Tell me about multiple sclerosis
By DR Y.L.M
I HAVE heard a lot about multiple sclerosis from my friends in America. Their relatives have been afflicted, it seems. But I have yet to hear of anyone in Malaysia who has it. Is it a common disease?
It's not common at all in Malaysia. It's most common among white people, especially those whose families initially came from northern Europe. Asians and Africans are at the lowest risk of developing it.
In fact, multiple sclerosis is common in countries which have temperate climates. The rule of thumb is the nearer you get to the North or South Poles, the higher your risk of getting it.
Therefore it is common in Europe, the north part of US, Canada, and even South Eastern Australia and New Zealand.
If you are a child and if you happened to live in Canada, for example, your risk of getting multiple sclerosis will reduce if you move south, such as to Texas or Mexico.
If you have hit puberty, then your risk remains the same as where you originated from.
Is it a disease of women?
Women are twice more likely to develop multiple sclerosis than men, it is true. It's also a relatively "young" disease, in that it occurs commonly in people aged 20 to 40.
It's also partially inherited. If your mother or father or brother or sister has multiple sclerosis, you will have 1% to 3% chance of developing it as well.
Multiple sclerosis is also said to be linked to viral infections, especially to the Epstein-Barr virus, which causes infectious mononucleosis.
It is also linked to thyroid disease, type 1 diabetes and inflammatory bowel disease, all of which are autoimmune diseases.
What is multiple sclerosis actually?
It's an autoimmune disease. This means your body's own immune system develops antibodies against your own tissue, in this case, the protective fatty myelin sheaths which cover your nerves in your brain and spinal cord.
The nerves themselves may be damaged in the end.
You see, your nerves comprise of long fibres called axons. They are wrapped up in an insulating substance called myelin, pretty much like an electrical wire.
When myelin is damaged, electrical signals can no longer effectively be conducted.
When this happens, nerve conduction is then impaired. Messages that travel either to or from your brain to your organs are then delayed or blocked.
It's important to know that the autoimmune mechanism of multiple sclerosis attacks your central nervous system, meaning the nerves of your brain and spinal cord, and not the peripheral nerves.
If I have multiple sclerosis, what will I experience?
It all depends on which nerves are affected and which are not.
If the nerves to your limbs are affected, then you may experience numbness or weakness in the affected limb. Usually it occurs on one side of your body at a time, or the bottom half of your body.
You may also feel tingling or pain in certain parts of your body.
If the nerves to your eye are affected, you may experience blurring of vision or double vision. You may even go blind, usually in one eye at a time.
There is sometimes also pain with eye movement because of the inflammation of the optic (eye) nerve sheath.
You may also experience electric shock sensations with certain head movements, tremors, poor coordination, unsteady gait, fatigue, or dizziness.
Most people (85% to 90%) with multiple sclerosis have an on again, off again course. You experience symptoms, then you recover either completely or partially. Sometimes your recovery can be for months or years!
Then it relapses. The symptoms become worse when you have a fever or feel hot. This type is called the relapsing-remitting subtype.
Another type of multiple sclerosis occurs when you start having attacks and progressive nerve decline without any definitive periods of remission.
This is called secondary progressive multiple sclerosis and is far more dangerous.
Usually the time it takes for the first type to develop into the second type is 19 years.
Is there a cure for multiple sclerosis?
Unfortunately no. The treatment is usually only for mediating the autoimmune response and managing your symptoms.
For those with mild symptoms which relapse easily, no treatment is needed.
But if you do need treatment, then steroids are the mainstay to reduce inflammation during a relapse. Interferon appears to also slow down the speed of multiple sclerosis worsening over time.
There is a newer drug called glatiramer which blocks the immune system from attacking myelin. Another drug called natalizumab stops immune cells from moving from your bloodstream to attack your brain and spinal cord.
Naturally, physiotherapy comes into play with limbs or organ involvement.