Multiple Sclerosis

Multiple Sclerosis (MS) is the most common acquired chronic neurological disease of the central nervous system affecting young adults, often diagnosed between the ages of 20-40 and, in Australia, affects three times more women than men. As yet, there is no cure. 

There is no known single cause of MS, but many genetic and environmental factors have been shown to contribute to its development.

Pathogenesis 

In MS, the body’s own immune system mistakenly attacks and damages the fatty material, called myelin around the nerves. Myelin is important for protecting and insulating nerves so that the electrical messages that the brain sends to the rest of the body, travel quickly and efficiently.  

As the demyelination occurs, patches of nerves become exposed and then scarred (sclerosis), which hinders the nerves ability to communicate messages properly, resulting in subsequent degeneration. This means that the brain cannot talk to other parts of the body, resulting in a range of symptoms that can include a loss of motor function (e.g. walking and hand and arm function, loss of sensation, pain, vision changes and changes to thinking and memory).  

Symptoms 

The symptoms of MS are often unpredictable. They may be mild or severe, short-term or long-lasting. They may appear in different combinations, depending on the area of the nervous system affected. The following are the most common symptoms of MS, but each person may be different. 

Typical first symptoms of MS 

  • Blurred or double vision 
  • Red-green colour distortion 
  • Pain and loss of vision because of swelling of the optic nerve (optic neuritis) 
  • Trouble walking 
  • An abnormal feeling or pain, such as numbness, prickling, or pins and needles (paresthesia). 

Other symptoms of MS 

  • Muscle weakness in the arms and legs 
  • Trouble with coordination. A person may have problems walking or standing, or be partially or completely paralyzed 
  • Spasticity 
  • Fatigue 
  • Loss of sensation 
  • Speech problems 
  • Tremor 
  • Dizziness 
  • Hearing loss 
  • Bowel and bladder problems 
  • Depression 
  • Changes in sexual function 
  • About 50% of all people with MS may have cognitive problems linked to the disease (concentration, attention, memory, poor judgment). 

Types of MS 

Relapsing-remitting MS (RRMS) 

This is the most common form of MS. New symptoms appear, or existing symptoms worsen over a period of days, weeks or even months. This is known as a relapse. It is followed by a partial or complete recovery known as remission. 

Primary progressive MS (PPMS) 

About 1 in every 10 people with MS are diagnosed with PPMS. In this type, the symptoms become gradually worse from the start of the illness, with no separate attacks or periods of remission. There can be times when symptoms are stable. 

Secondary progressive MS (SPMS) 

This is a later stage that follow RRMS. In this form, after years of having RRMS, your symptoms become gradually worse, without remission. 

Clinically isolated syndrome (CIS) 

This is where a person will have one episode of MS symptoms and then recover. The episode lasts days or weeks. Usually, you need at least 2 episodes of symptoms to be diagnosed with MS. Many people with CIS will eventually have more episodes and be diagnosed with MS. 

Diagnosis 

There are no specific tests for MS. Instead, a diagnosis of ML often relief on ruling out other conditions that might produce similar signs and symptoms. A GP will start by performing a thorough physical examination followed by: 

  • Blood tests – to rule out other diseases. Tests to check for specific biomarkers associated with MS are currently under development. 
  • Lumbar puncture – the sample of CSF can show abnormalities in antibiotics that are associated with MS. It can also rule out infections and other conditions with similar symptoms to MS. 
  • MRI – can reveal after of MS (lesions) on your brain, cervical and thoracic spinal cord. A patient may received an IV contrast to highlight lesions that indicate the disease is in an active phase 
  • Evoked potential tests – records the electrical signals produced by the nervous system in response to stimuli. The stimuli may be visual or electrical. Electrodes measure how quickly the information travels down your nerve pathways. 

Two things must be true to make a diagnosis of MS: 

  1. The person must have had 2 attacks at least 1 month apart. An attack is when any MS symptoms show up suddenly. Or when any MS symptoms get worse for at least 24 hours. 
  1. The person must have more than 1 area of damage to the central nervous system myelin. This damage must have occurred at more than 1 point in time and no have been caused by any other disease. 

Treatment 

There is currently no cure for MS, but there are treatments that can help.  

Disease modifying therapies 

DMTs, or immunotherapies, are medicines that target the immune system. They make relapses less frequent and severe, with less damage to the myelin layer. These medicines can be used for people with relapsing-remitting MS. They can slow down or prevents RRMS developing into SPMS. However, they can have significant side effects. 

Treatment for relapses 

Steroid medicines reduce inflammation in your central nervous system. This can make the symptoms in a relapse less severe. 

Symptom relief 

  • Regular exercise 
  • Physiotherapy for muscle problems 
  • Podiatry for muscle problems, bracing and orthotics 
  • Medicines to manage symptoms (e.g. constipation, muscle pain, bladder problems, depression) 
  • Cognitive rehabilitation to improve memory and thinking. 

Our Podiatrists have worked closely with many patients living with multiple sclerosis. Together we develop treatment plans are are realistic, individulised, and achieveable. This may include general skin and nail care, exercise, massage, foot mobilisation therapy, footwear advice and/or modification, or orthotic therapy.

For a thorough biomechanical assessment by one of our experienced Podiatrists, call 4323 9100 or book online.