Multiple Sclerosis or MS is a disease of the central nervous system characterised by inflammation and demyelination, the gradual loss of the insulation material around the nerves known as myelin. Sclerosis is the term given to describe the thickened and scarred small lesions which occur in the nerve tracts. The disease is continually active and forms new lesions regularly leading to gradually increasing levels of disability. The most common form of MS is the relapsing and remitting kind, meaning there are periods of worsening followed by at least partial recoveries.
As the neurological lesions can now be identified on MRI scanning this has greatly improved the accuracy and certainty of diagnosing multiple sclerosis. No specific agent which might trigger MS has been isolated but as it gets better with pregnancy and worse afterwards it may be that hormonal factors are involved. A large number of factors have been considered as potentially important such as infections, but infections have only been shown to be present in one out of every four times the disease presents.
The course of multiple sclerosis varies greatly and the disease can be classified partly by the characteristic pattern of incidence. More frequent in Caucasian peoples, MS increases in frequency as the latitude increases, in other words the risk is greater the further north the person lives. The likelihood of getting MS may be affected by genetic factors but environmental matters are known to be important as moving from a lower risk region to a higher risk region before fifteen years carries within it the risk of the new region.
The estimated number of patients suffering from multiple sclerosis in the world is two and a half million and as many are younger people this causes significant disability and interference with work and family life. While MS is not the direct cause of death it is estimated that it reduces life expectancy by between five and seven years perhaps secondary to urinary infections and other side effects of immobility. The largest numbers occur in northern European populations with women more commonly presenting than men in proportion of 1.6 to 2.1 times. Under fifteen years old and over fifty years women outnumber men 3 to 1, perhaps due to hormonal differences.
The primary and progressive form of multiple sclerosis is more likely to occur in male patients and the relapsing form in female patients. When an attack of the condition occurs it shows up in new symptoms of the central nervous system with symptoms typically occurring over a period of time and in different body areas. Loss of feeling in a body part, optic nerve involvement leading to double vision and sudden loss of muscle power in a limb are all examples of typical attacks. However, there may be no specific attacks but rather a steady deterioration in both mental and physical abilities.
The relapsing and remitting type of multiple sclerosis exhibits acute attacks with an improvement again afterwards, however most sufferers in this very common group will eventually become more steadily worse which is termed secondary progressive disease. If affected by the primary progressive type the patient typically undergoes a steady worsening in ability without remissions, with deterioration to complete paralysis. This type of disease responds less well to usual treatments and is more disabling. Relapsing and progressive disease occurs when the disability from attacks is not recovered in remissions.
While MS symptoms often spread themselves over a variety of functions in any particular person they can be focussed on more specific areas such as mostly affecting balance, vision or mental abilities. At some point in the course of the disease sufferers seem to reach a threshold where they worsen in a neurodegenerative pattern rather than secondary to inflammation. The complex nature of multiple sclerosis means that virtually any neurological system can be affected in minor ways, or the damage can be concentrated in one particular part of the system. Even without much evidence of nervous system lesions people can lose significant mental ability.
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Manchester Physiotherapist visit his website.