Multiple sclerosis (MS) is an immune-mediated condition of the central nervous system. In MS, the insulating coating around nerve fibers (called Myelin) is damaged. Myelin is necessary for the transmission of nerve impulses through nerve fibers.
If damage to Myelin is minimal, nerve impulses travel with minor interruptions; however, if the damage is severe, nerve impulses may be completely disrupted, and the nerve fibers themselves can be damaged.
These damages cause a range of symptoms experienced by people with MS.
It is estimated that 2.5 million individuals worldwide suffer from MS and there are about 1000 sufferers here in Malaysia. Most people are diagnosed between the ages of 20 and 40. Three times as many women have MS as men. MS is the leading cause of disability in the young.
Once diagnosed, MS stays with you, but treatments and can help you to manage the condition and its symptoms.
MS in Malaysia
There are approximately 1000 MS sufferers in Malaysia. However, only about 400 to 500 are diagnosed suffering from this disease. One of the key problems is because of the poor public awareness of this disease makes them not want to come forward for treatment.
In Europe and in the US, MS Societies have been instrumental in fostering increased awareness of the disease and unite family and friends and we hope to achieve the same
MS Society of Malaysia hopes to create more awareness among people with MS, caregivers and the general public.
The cause of Multiple Sclerosis is still unknown but studies suggest that it can be genetics, a person’s environment and even a virus may play a role.
Genes and family history
MS is not considered a hereditary disease; however, it’s likely that a combination of genes make some people more susceptible to developing MS.
While MS can occur more than once in a family, it is more likely this will not happen. There’s only around a two per cent chance of a child developing MS when a parent is affected. Several studies also show that people who move to a different region of the world before the age of 15 acquire the new region’s risk to MS.
MS is more common in people who live farther from the equator, although exceptions do exist. These exceptions include ethnic groups that are at low risk far from the equator as well as groups that have a relatively high risk close to the equator.
Decreased sunlight exposure resulting in decreased vitamin D production has also been put forward as an explanation.
No single virus has been identified as definitely contributing to MS, but there is growing evidence that individuals having been infected by the Epstein-Barr virus are at a higher risk of getting MS. This theory is still unproven and many people who do not have MS would have also been exposed to these viruses.
Smoking has been shown to be a risk factor in MS. Studies has found that smoking appears to increase someone’s risk of developing MS. There is still more we need to know about the link between smoking and MS. Stress may also be a risk factor although the evidence to support this is weak. Association with occupational exposures and toxins—mainly solvents—has been evaluated, but no clear conclusions have been reached. Vaccinations were studied as causal factors; however, most studies show no association. Several other possible risk factors, such as diet and hormone intake, have been looked at; however, evidence on their relation with the disease is “sparse and unpersuasive”.
The history given by persons suspected to have MS and neurological examination done by the doctor are the mainstay of diagnosis in MS. Magnetic Resonance Imaging (MRI), Evoked Potentials (EP) and occasionally Lumbar puncture (LP), are tests that may be useful in confirmation when a diagnosis of MS is suspected.
It is important to remember that there is no one test that can be used to diagnose MS. The diagnosis of MS is only made once other potential causes for symptoms have been ruled out.
MRI is a medical imaging technique
commonly used in radiology to visualize the internal function and structure of the body. In MS, the MRI can provide pictures of the areas of damage (lesions) in the central nervous system, caused by MS, and can also reveal whether there is loss of brain volume. MRI might have to be done more than once after an interval of months for a diagnosis to be made in some individuals.
EP is a test that measures the speed of nerve impulse conduction in the pathways of the central nervous system. In MS, nerve impulse conduction is slowed related to the myelin damage, and EP’s can record this slowing.
LP can be helpful when other investigations are negative. A small needle is inserted at the base of the spine and a small amount of the cerebrospinal fluid (CSF) is collected to test for the presence of proteins, which are known to be present with inflammation in the central nervous system.
Blood tests are done to look for other autoimmune conditions that may mimic Multiple sclerosis
There are four sub-types of the disease and it would be essential to differentiate these as management and treatment may differ for each type. The following are the 4 subtypes:
Relapsing-remitting MS (RRMS) is characterized by unpredictable relapses, which then fade away either partially or completely (remission) with no new signs of disease activity for months or years. Around 85 per cent of people with MS are diagnosed with this type of MS.
Primary-progressive MS (PPMS) is characterized by a slow accumulation of disability, without any attacks. It may stabilize for periods of time, and even offer minor temporary improvement but overall, there are no periods of remission. Approximately 10 per cent of people diagnosed with MS have PPMS.
Secondary-progressive MS (SPMS) follows a diagnosis of RRMS. Over time, distinct relapses and remissions become less apparent and the disease begins to progress steadily, sometimes with plateaus. About half of people with relapsing-remitting MS start to worsen within 10-20 years of diagnosis, often with increasing levels of disability.
Progressive-relapsing MS (PRMS) is the rarest course of MS, occurring in only about 5 per cent of people diagnosed. People with this form of MS experience relapses with or without recovery and steadily worsening disease from the beginning.
MS is complex, and has many symptoms.
Symptoms are unpredictable and vary greatly from person to person. Most people won’t experience them all, certainly not at the same time.
Physical symptoms of MS might commonly include problems with vision, balance, bladder, bowel, speech, swallowing and tremor. Other symptoms might include dizziness, fatigue, stiffness and spasms.
MS can affect memory and thinking, and also have an impact on emotions. Like all MS symptoms, you might experience this in varying degrees, or not at all.
Sexual function for both men and women can also be affected for people living with MS. There are ways to manage these symptoms, and the more you and your partner understand what’s causing them, the better you can tackle them.
There are a variety of ways to manage symptoms, ranging from pharmacological treatments to non-medicinal strategies such as physiotherapy, occupational therapy, exercise programs and alternative and complementary treatments. Speak to your neurologist or physician to get the best treatment.
There are many different ways to manage MS. This might include drug treatments for individual symptoms or relapses, diet, exercise and alternative therapies.
Early treatment of MS can improve symptoms and reduce the frequency of relapses. It can be frustrating if treatments aren’t suitable for you or don’t work as well. People with MS find it useful to actively manage their health by altering their diet and engaging with exercise and making lifestyle changes.
Food and Drug Administration(FDA) approved treatment for MS
SUBCUTANEOUS INJECTION (UNDER THE SKIN) – INTRAMUSCULAR (DEEPER TISSUE)
INTRAVENOUS INFUSION (GIVEN IN HOSPITAL)
DISEASE MODIFYING THERAPY AVAILABLE IN MALAYSIA
Choosing the right treatment
Treatment for Multiple Sclerosis will vary from patient to patient. Neurologist/Physician will select an appropriate treatment after discussion with people with MS based on suitability and local availability.