MS - Multiple Sclerosis

Multiple Sclerosis, often abbreviated to MS, is a progressive and degenerative disease of the neuro-muscular and central nervous system (CNS)[4]. Multiple Sclerosis (MS) is present in more than 100,000 people in the UK alone [5]. However, is is thought that MS affects more than 2.3 million worldwide [4].

In the early onset of the disease the symptoms can be very mild. The person diagnosed with the disease will be able to function normally and their day-to-day life will be unaffected. However as the disease progresses to a more serious form the symptoms can irreversibly change someone’s life.[1]

There are 4 types of MS. Firstly, Relapsing, Remitting MS (RRMS), this is characterised by short and sporadic periods of symptoms. Secondly, Secondary Progressive MS (SPMS), 65% of people with RRMS will go on to develop SPMS, this is characterised by incomplete recovery of attacks. Next, Primary Progressive MS (PPMS) will only affect a small amount (10%) of people with MS. PPMS is characterised by a progressive worsening of symptoms with no major attacks. Finally, Benign MS, this shows no clinical symptoms with few mild attacks. [2][4]

What is the Cause? How does it occur?

The cause is believed to be multi-factorial [4]. The first argument is the autoimmune attack, this it where the T-cells attack the Myelin Sheath that coats the nerves, reducing its efficiency. There are also genetic predispositions to contracting MS. This is located around the human leukocyte antigen (HLA) on chromosome 6 that acts as presenting proteins in the immune response. Studies have shown that MS Suffers have over-active T-cells in their immune system which attacks the myelin sheath of the Central Nervous System (CNS)[6], this can go on to damage the cells that make it (oligodendrocytes). Without insulation or protection the nerve can become damaged, known as lesions. Lesions can go on to cause slowed or preventative transmission[4]. There is a mutation within this system that leads to enhanced progression of MS. There has also been studies to show the impact of an adequate diet on MS symptoms. Low levels of Vitamin D3 have been linked with the disease as have low levels of essential Omega 3 fatty acids, this is because they maintain the health of the neural tissues [2][8].

Multiple Sclerosis directly affects the nerve transmission around the body. Our body is very well connected with approximately 95 to 100 billion nerves within the body[3]. Nerves are the transmission systems of the body, think of them like roads. Messages are passed down these roads, much like cars passing down a motorway to a destination. The messages travel through the nerves to up regulate/stimulate or down regulate/sedate a target tissue. Majority of human nerves are insulated with a fatty material known as the Myelin Sheath. This wraps around the nerve increasing its insulation and speed of conductivity.

A common physical sign of MS is a progressive loss of the insulating tissue [2]. Without the Myelin Sheath nervous transmission loses its efficiency. Using the Road Analogy from before, if the roads are missing or of poor quality, cars will not be able to travel down them, meaning they reach their destination slower, or not at all.

The diagnosis of MS looks at damage to the CNS, brain, spinal cord and optic nerve using an MRI machine. The Doctor will attempt to assess whether the damage occurred within a month of one another and finally rule out any other diagnoses[4]. Other methods, include assessing brain waves to determine the integrity of the Myelin Sheath. The most invasive of the tests is the lumbar puncture to which extracts ans tests antibodies present in spinal fluid. [5]

What are its symptoms? How is it diagnosed?

The CNS connects many areas of the body hence why the symptoms are so varied. The symptoms are as listed below:[4]

• Fatigue, this affects 80% that suffer from MS and reduces activity.
• Difficulty walking, Spasticity, and numbness. All 3 of these symptoms relate because they are due to the sporadic under-stimulation of the peripheral limbs, due to reduced sensory strength delivered to the extremities.
• Visual Difficulties, many describe it as progressive blurred vision, and eye pain.
• Bladder problems, such as frequent urination and incontinence. This is managed by pelvic floor exercises, medication or catheterization.
• Weakness and Muscle Stiffness, caused by a lack of stimulation to the muscle. Over long periods of not using a muscle frequently it can lose tone and strength.
• Pain, 55% of people reported they suffered from pain that affected their life in some way or another.
• Other symptoms, frequently reported by MS diagnosed patients is, clumsiness, tremors, slurred speech, cognitive and emotional changes.

Who does it affect?

MS has obvious patterning in who and where it affects. It seems to affect people aged 20-40 years and it more common in women than it is in men. A recent statistic calculated that MS is three times more common in women than it is in men. [2][7]

MS seems to have small pockets of geographical distribution where it is most common. It is generally not found in Asia, Africa, or America, but is very common in areas such as Canada and Scotland. Due to its geographical distribution it’s infrequently seen in any other race apart from Caucasians [7]. MS is thought to be a genetic issue, that gene is colloquially known as the “Viking Gene”. The history of MS has been traced and it has been found to be present only in areas where the Vikings invaded and settled.

What is the course of treatment?

The main form of treatments attempt to treat the symptoms instead of the main cause. Because MS is a degenerative and progressive disease it’s very hard, near impossible, to then cure due to its progression rate. By reducing the life-altering effects the disease has it can help people to manage their disease better. Treatment courses include diet, physiotherapy, exercise and drugs.

If you have MS it’s important to consume the correct volumes of energy (protein and carbohydrate) to prevent lethargy and wastage. A great tip is to base all meals around a high starch, fibre and carbohydrate source, such as pasta or potatoes. Moreover, it’s thought that being severely underweight or severely overweight can lead to worsened symptoms. In addition, it’s advised that a person take Vitamin D3, Omega 3 and (omega 6) Primrose oil, to maintain health of the neural tissue, and function of the body. Omega 3 and Vitamin D3 can be sources in other places other than supplements. Rich sources of Omega 3 include oily fish (salmon) walnuts, soy beans and avocado. On the other hand, Vitamin D can be sourced not only from food, but the sun. UVB rays are the most potent Vitamin D sources. In addition, Vitamin D can be found in egg yolks, oily fish, milk and cod liver oils .Other tips may include taking laxatives to ease constipation. [9]

Mild exercise such as stretching, walking, or cycling has been show to improve symptoms of MS, strengthen muscles, maintain mobility and prevent relapse.