Multiple sclerosis isn’t a terminal illness, but it’s a lifelong condition that can have a devastating impact on quality of life. Advances in research and treatments have improved the lives and life expectancy of sufferers in the last 10 years.
What is Multiple Sclerosis (MS)?
Multiple Sclerosis (MS) is a lifelong disease of the brain and spinal cord. It occurs when the immune system attacks the protective sheath that covers nerve fibres which affects the messages from the brain being delivered to the rest of the body. There is no cure for the disease, but there are treatments which can manage symptoms.
How Common is MS?
According to the National Multiple Sclerosis Society, 200 people are diagnosed with MS every week in the US.
Over 25,000 Australians are living with MS with on average 10 people being diagnosed every week. Most people are diagnosed between the ages of 20 and 40 years. The number of people living with MS in Australia increased from 95.5 per 100,000 in 2010 to 103.7 per 100,000 in 2017. The increases in rates are being experienced worldwide and are thought to result from people living longer with MS.
Around 2.3 million people around the world are living with MS.
Who Is Most at Risk of MS?
MS is the most commonly acquired central nervous system disease affecting young adults. The general population has a 1 in 750-1000 risk of developing MS.
Men Vs Women
Women are four times more likely to suffer from MS than men. There’s little difference between the number of males and females being diagnosed before puberty, but in older children and adults more females than males are diagnosed.
MS isn’t the only autoimmune disease that strikes women more often than men. It’s thought that a female's second X chromosome makes them better able to fight off viruses than males’ XY chromosomes. The strong immune system can sometimes turn against its own tissues, resulting in an autoimmune disease. Around 6.4% of women have an autoimmune disease compared to 2.7 percent of men.
Genetic Link
While MS isn’t considered an inherited disease, there is a genetic link to MS and a person’s chance of developing MS increases if a parent, sibling or child has MS. Researchers have identified around 200 genes as contributors to the overall risk of developing MS.
Environmental Factors
Researchers have identified several factors as increasing the overall risk of developing MS, including:
Obesity
Being overweight in childhood, adolescence and early adulthood can increase the chance of later developing MS, particularly in girls.
Geographic
The further away from the equator you live, the greater your risk of developing MS. There is twice the prevalence of MS in Tasmania as there is in Queensland.
Vitamin D
Vitamin D may also be a potential geographic cause, those people who have low levels of vitamin D in their blood are at greater risk of MS. Vitamin D may protect against immune-mediated diseases like MS.
Smoking
A person’s smoking can increase their risk of developing MS. Stopping smoking can slow the progression of the disease.
Infections
Researchers have researched several bacteria and viruses to determine if they increase the chance of developing MS. The viruses studied have included measles, canine distemper, human herpesvirus-6, Epstein-Barr virus (EBV), and Chlamydia pneumoniae. Research is still in its early phase but they have established a strong link between an EBV infection, the virus that causes glandular fever, followed by an MS diagnosis.
Prevention of MS
Researchers believe that if they could develop a vaccine for EBV, 90% of MS cases could be prevented. Even without an EBV vaccine, if the other risk factors of obesity, vitamin D deficiency, and smoking were eliminated, 60% of MS cases wouldn’t occur.
Another research study found that women with at least one child are at least 50% less likely to develop MS than if they never had children. An increased number of pregnancies may deliver further reductions in risk, with the study showing women with three children had a 75% lower risk of early MS symptoms, most probably because of hormones.
What is an Autoimmune Disease?
An autoimmune disease is when the immune system attacks the body because it mistakes parts such as joints or skin as foreign. Some autoimmune diseases attack one part of the body, while others affect the entire body. While it’s not known what causes autoimmune diseases, genetics, a Western diet, exposure to chemicals and infections are probable causes.
Other Types of Autoimmune Diseases
MS is just one of a large group of autoimmune diseases. Other common types include:
- Diabetes Type One
- Psoriasis
- Rheumatoid Arthritis
- Inflammatory Bowel Disease
- Addison’s Disease
- Graves’ Disease
- Hashimoto’s Disease
- Celiac Disease
- Lupus
Symptoms of MS
Because of MS’ attack on the central nervous system, the symptoms of MS are many and varied. Some people living with MS won’t suffer more than mild numbness in limbs, while others develop severe paralysis. No two cases of MS are the same, even within family groups. Some symptoms are obvious, while others aren’t. Not all symptoms impact everyone living with MS.
Some of the early signs of MS include:
- Fatigue and tiredness
- Muscle spasms & weakness
- Poor vision
- Numbness and tingling
- Pain
- Thinking and learning problems
- Sexual dysfunction
Other MS symptoms include:
- Dizziness and vertigo
- Mood changes
- Difficulty walking, coordination
- Sensitivity to heat/cold
- Slurred or slowing of speech
- Chest or rib pain known as the ‘MS hug’
- Bladder and bowel dysfunction
- Chronic fatigue
Diagnosis of MS
Doctors have used several methods to help with diagnosing MS and ruling out other conditions that have similar symptoms to MS. They may start with taking a medical history and neurological exam before moving on to a range of tests including an MRI, lumbar puncture and evoked potential test.
A Magnetic Resonance Imaging (MRI) test and blood tests are used to diagnose MS. The MRI can detect abnormal tissue in the body and any irregularities. It also helps doctors evaluate the layer of myelin that protects nerve fibres. MS damages myelin which means the fat content is reduced and stripped away so it can no longer repel water in the body. Evidence of demyelination proves the MS diagnosis.
A lumbar puncture can also help with diagnosing MS. A sample of cerebrospinal fluid (CSF) is removed for testing to see if it contains:
- Elevated levels of antibodies called IgG antibodies
- Proteins
- High levels of white blood cells
The lumbar puncture can rule out other conditions with similar symptoms. Not everyone with MS has abnormalities show up in the lumbar puncture.
An evoked potential test looks for impaired transmission on the optic nerve pathway. It tests how long it takes for the nerves to respond to visual stimulation. This is a common test because damage to the optic nerve occurs early in most MS patients.
The blood tests don’t diagnose MS, but can help rule out other conditions with similar symptoms such as HIV/AIDS, Lyme disease, and syphilis.
Types of MS
According to MS Australia, there are three types of MS including:
Relapsing remitting (RRMS)
The most common form with approximately 85% of people initially being diagnosed with this form, characterised by partial or total recovery after flares or relapses.
Secondary progressive (SPMS)
Over 50% of sufferers will develop SPMS within 10 years of diagnosis. This stage is a relapsing-remitting course which becomes steadily progressive. Ninety percent of sufferers have reached this stage after 25 years.
Primary progressive (PPMS)
Around 15% of people living with MS are diagnosed with this form, usually after the fact when it becomes clear the disease is progressive and doesn’t remit.
Impact of MS
When people are first diagnosed with MS, often their initial fear is they will be in a wheelchair within five years, however this is rarely the case. Many people have very minor symptoms that have little to no impact on their mobility, but there are others with more severe forms.
But for others the symptoms of MS have a big impact. The quality of life for a MS sufferer in Australia in 2017 was 31% less than the general population and for someone with a severe form of MS, their quality of life is 41% lower compared to people with MS with no disability. Someone living with MS can now expect to live 95% of a normal life expectancy.
Treatments for MS
Research has improved the lives of people living with MS. Today their symptoms are less severe, quality of life has improved and so has life expectancy.
Drug Therapies
Treatment for people living with MS has increased significantly since 2010. From 2010 to 2017, there has been an increase of 40% of those people with MS taking a drug that reduces the number and severity of relapses and slows or halts the progress of the disease. Around 64% of people with MS in 2017 used disease-modifying therapy.
The two primary purposes of the drugs are to either:
- Ease symptoms
- Reduce the risk of relapse and disease progression
A wide variety of drugs are prescribed to relieve symptoms and improve quality of life. Some drugs work to improve muscles stiffness and assist in mobility, others reduce inflammation and the immune response, and protect myelin and nerve cells from damage.
For those people with progressive MS, doctors may prescribe immune suppressants. Immunotherapies help with relapsing-remitting MS by modifying the activity of the immune system. Steroids can control the severity of an MS attack by reducing inflammation.
Diet and Exercise
Some people claim certain foods and diets such as Swank or Paleo have helped with their symptoms of MS but research is still continuing to find any conclusive evidence. It’s recommended that patients eat a healthy, well-balanced diet. There are also no recommended supplements that have been effective in clinical trials.
There are known benefits of regular exercise after an MS diagnosis to:
- Improve strength and endurance
- Reduce MS-related fatigue
- Manage spasticity
- Avoid secondary complications
For those young adults being diagnosed with MS today, they can have hope for their future well-being that previous generations didn’t have. While there is still no cure, there are more effective treatments available than ever. With more research and advances in technology, there may one day be a cure.