Multiple Sclerosis This area will provide information, education, and links on MS.
WHAT IS MULTIPLE SCLEROSIS?
This is simple to answer: multiple means "many" and sclerosis means "scarring" - a literal description of the damage that is seen in the brain and spinal cord, but it is not a diagnosis because it does not indicate a cause for the disease. Why then do specialists insist that there must be more than one area affected? This is simply because the first description of the disease, by the French neurologist Charcot, over one hundred years ago, as "la sclerosis en plaques", is translated as "multiple" sclerosis, implying several symptoms. Yet single attacks - such as optic neuritis or Bell's Palsy - are often the first symptoms of MS but many patients never have another, different attack.
However, Magnetic Resonance Imaging (MRI) of patients, with a single symptom and no evidence of other problems on clinical examination, has shown that about three-quarters of these patients already have multiple areas of the brain affected. The patient may never have another, different attack so, in these circumstances what can the neurologists say? MRI has also shown this in children as young as four, so MS is not, as frequently stated, confined to adult years.
Our nervous system controls everything we do through a highly complex network of nerve cells and interconnecting fibres that run through the body. The disease process in MS can result in structural damage to the nerve cell, to the myelin sheath which surrounds the fibres and to the central core or fibre which transmits the signals to and from the brain and the rest of the body. When such damage is present, the passage of these signals can be delayed or partially or completely blocked by the very scars which, in other parts of the body, are the mark of healing. There are preferred sites such as the eye nerves, areas around the ventricles (cavities) of the brain and the spinal cord at mid-neck level. The areas of damage always develop around small veins and are associated with the leakage of proteins and even red blood cells into the nerve tissue. This causes inflammation and swelling.
The cells which are most vulnerable to damage are not the actual nerve cells but those, called oligodendrocytes, which form the myelin sheaths. In recent years, most of the research into MS has been upon the immune system and it has been suggested that there may be links to viruses. But there is no evidence whatever of infection in MS - despite samples of brain tissue having been taken from living patients during an attack in an attempt to culture a virus. So MS is definitely NOT infectious. The immune changes are seen in many different diseases of the nervous system and hence are secondary features.
Although it is frequently stated that the cause or causes of MS have not been clearly identified, some distinctly similar conditions can be noted. For example, divers can develop a form of disease with pathology which is similar to MS, the damage in the nervous system is due to leakage from small veins. In divers, this leakage is formed by gas bubbles in the circulation formed during decompression (air embolism). Similarly a natural disease process can occur due to particles of fatty tissue entering the circulation. This is called 'fat embolism' and this form of embolism can occur in a variety of conditions causing tissue damage, e.g. with fractures.
Magnetic Resonance Imaging has shown that the initial damage in MS is often "silent", that is without the production of symptoms. The presence of the damage may then be unmasked by a problem or problems totally unrelated to the cause of the disease. For example, most patients have discovered that heat can make them worse (and American neurologists have provoked symptoms with the 'hot bath test' since 1937), but this does not mean that hot baths cause MS! They just exacerbate the existing problems. Various other things can provoke attacks especially, for example, bladder infections.
SIGNS AND SYMPTOMS
There is no single test for diagnosis of MS and other possible explanations for the symptoms are first eliminated. For a patient to be told they have MS, neurologists consider they need to find evidence that there are at least two sites damaged in the nervous system (two is the minimum number to be 'multiple'). The signs and symptoms of MS depend upon which nerves are affected. Different nerves control different functions and sensations in the body hence people can experience a variety of symptoms some of which come on suddenly, others appearing gradually.
These symptoms may include blurred or double vision, strange sensations in and difficulty controlling and moving arms and legs, weakness, fatigue, 'pins and needles', impaired balance and bladder problems. There are numerous symptoms and anyone with MS may experience a few or many of them - and no two people will have precisely the same spread and severity of symptoms. Similarly, people with MS may experience a variety of symptoms at different times and to varying levels of severity.
The appearance of symptoms is, understandably, alarming. Almost as bad is the uncertainty of how they may develop or what may happen - and the feeling that the whole future of both patients and their dependants is suddenly under threat.
Symptoms in MS can appear or become more pronounced when the MS is active and may lessen or disappear when it is quiet. Often symptoms can feel - and may be - worse when a person is tired, under stress (upset, worried, anxious), or suffering from some common and totally unrelated condition such as a bad cold or influenza, an infection, or injury.
These fluctuations do not necessarily mean that the MS is getting worse; only that everyone has good days and bad days, and that the influence of other, unrelated, conditions is real and should not be ignored.
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