MS Awareness

• MS is not easy to diagnose as it can cause a number of different symptoms
• its hard to pin point when MS begins
• the early signs and symptoms are different for everyone
• diagnosis can take several months
• a number of different causes need to be explored and many different tests need to be carried out
• The tests for MS
  • Neurological examination
    • Your neurologist will ask you lots of questions about past symptoms and problems – this is known as ‘history taking’. It helps the neurologist get a better picture of you and can help identify any other problems that may explain current symptoms.
    • A physical examination checks for changes or weaknesses in your eye movements, leg or hand coordination, balance, sensation, speech or reflexes. Whilst a neurologist may strongly suspect MS at this stage, a diagnosis won’t be given until other test results confirm MS.
  • Magnetic resonance imaging (MRI)
    • Confirm a diagnosis in over 90% of people with MS
    • An MRI scanner uses a strong magnetic field to create a detailed image of your brain and spinal cord. It is very accurate and can pinpoint the exact location and size of any damage or scarring (lesions).
    • To get the image of a person’s brain and spinal cord they must lie down and enter a small tunnel in the centre of the MRI scanner. The process can take between 10 and 60 minutes and is painless, though some people can feel a little claustrophobic in the scanner. The Newcastle Upon Tyne Hospitals NHS Foundation Trust has produced a video which explains what to expect when you have an MRI
  • Evoked Potentials
    • This involves testing the time it takes for your brain to receive messages
    • This is carried out by placing small electrodes on your head to monitor your brainwaves responding to what you see or hear.
    • If myelin damage has occurred, messages to and from your brain will be slower.
  • Lumbar Puncture
    • This is sometimes called a spinal tap.
    • It involves a needle being inserted into the space around your spinal cord, under local anaesthetic.
    • A small sample of the fluid that flows around the brain and spinal cord, called cerebrospinal fluid, is then taken and tested for abnormalities.
    • People with MS often have antibodies in this fluid.
    • People commonly report headaches following a lumbar puncture. The medical staff should advise you on how to manage this. Newer, smaller needles cause less discomfort, although they’re not yet being widely used.

Types of MS

• Relapsing remitting MS (RRMS)
  • 85% of people with MS are diagnosed with this type
  • distinct attacks of symptoms which then fade away either partially or completely
• Secondary progressive MS (SPMS)
  • sustained build up of disability. Completely independent of any relapses
  • Many people with RRMS go on to have SPMS
• Primary progressive MS (PPMS)
  • Affects 10-15% of people diagnosed with MS
  • Symptoms gradually get worse over time, rather than appearing as sudden attacks (relapses)

MS in children

• MS in children is rare. Around five to ten per cent of young people with MS will experience MS symptoms before the age of 16.

Benign MS

• If you have a small number of relapses followed by a complete recovery, you may be described as having benign MS.
• Benign MS can only be diagnosed retrospectively, after a period of at least 10 to 15 years.

Signs and Symptoms

• Early signs
  • Optic neuritis
    • one of the more obvious early symptoms, but this is often because this is a more ‘concrete’ symptom as opposed to ‘vague’ neurological symptoms like numbness or tingling.
• Balance
  • affect people differently
  • vary from day to day
• Bladder
  • two main types – storage and emptying
  • Doctors don’t know why some people get one or the other and other people get a bit of both
• Bowel
  • bowel incontinence
  • constipation
  • the two can be linked but not always
• Eyes and sight
  • Optic neuritis
    • inflation of the optic nerve
    • varies from blurred vision to complete loss of sight
    • this is the nerve that carries messages from the eye to the brain
  • Eye movement
    • the nerve pathways that control the movement of their eyes can be affected
    • eyes may not move smoothly
    • the two eyes may be out of alignment
• Fatigue
  • an overwhelming sense of tiredness that occurs after very little activity
  • affects people in different ways
  • may change daily or hourly
• Memory and thinking
  • cognitive problems
    • most people will be affected mildly
    • difficulty concentrating
    • being unable to find the right word
    • short term memory problems
• Mental health
  • depression
  • stress
  • anxiety
• Pain
  • invisible symptom
  • pain might feel like squeezing, crushing, cold, hot, stabbing or burning
  • MS hug – a tightness in the chest
• Sexual problems
  • around 50-80% of women will experience some form of sexual dysfunction
  • Men may have problems with erections and ejaculation
• Spasms and stiffness
  • common symptom
  • affect at least 20% of people with MS
  • affect people differently and vary over time
• Speech
  • 40-50% are affected by speech difficulties
  • MS damage in different parts of the brain affects the way speech is produced. This can cause problems that may come and go including slurred speech, low volume or a weak voice.
• Swallowing
  • damage to any part of the brain that controls swallowing
  • damage between the brain and the spinal cord
  • Temporary changes in swallowing can happen during a relapse and improve, or disappear completely, over time.
  • can become more difficult in the long term
• Tremor
  • trembling or shaking movement
  • cannot control voluntarily
  • for some people the tremor is so mild that they’re the only one aware of it
  • two kinds of tremor
    • intention tremor
      • comes when you want to reach for something
    • postural tremor
      • when you have a tremor as you sit or stand
  • MS tremors are usually caused by damage to myelin in an area of the brain known as the ‘cerebellum’, and the nerves leading to and from it.
  • For a small percentage of people, it is more severe, causing limbs to shake so that you need help with everyday tasks like eating and drinking.
  • Specialists like physiotherapists and occupational therapists can assess the problems that tremor and other movement difficulties are causing you.
• Pseudobulbar Affect
  • a neurologic effect that occurs in 10 percent of people with MS, although some research suggests a much larger percentage. It is characterized by sudden, uncontrollable expressions of laughter or crying without an apparent trigger.

• No one knows the exact cause of MS, but it is likely a mixture of genetic and environmental factors
• Genes and family history
  • MS is not directly inherited as there is no single gene that causes it – unlike cystic fibrosis
  • it is likely a combination of genes that make some people more susceptible to developing MS, but not everyone with this gene combination will develop MS. Genes are only a part of the story.
  • while MS can occur more than once in a family it is only a 2% chance of a child developing MS when a parent is affected.
• Environmental factors
  • MS is more common in places further away from the equator
  • It is virtually unheard of in Malaysia or Ecuador, but relatively common in Britain, North America, Canada, Scandinavia, southern Australia and New Zealand.
  • Viruses
    • It is not clear why people further away from the equator are more likely to develop MS. Perhaps a bacteria or virus plays a role
    • No single virus has been identified as definitely contributing to MS, but there is growing evidence that a common childhood virus, such as Epstein Barr virus (which can cause glandular fever), may act as a trigger.
    • This theory is still unproven and many people who do not have MS would have also been exposed to these viruses, so just like genes, they are unlikely to be the whole story.
  • Vitamin D

• There is a growing amount of research that suggests that a lack of vitamin D could be a factor in causing MS.
• Most of our Vitamin D is from exposure to sunlight.
• Low levels of vitamin D have been linked to higher numbers of people developing many different conditions, including MS.
• Smoking
  • smoking appears to increase the risk in developing MS
  • It is not clear why but one theory is that the chemicals in the cigarette smoke affect the immune system
  • There is still more we need to know about the link between smoking and MS. This includes whether the risk increases the more someone smokes, how smoking interacts with other risk factors for MS and whether smoking also affects progression in MS.

• Multiple sclerosis (MS) is a neurological condition which affects around 100,000 people in the UK.
• Most people are diagnosed between the ages of 20-40, but it can affect younger and older people too.
• Roughly three times as many women have MS as men.
• a condition of the central nervous system
• the coating around nerve fibres (called myelin) is damaged, causing a range of symptoms.
• once diagnosed MS stays with you for life
• Treatments and specialists can help to manage the condition and its symptoms
• The cause is unknown and a cure is yet to be found but research is progressing fast
• To understand what happens in MS, it’s useful to understand how the central nervous system works.
  • A substance called myelin protects the nerve fibres in the central nervous system, which helps messages travel quickly and smoothly between the brain and the rest of the body.
  • In MS, your immune system, which normally helps to fight off infections, mistakes myelin for a foreign body and attacks it. This damages the myelin and strips it off the nerve fibres, either partially or completely, leaving scars known as lesions or plaques.
  • This damage disrupts messages travelling along nerve fibres – they can slow down, become distorted, or not get through at all.
  • As well as myelin loss, there can also sometimes be damage to the actual nerve fibres. It is this nerve damage that causes the increase in disability that can occur over time.