Multiple sclerosis

Diagnosis

The symptoms of MS range from being barely detectable to being severely disabling. Once present the disease is lifelong. The symptoms experienced by each person with MS vary, and depend on the site of myelin  destruction. For example, if myelin in the motor pathways is damaged patients may become weak; if the disease affects the cerebellum , people may develop co-ordination difficulties. The most common symptoms include:

• transient blindness (optic neuritis) and double vision (diplopia)
• poor co-ordination
• numbness or a tingling sensation in the limbs
• limb weakness and spasticity
• sexual problems - including lack of orgasm, impotence, erectile dysfunction, lack of sexual feeling and reduced libido
• difficulty with bladder and bowel control - demyelination in the CNS can cause various bladder problems e.g. incontinence, and hesitant or frequent urine flow. Only a few people experience difficulty in regulating their bowels.
• nausea and vertigo
• difficulty with speaking and swallowing
• memory and concentration problems
• fatigue.

Not everyone with MS will experience all of these symptoms. The most common course of the disorder is that symptoms occur in attacks. After a number of years, there is, however, an increasing tendency for the patient to enter a phase of slow, steady deterioration. The average disease duration is in excess of 30 years. People with MS can be categorised according to the course of progression of their disease, or the type and severity of their symptoms. The categories of MS are:

• Relapsing-remitting - clearly defined attacks with full recovery or with residual deficits. It is thought that approximately 75% of people initially experience a relapsing-remitting form of the disease.
• Primary progressive - people experience steady disease progression from onset without any attacks. Approximately 10% of people with MS experience this course of disease.
• Secondary progressive - this course of disease occurs when people with relapsing-remitting MS experience gradual progression of disability; approximately 40% develop secondary progressive disease within 6 to 20 years of disease onset.
• Benign - describes someone with MS who has remained fully functional 15 years after disease onset.
• Malignant - a disease with rapid progressive course leading to significant disability in a relatively short time period.

The outcome of MS is extremely variable and unpredictable and generally much better than people think. Thus, many people will not experience severe disabilities.