors may make certain individuals susceptible to the disease.

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Not yet. There are now FDA-approved medications that have been shown to "modify" or slow down the underlying course of MS. In addition, many therapeutic and technological advances are helping people manage symptoms. Advances in treating and understanding MS are made every year, and progress in research to find a cure is very encouraging.

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Doctors may recommend treatment with one of the FDA-approved "disease-modifying" drugs as soon as possible following a definite diagnosis of MS with active or relapsing disease. These drugs help to lessen the frequency and severity of MS attacks, reduce the accumulation of lesions (areas of damage) in the brain, and may slow the progression of disability. Other approved disease-modifying drugs may help in reducing disability and/or the frequency of attacks in patients with secondary-progressive, progressive-relapsing or worsening relapsing-remitting MS. This drug is a chemotherapeutic agent. The lifetime dose is limited to prevent heart damage. In addition to drugs that address the basic disease, there are many therapies for MS symptoms such as spasticity, pain, bladder problems, fatigue, sexual dysfunction, weakness, and cognitive problems. People should consult a knowledgeable physician to develop a comprehensive approach to managing their MS , and take an informed decision regarding the chosen line of treatment.

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In early MS, symptoms that might indicate any number of possible disorders come and go. Some people have symptoms that are very difficult for physicians to interpret, and these people must "wait and see." While no single laboratory test is yet available to prove or rule out MS, magnetic resonance imaging (MRI) is a great help in reaching a definitive diagnosis.

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