Multiple Sclerosis (MS) affects ~2 million individuals globally, and is the most common cause of non-traumatic disability in young adults1. It is characterised by damage to white matter sheathes (myelin) protecting neurons in the central nervous system, thought to be caused by autoimmune processes.
The condition can cause a myriad of symptoms, the most common of which include fatigue, limb weakness/numbness, tremor, gait difficulties, double-vision and other visual problems, difficulty speaking, and dizziness2.
In relapsing-remitting MS, people experience acute symptom attacks (onset over hours-days), with symptoms resolving gradually afterwards (partially, or fully).
In secondary progressive MS, symptoms can develop more gradually and tend to persist. Both types of MS are associated with impaired quality of life and disability.
Pathology and functional impact of Multiple Sclerosis
Classical understanding of the underlying brain pathology in Multiple Sclerosis emphasises autoimmune-mediated damage to myelin, a fatty substance that surrounds and protects neurons in the central nervous system.
Damage to myelin means that electrical signals between neurons do not operate as they should, leading to the wide variety of neurological symptoms that can occur. The term ‘sclerosis’ refers to the scar tissue that forms in the damaged tissue as a result of these pathological processes.
The aetiology or fundamental causes of MS are poorly understood3. MS is more common with increasing distance from the equator, leading to the suggestion that reduced exposure to sunlight might predispose some people.
In a large meta-analysis of the available evidence, the factors most strongly associated with MS were smoking and previous infection(s) with the Epstein-Barr virus4.
Research and development in Multiple Sclerosis
Diagnosis of MS requires specialist input, because it can be easily overlooked or mistaken for other conditions (and vice versa). In most cases, two or more symptom attacks separated in space (in terms of the brain regions affected), and in time, are necessary to meet the strict diagnostic criteria.
Diagnosis is likely to include detailed history, neurological examination, brain scans, measurement of speed of nerve conduction (evoked potentials), lumbar puncture, and blood tests.
Comprehensive treatment of Multiple Sclerosis should involve an individualised, multidisciplinary approach. This is particularly important because of the heterogeneous and fluctuant nature of the condition.
Currently available, licenced drug treatments for MS act as ‘disease-modifiers’, reducing the risk of new symptom attacks, typically by dampening aspects of the body’s immune response.
Examples of disease-modifying medications listed by NICE for the treatment of relapsing-remitting MS under certain circumstances include alemtuzumab, teriflunomide, and fingolimod.
In addition to considering disease-modifying medication, many other types of treatment are available that are capable of providing symptomatic relief in MS, to maximise comfort, dignity, and independence.
It is helpful to focus treatments on specific target areas, e.g. cognitive problems, emotional lability (and low mood), mobility problems, fatigue, incontinence, pain, and muscle spasticity5.
The search for well-tolerated pharmacotherapies capable of stemming disease progression in Multiple Sclerosis, and for ameliorating cognitive dysfunction, continues, and represents a key unmet need.
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Foong J., et al (2015). Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain Pathol.
Oken B.S., et al (2006). Cognition and fatigue in multiple sclerosis: Potential effects of medications with central nervous system activity. J Rehabil Res Dev.
Muhlert N., et al (2014). Memory in multiple sclerosis is linked to glutamate concentration in grey matter regions. J Neurol Neurosurg Psychiatry.
Multiple Sclerosis: management of multiple sclerosis in primary and secondary care (CG186). National Institute for Health and Care Excellence (NICE). 2014.
- Global Economic Impact of Multiple Sclerosis. Multiple Sclerosis International Federation, 2010.
- Rolak LA. Multiple sclerosis: it's not the disease you thought it was. Clin Med Res. 2003 Jan;1(1):57-60.
- Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol. 2014;72(3-4):132-41.
- Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015 Mar;14(3):263-73.
- Multiple Sclerosis: management of multiple sclerosis in primary and secondary care (CG186). National Institute for Health and Care Excellence (NICE). 2014.