Multiple Sclerosis

Multiple Sclerosis, also known as MS, is a disease of the central nervous system which affects around 30 people per 100,000, with estimates that it affects more than 2.3 million people worldwide.1 As such, it is the most common immune-related disorder that affects the central nervous system. As a prevalent disease in both developed and developing countries, it is an important topic for everyone to be aware of.

What is MS?

The term Multiple Sclerosis refers to scars (or sclerae) which are found on the white matter of the brain and spinal cord of patients with the condition. The disease attacks part of the brain cells called the myelin sheaths, which are a type of fatty insulation that help electrical signals in the brain to travel smoothly and to pass signals to other nerves accurately. When this insulation is damaged, it is harder for brain cells to communicate because information is lost as signals move from one cell to the next.

This damage leads to a range of physical and mental symptoms, including fatigue, difficulty walking, vision problems such as blurred vision, problems controlling the bladder, numbness or tingling in different parts of the body, muscle stiffness and spasms, problems with balance and co-ordination, and problems with thinking, learning and planning.2 Symptoms generally begin to show between the ages of 20 and 35, with an average age at onset of 29.2 years.3 The condition is lifelong and also degenerative, meaning that the symptoms will worsen over time.

It is currently not known what causes MS to develop, though it is thought that the cause may be either a problem with the immune system causing the body to attack itself, or a problem with the cells in the brain which produce the myelin that acts as insulation.4 There is no known cure for MS, however, there are a range of treatments which can help to mitigate symptoms and slow the progression of the disease.

The course and prognosis of MS

There are two different types of MS which progress in different ways. Relapsing Remitting MS is the more common type, affecting 8 out of 10 people with the disease.2 These people suffer from occasional worsening symptoms, known as “relapses”, in which the patient has severe symptoms for a period of days, weeks, or months. They will then slowly improve over time, and go into periods called “remission” in which symptoms are lessened or absent altogether. These periods of remission can last for years, however, relapses can occur again without warning.

The second type of MS is called Primary Progressive MS, in which symptoms worsen over time. There are no periods of remission, and the symptoms continue to become more severe. A small number of people are diagnosed with Primary Progressive MS immediately, though many people with Relapsing Remitting MS will eventually develop Primary Progressive MS as their condition worsens.

MS itself is rarely fatal, though patients can suffer complications related to the disease such as chest or bladder infections, or swallowing difficulties. However, new treatments are improving the life expectancy of people with MS, and patients now have a life expectancy of 5 to 10 years lower than average.2

Treatment of MS

There are a variety of treatments available for MS, depending on the particular symptoms that someone is experiencing. For example, in the case of Relapsing Remitting MS, relapses can be treated with a course of steroids to speed up recovery from the relapse period by reducing nerve inflammation. Alternatively, if a patient is recently diagnosed and is not responding to steroids, then plasma exchange can be used as a treatment. This is where blood is taken from a patient and then separated into plasma (the liquid part of blood) and blood cells. The blood cells are mixed with a type of protein and are then returned to the patient's body. This process removes autoantibodies from the blood to lessen symptoms.5

Other types of treatment are intended to slow the progression of the disease as a whole. Intervening early in the progression of MS helps to lower relapse rate by counteracting the immune response which occurs in the beginning stages of the disease. These treatments include the use of beta interferon, the most common medication for the treatment of MS, which is injected to prevent inflammatory cells from crossing from the blood into the brain, therefore reducing neuron inflammation.6 Other drugs used include immunosuppressants, which suppress the body's autoimmune response in order to prevent the autoimmune system from attacking itself7, and drugs which target proteins on immune cells to prevent nerve damage caused by white blood cells.8

In addition to these treatments to slow the progression of the disease, other treatments help to improve patient quality of life. These can include physical therapy to help strengthen muscles and make it easier to perform everyday tasks, muscle relaxants to ease cramps and muscle stiffness, and/or medications to reduce fatigue or to treat symptoms such as depression or pain.

Caring for someone with MS

Caring for a person with MS is challenging because the disease is unpredictable. A patient may be able to live independently for months or years at a time, then they may rapidly worsen and need considerable support during a relapse. This unpredictability also makes the disease psychologically challenging for the patient, because it is difficult for them to make future plans when they do not know how their symptoms will be. Caring for someone with MS therefore requires patience and empathy, with the ability to adapt to new circumstances quickly.

One useful role that a caregiver can take, in addition to supporting the patient in practical and psychological ways, is to keep a record of symptoms. Doctors can better treat a condition when they understand its progression, so having a diary of symptoms and their severity is very helpful.

If you or someone you know is suffering from MS and want to know more about financial support for caregivers, then Burd Home Health can help. Find out more at https://www.burdhomehealth.com/

References

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577

2 https://www.nhs.uk/conditions/multiple-sclerosis/symptoms/

3 http://whqlibdoc.who.int/publications/2008/9789241563758_eng.pdf

4 https://link.springer.com/article/10.1007%2Fs12016-011-8287-6

5 https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274

6 https://link.springer.com/article/10.2165%2F11591110-000000000-00000

7 https://www.ncbi.nlm.nih.gov/pubmed/15261554

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