Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic condition that affects the central nervous system.

Over two million people are currently diagnosed with MS across the world, with the condition being three times more likely to occur in women than in men.

Often people are diagnosed between the ages of 20-40, however, the condition can affect younger and older people. The risk of an individual developing MS is increased if they have a close relative who suffers from the disease.

Pathophysiology

Multiple Sclerosis is the result of damage to the sheath that surrounds and protects nerve fibers in the brain and spinal cord.  This sheath is called myelin. This damage leads to scarring or lesions in the nervous system; sclerosis is a Greek word meaning ‘scarring’. This damage simply means that your nerves are not able to send signals properly within the brain, spinal cord, and optic nerves.

The first episode of inflammation and subsequent demyelination in the central nervous system is called Clinically Isolated Syndrome (CIS). This CIS can progress to MS if further activity develops.

The cause of MS remains unknown, although many theories exist. One theory is that MS is an autoimmune disease caused by genetic or environmental factors. Another theory is that MS is caused by a virus.

Types of MS

It is difficult to determine the prognosis in an individual with MS due to the fact that the condition varies from one person to the next. However, a 95% normal life expectancy is likely for all individuals with MS.

MS can be separated into three categories, or types, each ranging from mild to severe:

• Relapsing-remitting MS (RRMS)- Those with RRMS have partial or full recovery following attacks. It is the most common type of MS with 70%-75% of people having this type of MS, to begin with.
• Secondary progressive MS (SPMS)- Those with SPMS find they experience relapsing-remitting, which then becomes more progressive, with disability becoming slowly worse independent of relapses.
• Primary progressive MS (PPMS)- This type of MS is progressive from the very beginning and symptoms often do not remit. Of all those diagnosed with MS, 15% are diagnosed with PPMS.

Symptoms

The symptoms experienced by individuals with MS vary from person to person, as it depends on which part of the nervous system is affected and how badly it is damaged.  This is why two individuals with MS will not have the same experiences.

Symptoms of MS include:

• Muscle spasms
• Problems with weakness, coordination, and balance
• Fatigue
• Vertigo
• Pins and needles
• Neuralgia (chronic pain arising from the trigeminal nerve in the face)
• Visual disturbances including blurred vision
• Bladder incontinence
• Constipation
• Depression
• Cognitive difficulties
• Memory loss
• Difficulty swallowing

Treatments

The aims of MS treatments are to:

1. Alleviate symptom
2. Decrease the risk of relapses and disease progression

Treatments include:

• Disease-modifying therapies
  These therapies, also referred to as immunotherapies, act by modifying the immune system and thus slow the number and severity of attacks on the central nervous system. This simply means that the myelin sheaths that protect your central nervous system are less damaged as they are attacked less.
• Steroids
  This medication is used to decrease inflammation and how severe the attack is.
• Immune suppressants

This includes the medications methotrexate and mitoxantrone. These are often used in individuals with progressive MS.

• Botox

This can be used to treat urinary incontinence after first-line treatments fail. First-line treatment usually involves anticholinergic medications.

• Fampyra

This is used with the aim to improve walking.

• Sativex

This is used to alleviate symptoms of spasticity.

In addition to the treatments above, physicians will also employ other methods to help treat MS symptoms such as; exercise, diet, and equipment and aids.

Written by Jade Marie Evans, PharmD

References:

• Health direct . 2018. Multiple sclerosis (MS).
• NHS choices . 2018. Overview Multiple sclerosis . [Online]. [9 June 2019]. Available from: https://www.nhs.uk/conditions/multiple-sclerosis/