Multiple sclerosis is the most prevalent chronic progressive neurological disease among young people, affecting over 25 600 Australians in total (MS QLD 2019).
What Is Multiple Sclerosis?
Multiple sclerosis (MS) (which means ‘many scars’) is an incurable neurological condition. It is characterised by an abnormal immune response that targets myelin, a fatty material responsible for insulating the nerve fibres in the central nervous system (CNS) (which comprises the brain, spinal cord and optic nerves) (Better Health Channel 2019).
When the immune system mistakenly attacks the myelin, it is destroyed in a process known as demyelination. This leaves the underlying nerve exposed, leading to inflammation and scarring (lesion formation) (MSRA 2020; Better Health Channel 2019).
This damage disrupts the nerve impulses, impairing their ability to transmit messages between the brain and the body. As a result, the individual will experience a variety of neurological and other symptoms (Better Health Channel 2019).
While the brain will attempt to heal the scarred tissue, some damage may be irreversible. Consequently, the brain will suffer atrophy (loss of volume) (Better Health Channel 2019).
Types of Multiple Sclerosis
MS is an unpredictable disease and may progress differently depending on the individual (MS Australia 2020a).
There are three main clinical courses (‘types’) of MS:
Relapsing-remitting MS (RMMS) is the most common form of MS, accounting for about 85% of initial diagnoses. RMMS causes flare-ups of active disease activity, which are then followed by partial or total remission where the disease does not appear to be worsening. Symptoms may completely disappear during remission periods, or the individual may only partially recover from flare-ups.
Primary-progressive MS (PPMS) is less common. It is characterised by a gradual worsening of symptoms from the onset, causing increased disability. There are generally no remission periods.
Secondary-progressive MS (SPMS) occurs when an initial RMMS diagnosis begins to cause progressive worsening of symptoms. Most people with RRMS will eventually develop SOMS, however, this may take several years or even decades.
(Better Health Channel 2019; MS QLD 2019a; MS Australia 2020a)
(Diagrams adapted from MS Australia 2020a; Lublin et al. 2014)
What Causes Multiple Sclerosis?
A singular cause of MS is unknown, however, it is believed that the condition is linked to an interaction between several factors, including:
Genetics
Infection with certain viruses, including Epstein-Barr virus
Living in an area further from the equator
Lack of vitamin D
Smoking.
(Better Health Channel 2019)
How Is Multiple Sclerosis Diagnosed?
As there is no single test for diagnosing MS, it may take years to reach a conclusion (Healthdirect 2020).
Furthermore, many of the early symptoms are non-specific, which increases the difficulty of making a diagnosis (Better Health Channel 2019).
Patients may undergo a variety of tests in order to establish a diagnosis, including:
Neurological examination
Blood tests to rule out differential diagnoses
Magnetic resonance imaging (MRI) to assess for the presence of scarring
Lumbar puncture to assess the cerebrospinal fluid.
(Better Health Channel 2019)
In order for MS to be diagnosed, there must be evidence of different areas of damage in the CNS that have occurred at different times (Healthdirect 2020).
While it is possible for children to be diagnosed with MS, the majority of people diagnosed are adults between 20 and 40 years of age. About 75% of those living with MS are women (Better Health Channel 2019).
Symptoms of Multiple Sclerosis
The symptoms of MS vary between individuals and are often unpredictable, with no two cases the same. Generally, symptoms depend on the area of the CNS that has been affected (Better Health Channel 2019).
The prevalence of depression is three times higher in people living with MS than in the general population, with half of those diagnosed experiencing depressive episodes (MS QLD 2019b).
MS Symptoms can be categorised into several areas. People living with MS may experience a combination of the following:
The Role of the Healthcare Professional in Multiple Sclerosis Care
Treatment of MS may involve an interprofessional team, depending on the patient’s symptoms. The health professionals involved may include a:
Nurse
MS specialist
Neurologist
Physiotherapist
Occupational therapist
Continence advisor
Speech therapist
Dietician
Psychologist or neuropsychologist
Rehabilitation team
Pharmacist
Urologist.
(Multiple Sclerosis Trust 2019; Better Health Channel 2019)
Conclusion
The unpredictable nature of MS and lack of strong diagnosis methods poses challenges for healthcare professionals.
Therefore, it is imperative that when caring for these patients we adopt an interprofessional and individualised approach to achieve the highest level of patient care.
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