Chapter 2

Multiple sclerosis

DEFINITIONS

Benign MS

Relapsing remitting MS

Secondary progressive MS

Primary progressive MS

EPIDEMIOLOGY

Prevalence

Age

Gender

Geography

AETIOLOGY

Environmental factors

Viral infection

Vitamin D deficiency

Other factors: environmental

Genetic factors

Familial

Specific genes

PATHOLOGY

The process of demyelination

Axonal loss

OUTCOME AND PROGNOSIS

SIGNS AND SYMPTOMS

Physical

Speech

Swallow

Sensorimotor

Cognitive and perceptual

Secondary complications

Definitions

Multiple sclerosis (MS) is defined as a chronic, inflammatory, demyelinating auto-immunological disease. The name multiple sclerosis refers to the scars (sclerosis), known as plaques, formed in the nervous system. There are four types of MS classified according to the course/progression of the disease process.

Benign MS

This subgroup is diagnosed retrospectively. These individuals show little or no disease progression.

Relapsing remitting MS

This is the most common type of MS representing 80% of the people diagnosed with MS. Symptoms occur for a period of time (relapse, exacerbation) and then improve (remission), either partially or completely.

Secondary progressive MS

This type is a progression of relapsing remitting MS, when the individual shows a sustained deterioration for at least 6 months. On average, by 15 years, around two-thirds of people with relapsing remitting MS will have developed secondary progressive MS.

Primary progressive MS

This form of MS affects around 10% of the people diagnosed. The course of the disease begins with subtle problems that worsen over time. There is no relapse remitting pattern, their MS is progressive from the beginning.

Epidemiology

Prevalence

According to government guidelines, MS is diagnosed in 3.5–6.6 people per 100 000 of the population each year in England and Wales.

Age

MS is usually diagnosed between the ages of 20 and 50 years.

Gender

Approximately, the ratio of women to men affected is 2:1.

Geography

MS occurs with much greater frequency in areas that are farther away from the equator.

Aetiology

The definitive cause is unknown. However, the evidence suggests that the cause may be a combination of both genetic and environmental factors.

Environmental factors

Viral infection

The evidence indicates that a viral infection, produced by a widespread microbe rather than a rare pathogen, could be the origin of the disease. For example, human herpes virus, chicken pox and glandular fever.

Vitamin D deficiency

Vitamin D deficiency has been linked with a higher risk of MS. This may occur as a result of inadequate intake of the vitamin, coupled with a lack of exposure to sunlight and may explain the geographical distribution of MS in countries further away from the equator.

Other factors: environmental

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