Multiple sclerosis (MS) is a long-term neurological disorder that affects more than 100,000 people in the UK and has a wide range of symptoms. It’s an attack by the body’s own immune system on myelin, the white tissue that protects the brain, spinal cord and body nerves. It produces inflammation, plaques and scars that slow down/block nerve signals and can permanently damage the nerves. In some cases, tackling multiple sclerosis, surgeries and drugs, has lead to diabetes.
New approved drugs are changing the impact of this chronic condition and reducing the chances of diabetes development and complications.
Multiple sclerosis often starts around midlife and is twice as common in women, but the cause isn’t known, although it may be linked to living further away from the equator, viral/bacterial infections, low vitamin D levels, smoking, obesity and/or genes. One in 50 people with an affected close relative may develop MS.
These can affect any part of the nervous system, producing abnormal sensations (numbness, tingling, shooting pains) and movement (weakness, stiffness, clumsiness, spasms). It may start with blurred or painful vision, trigger vertigo or affect hearing, balance, bladder control, sexual function, taste, smell and even body temperature control. It can also disrupt thinking, memory, mood, speech and ‘automatic’ body functions, such as heart rate and blood pressure. Fatigue is common with MS.
Four out of five people start with relapsing remitting MS and are well in between attacks; remyelination sometimes occurs. Half develop secondary progressive MS in the next 10 years, gradually worsening with fewer periods of remission and more than one in 10 have primary progressive MS that gradually deteriorates, from the start.
This depends on how the symptoms affect you. Relapses (sometimes triggered by infections) are often helped by steroids, given by intravenous drip. If they’re needed frequently, long-term treatment that targets the immune system (such as azathioprine) may reduce relapses. Disease-modifying therapies (DMTs), such as beta interferon and glatiramer-acetate injections, have now been approved by NICE, the National Institute for Health and Care Excellence, although not everyone who could benefit receives them yet. DMTs reduce the number of relapses, longer-term damage and work better if given early. If they don’t work quickly and MR scans indicate severe inflammation you may be offered haematopoietic stem cell transplantation (HSCT) which uses your own healthy stem cells (from bone marrow) to replace unhealthy immune system cells and halt(but not reverse) nerve damage. DMTs can have powerful side-effects, so you’ll be counselled carefully about the pros and cons. Ongoing research suggests the cholesterol lowering drug, simvastatin, could help secondary progressive MS.
Living with Multiple Sclerosis
Team care from your GP, neurologist, MS specialist nurse and other health/social-care professionals is important. Medication can treat symptoms such as bladder problems, spasms and dizziness. Physio, complementary and alternative medicines can help, too. Cannabis based Sativex can be prescribed for some patients. You may need aids for personal care and mobility or, eventually, a carer and qualify for benefits. Counselling and support from the psychology services and the MS Society can help.
Tests You ‘May Need’
- A neurological examination and/or inner-ear tests, as other common conditions can produce similar symptoms.
- Blood tests, including those for mineral and vitamin deficiencies, infections, diabetes and thyroid disease.
- Electrical conduction tests (such as Visual Evoked Potential tests) to see how fast nerve signals are travelling between the brain, eye and other body areas.
- A brain MR scan to rule out other conditions and look for plaques and demyelination, although symptoms don’t always match inflammation patterns.
- A lumbar puncture a chemical test of cerebrospinal fluid obtained from around the spinal cord, using a local anaesthetic.
E320 – Multiple Sclerosis and New Treatments – www.diabetic.today