Articles on Medical Diseases and Conditions

Tag: Multiple Sclerosis

  • Some types of CAM therapy

    There are many, many types of CAM therapy that may be used by people with MS, most of which we cannot consider in detail here. Furthermore the popularity of such therapies in MS can change very rapidly, with new therapies or new variations of previously available therapies regularly appearing, and the use of others decreasing rapidly after only a brief high profile existence. Thus in this section we consider some of the key CAM therapies that appear to have gained longer term use, or appear to be on the verge of doing so.

    Cannabis

    There has been a great deal of discussion about the use of cannabis recently in relation to the symptoms of MS. Based originally on individual reports by people with MS that at least two of the more problematic symptoms of MS, tremor and spasticity, seemed to respond well to cannabis, there has been an increasing interest in its use by people with MS. However, at present, cannabis is illegal in Britain – some people with MS have already been prosecuted for possessing, growing or supplying it – and it cannot be prescribed for MS.
    Nonetheless the pressure from people with MS to research the effects of cannabis more formally has resulted in the setting up of major clinical trials, the most significant of which are funded by the Medical Research Council, although some are being undertaken by pharmaceutical companies. These trials are not using cannabis in its original form, but are using what are called cannabinoids (one or more of the very many active substances in cannabis). Thus if the trials are a success, it will not mean that cannabis itself will be made available to people with MS, but almost certainly will lead to the use of manufactured drugs that have some cannabinoids as constituents. The results of some of the key trials are now beginning to appear indicating that a statistically significant beneficial effect on such Multiple Sclerosis symptoms as spasticity (and particularly pain associated with such spasticity). In due course one or more products based on such cannabinoids will become available. However, it is important to note that becoming ‘available’ will almost certainly mean only by prescription from a medical practitioner who is willing to offer such drugs. Furthermore, even then such drugs may not become available through the NHS for some time, and may only be available initially through private payment.
    Currently, there is evidence that an increasing number of people with MS are using cannabis on an occasional or sometimes regular basis; it has become a very difficult issue because, although they do feel that they gain from taking it, they are having to balance what they feel is a significant reduction in their symptoms against committing an illegal act. Using the drug in any form is illegal, including ‘inactivated’ tinctures with limited narcotic effects. Growing, buying, selling and using cannabis carry penalties including heavy fines and jail sentences, even when there may be a medical justification for its use. There is a group campaigning for a change in the law (the Alliance for Cannabis Therapeutics) to allow the use of cannabis for medically designated purposes, and if you feel strongly about the issue you may wish to join this group (see Appendix 1).

    Hyperbaric oxygen

    Hyperbaric oxygen therapy (HBO) consists of breathing oxygen under high pressure, usually by sitting or lying in a large pressurized chamber, and this proved to be one of the more popular complementary therapies for MS in the 1980s and early 1990s. The former national charity Action for Research in Multiple Sclerosis was instrumental in supporting the installation and running of pressurized chambers in many local therapy centres. A substantial number of these chambers are still in operation in therapy centres now run by Regional Federations of MS Therapy Centres.
    The original theory behind the therapy was that MS might be a vascular (blood system-related) condition in which tiny blood vessels in key parts of the nervous system become blocked by fatty globules circulating in the blood, thus leading to nervous system damage. It was thought that hyperbaric chambers (used to assist the management of nitrogen ‘bubbles’ in the blood of divers suffering from the ‘bends’), might be a way of eliminating these circulating fatty globules, and perhaps – through the use of additional oxygen under pressure – might even repair existing damage. Many people claimed success in managing symptoms, and even slowing down or stopping the course of their MS. However, clinical trials of HBO produced a much less promising outcome. HBO did seem to have an effect for some people in lessening urinary symptoms (such as incontinence) and in reducing fatigue, but had no significant effect on any other symptoms, or on the course of the disease. Many people who say that they feel better as a result of HBO still use the therapy, although most doctors are very sceptical that it has any real effect on Multiple Sclerosis.
    Whether you choose to have HBO is, of course, up to you. The main issue from a personal point of view is setting the benefits that you feel you may be obtaining against the practical issues of attending a centre on a regular, often initially daily, basis, and being in a chamber for an hour or more while it is pressurized, reaches its appropriate ‘diving depth’ and then depressurized. Costs for HBO in the therapy centres are often subsidised, but can still be relatively expensive over the initial phase of the therapy.

    Herbal products

    Although we often think of herbal medicines as being ‘alternative’, in fact a high proportion of both over-the-counter and prescribed drugs have a plant origin. However, in recent years, herbal medicine, often considered as a natural non-manufactured therapy, has become very popular. Practitioners operate under a range of different approaches. Although herbal remedies sound very benign and safe, they can be very powerful and can have side effects. Make sure that any practitioner is very well trained in the properties, toxic as well as beneficial, of the herbs that are used, and also has a good knowledge of MS. Herbal medicine and its practitioners are amongst the newest professionalized groups engaging in complementary medicine, even though herbalism has a very ancient history. Many herbal products available in chemists and health food shops, are capitalizing on the popularity of herbal approaches to health.
    A detailed overview of the possible effects of the many hundreds of individual herbal products on MS is beyond the scope of this book, and indeed good herbal practitioners would argue that a careful process of individual diagnosis and therapeutic recommendation is needed for someone with Multiple Sclerosis. However, there are some general guidelines that it is helpful to bear in mind:

    • It is wise to think of herbs in the same way that you think of drugs
    (indeed many herbs are drugs).
    • Many herbs contain compounds that have not yet been fully identified, and some of these may be toxic.
    • Good preparation of herbal medicines is critical to ensure both their safety and their efficacy.
    • Be very careful when using herbal medicines if you have several medical problems, or are pregnant or breastfeeding.

    Some herbal medicines interact with proprietary drugs often used to treat MS or its symptoms, so it is particularly important that you talk to your doctor first if you are taking such drugs.
    As with other complementary therapies, certain herbal remedies may be of value in relation to general health, and certain symptoms of MS might indeed be helped, but there is no evidence that herbal medicine can alter the course of MS. As a final warning, it is worth noting that some Chinese herbal remedies may contain animal products, of which some may be from banned sources, or not included on the label. For a more detailed review of particular herbal products in relation to MS, see the relevant section in the book by Bowling (see Appendix 2).

    Homeopathy

    Homeopathy is a system of therapy in which minute doses of a substance are taken on the basis that these will cure or control symptoms that would be produced by the very same substance in much larger doses. This is often described as an approach where ‘like cures like’, which some people argue is similar to that of vaccination, where a very, very small dose of a disease may protect against subsequent infection – although in the case of homeopathy, the small dose is to remedy what is seen as a current ‘disease’. It is argued that, paradoxically in relation to conventional science, the smaller the dose the more powerful the effect. Many scientists argue that the doses are so small that they cannot be detected using laboratory instruments and are thus sceptical about the efficacy of homeopathy, but homeopaths believe that their system of therapy is both effective and safe.
    Homeopaths normally focus on the person as much as the disease, and thus any specific symptoms of MS are only one aspect of the person’s life and experiences, used to determine a relevant therapy. As the homeopathy is undertaken on such a person-centred basis, it has proved difficult to undertake clinical trials to prove to the scientific community that it is an effective help for people with Multiple Sclerosis. Increasingly more sophisticated trials are being developed, and some have shown that homeopathic preparations do have a statistically significant effect on
    certain symptoms, although not yet in relation to MS. Nevertheless, there are people who claim that homeopathic treatment has substantially helped their symptoms. As might be anticipated from homeopathic theories, if a remedy is given that appears to be relevant to the symptom, an initial ‘aggravation’ of the symptom may occur – in short it can get worse – before any improvement is noticed.

    Acupuncture/acupressure

    Some people with MS have reported some benefits from either acupuncture or acupressure. Acupuncture, in its traditional form, is based on the idea that energy (chi or qi) flows round the body through channels (called ‘meridians’), which become blocked at times of illness and stress. Acupuncturists use the insertion of very fine needles at key points on these meridians unblocking energy flows to help restore health. Acupressure (often known as shiatzu) works on a similar principle, but uses pressure from fingers or thumbs at these energy points.
    As with some of the other complementary therapies, it is difficult to undertake a scientific trial of the value of acupuncture or acupressure, although some very specific testing has been undertaken on pain and nausea relief using particular acupuncture points. The results suggest that, in certain circumstances, acupuncture does appear to relieve pain and nausea; however, it would be wise to seek a diagnosis of why you have pain or nausea from your GP or neurologist, before undertaking such a treatment for pain, in case there are other causes that need to be treated, or indeed other ways of relieving the pain that may be more effective.
    There have been some, albeit small, and uncontrolled studies of acupuncture on people with Multiple Sclerosis. Reports from these studies indicated a range of mild benefits in relation to several symptoms, which suggests that larger and better conducted studies should be undertaken. Acupuncture may have some effects on the immune system, although this has not yet been fully explored. However, it should be noted that, although acupuncture is generally extremely well tolerated, there are occasional reports of pain and soreness at the needle site, as well as stiffness and muscle spasms. This may be due both to skin sensitivity, and a tendency to muscle spasms in MS.

    Yoga

    Yoga is widely used by many people with MS, and there are now both specialist centres and teachers for them. From a practical point of view, in many respects yoga can be seen as providing a form of exercise known to be helpful in keeping your muscles working, as well as providing a form of calming of the mind, helpful in countering depression, stress and fatigue. Yoga is also a form of meditation that requires dedication and time. For those people who can commit to it, it may help not only with individual problems (such as work-related stress), but also everyday living. For some people it can lead to a more rewarding lifestyle. In some circumstances yoga may prove an effective technique for the management of individual symptoms (such as stress or pain), but you will benefit largely from your own efforts.
    One advantage of yoga for people with MS is that, in addition to its emphasis on slow movement, and peace and calm, once you have received some training, you can undertake the exercises at home, without any additional equipment or expense. Its emphasis on deep and controlled breathing can also be helpful, particularly if your posture is not what it should be, or if you are sitting for long periods. The main concern with yoga and MS is that you should work well within your limitations in a relaxed way, and be careful not to push yourself too far, or raise your body temperature, as this may increase fatigue. If you are undergoing, or have been undergoing physiotherapy, it may be an idea to consult your physiotherapist before starting yoga.
    You can obtain more information about yoga from the Yoga for Health Foundation, which runs special classes for people with MS and other conditions, or from the Yoga Therapy Centre at the Royal London Homeopathic Trust.

    Massage

    There are many forms of massage. Some of them are very vigorous and seek to realign any muscles of the body that the therapists believe are out of line. Such forms of massage should be avoided by people with MS, for many of the problems faced by people with the disease, such as spasticity, are a result of neurological damage, and cannot just be ‘reworked’ by a very vigorous massage. The more relaxing and gentle forms of massage, on the other hand, are potentially of considerable value, not only in relaxing muscles and reducing spasticity, but also in promoting a general sense of wellbeing. It is very important that you check what form of massage the therapist is offering, and ensure that the therapist has been well trained and, above all, knows about MS.

    Aromatherapy
    Aromatherapy is usually a massage with essential oils; sometimes oils are heated and released into the atmosphere around you. Although, in other forms of massage, an oil is often used as a lubricant during the massage, in aromatherapy specific oils are used for massage or heating and release, following an aromatherapy diagnosis of your state of mind and body. The oils are very concentrated, and should always be used in a carrier oil (such as sweet almond oil) during massage. They must not be taken by mouth. Some of the oils should not be used if you are pregnant, or have certain other conditions, such as epilepsy, and it is crucial that you let your aromatherapist know about these. Although some of the more exotic and far-reaching claims for aromatherapy have never been tested, some people with MS have found it very relaxing and stress-reducing.

    Reflexology
    Reflexology is a therapy based on the idea that energy and other flows in the body are linked to, indeed terminate, at key points in the feet, providing a ‘map’ of key organs and systems in the body. It is believed that problems in all areas of the body can thus be identified and indeed treated through manipulation of the feet.
    Some people with MS have indicated that they have found this therapy helpful and relaxing, although there is no formal evidence that it affects the course of MS, or even major symptoms of the disease. However, as a relaxing therapy, it may benefit some people with the condition.

    Chiropractic
    Chiropractic is a long-standing approach to health based on a particular view of the ways in which the human body works and may be managed. Practitioners manipulate the bones, muscles and tissues, especially around the spine, to enhance health. In chiropractic, the focus is mainly the nervous system, and enhancing the blood supply around key tissues. Practitioners can use a variety of techniques, which vary in strength.
    Chiropractic is founded on the belief that a wide range of bodily pain and disease processes originate in abnormal nerve function. A course of treatment is usually composed of short sessions spaced out over several months. Treatment consists of manipulation of the spinal column and individual vertebrae. Chiropractic recommends itself particularly for back pain and persistent headaches. In very rare instances, manipulation of the spinal column can cause lasting damage, so always ensure that you consult a qualified chiropractor and that you discuss your MS fully before any treatment begins. It is increasingly likely that your own doctor will know more about chiropractic and can discuss any possible benefits or disadvantages with you.

    Osteopathy
    Osteopathy is a relatively well-regulated and trained profession compared to other complementary therapies, and a practitioner must be registered with the General Council and Register of Osteopaths (see Appendix 1). Osteopathy, like chiropractic, is a long-standing approach to health in which practitioners manipulate the bones, joints, muscles and tissues, especially around the spine, to enhance health. In fact osteopathy regards the entire musculoskeletal system as the critical basis of good, and ill, health. Treatment may involve established medical diagnostic procedures (including X-rays and standard biochemical tests) in addition to manipulation of joints, rhythmic exercise and stretching. Osteopathy can improve mobility in some affected joints. Cranial osteopathy involves gentle manipulation of the bones of the head and spine.
    The main concern, as with the other complementary therapies, is the extent to which the use of osteopathy could significantly affect the course of symptoms of MS. Whilst a sense of wellbeing may well result from its use, there is no evidence that it has any effect on the course of MS itself.

    As a concluding point, it is important that you take note of what your physiotherapist says about osteopathic or chiropractic treatment, particularly if he or she has wide experience of people with MS, has been treating you for some time, and knows your own situation well. In addition, if you feel that your physiotherapy is helping you manage your MS, then there is every reason to stick with it – particularly as you will almost certainly have to pay additional money for osteopathic or chiropractic diagnosis and treatment. However, some people with MS have found such massage to be of value, but it is not possible to know whether you will be one of these people.

    Meditation and relaxation techniques

    ‘Mind and body’ alternative therapies have become increasingly popular in relation to MS in recent years. The rationale of such therapies is that, if a state of mental relaxation can be achieved, anxiety is decreased, and beneficial physical effects will occur – such as muscle relaxation and reduced blood pressure. There are many different techniques for achieving such mental relaxation. Indeed there are many different meditation techniques some of which are relatively simple to undertake; others require much more training and support.

    As far as MS is concerned, particularly in improving muscle relaxation, meditation and relaxation techniques may help reduce the incidence of muscle spasms and spasticity. At a more general level there is an increasing but under-researched possibility that relaxation techniques may improve the operation of the immune system. In general the possible benefits can be set positively against what, is for the most part, a very low-cost alternative therapy.

  • Finding a practitioner

    Finding a competent practitioner for a complementary therapy is not always easy. There is little statutory regulation for qualifications or practice for most of the therapies and therapists. However, the best ways of finding a practitioner are through:

    • an MS resource or therapy centre, where often other people with MS and staff in the centre will have experience of particular therapists;
    • a recommendation or referral from a neurologist, GP or other healthcare professional;
    • registers set up by the professional bodies of whichever therapy you are interested in;
    • referral for homeopathy to one of the NHS hospitals providing this service;
    • contacting the British Complementary Medicine Association, or the Institute of Complementary Medicine (see Appendix 1).

    Ask whether practitioners are trained and licensed; whether they are insured for malpractice, negligence or accident; and how complaints are handled. One of the key things is to try and ensure that whichever therapist you go to has a good understanding of MS. Both of you should be able to evaluate its benefits.

  • Complementary therapies and Multiple Sclerosis

    When there is no current scientifically accepted cure for a disease, people understandably want to try other means of management. Many people over the last 30 or 40 years have claimed that they have the answer to MS, but the difficult problem for all such potential therapies is to find out whether there really is a connection between the treatment and a remission.
    A distinguishing characteristic of complementary therapies is their focus on the ‘whole person’, using the body’s own healing powers. Many of these therapies are only now being scientifically studied. Some complementary therapies fall outside what is considered conventional scientific medicine, but may be used alongside it, such as acupuncture. Other therapies are generally considered much more unorthodox by the medical profession (described as ‘alternative’), e.g. naturopathy, herbalism or crystal healing. However, complementary and alternative treatments are often considered as a group under the heading of CAM (complementary and alternative medicines).
    Research suggests that up to 60% of people with Multiple Sclerosis are using some form of CAM – people with MS visit CAM practitioners nearly 50% more often than others without MS. Whilst some people use CAM alone, by far the majority use both CAM and conventional medicine together.

  • Other support

    Many people with MS will need professional support services and assistance at some time, to manage the changes in their lifestyles, and to monitor effects of any new drugs. Depending on the precise nature of your MS and its effects, such services may include nursing, physiotherapy, occupational therapy, speech therapy, psychological assessment and support, counselling and advice on housing, employment, financial and other similar issues (see later chapters). Such professional support services for all the many consequences of MS have not previously been adequate, in fact often woefully inadequate and ill coordinated. Despite serious financial constraints, there are now many attempts underway locally to provide better coordinated services and support.

    Rehabilitation

    ‘Rehabilitation’ is perhaps the new watchword of longer term care in MS. Broadly it means professional care targeted to achieve your maximum potential. Regional Rehabilitation Units have been created in recent years for the support of people with many conditions, but there are also an increasing number of more specialist MS rehabilitation units or programmes. At present there are only a limited number of places available on these rehabilitation programmes, and there is a selection process involved, usually on the basis of who might be expected medically to get the most benefit.
    During inpatient rehabilitation you would normally be in a hospital or rehabilitation centre as a patient for some weeks, depending on the programme, your MS and how you progress. In this time you might be offered:

    • regular assessment and monitoring of your condition
    • carefully targeted drug therapies as appropriate
    • intensive physiotherapy and occupational therapy
    • nursing care
    • possibly speech therapy, and
    • psychological and counselling support.

    Within a structured programme the aim will be to tailor aspects of this programme to your individual situation and needs. Following the time spent as a patient, you would probably have periodic further assessments to determine how you are progressing. Increasingly MS clinics are being opened in major centres providing support for more people with MS than is available on a lengthy inpatient basis. The aim is to undertake systematic rehabilitation here on an outpatient basis. There is a concern that outpatient care may not be sufficiently intensive to produce major change in functioning.

    How useful is rehabilitation?

    There is increasing evidence that rehabilitation programmes provide some benefits for people with MS. Studies of rehabilitation programmes are very difficult to undertake in MS for various reasons:

    • People have very different types of MS, and it is still unclear as to who would most benefit from the programmes.
    • There is no completely standardized programme of rehabilitation.

    Studies that have been undertaken so far appear to suggest that a range of benefits arise for many people in the short to medium term but,
    after 1 year or more from the end of an inpatient programme, there is decreasing difference between those who have been through the programme and those who have not. Almost as soon as people with MS are discharged from rehabilitation programmes, they begin gradually to lose the gains that they had from the programme. This is not really surprising because, back home, they do not for the most part have the intensive care available in the programme, and all sorts of other issues intervene to complicate people’s lives. This is why there is an increasing emphasis on outpatient care through MS clinics and MS ‘drop-in’ centres to provide ways of continuing to offer ongoing treatment.
    Further studies in this area are being undertaken to see whether there are particular symptoms or abilities that benefit over the longer term more than others from rehabilitation programmes, and which people with MS might benefit most from them.

    Going into hospital

    Given the range and increasing complexity of tests and treatments, a stay in hospital – even as a day patient –is not uncommon and, if such a stay can be organized over a period of 2 or 3 days, it may be easier for both your neurologist and you to have these undertaken in hospital rather than on an outpatient basis, although outpatient visits will subsequently be necessary. Some treatments are given in hospital. However, neurologists do not agree on how long that hospital stay should be; some feel that the drugs can be administered with very short stays (a matter of hours), while others feel that a day or two to a week, depending on the therapy, may be necessary. Some people with MS may need to go to hospital for investigation of particular symptoms (e.g. urinary problems).
    In general, there is very substantial financial pressure, among other issues, to reduce both the number and length of stays in hospital. So, where possible, your hospital stays will be shorter except when you go in for inpatient rehabilitation (see above) and more and more people are given self-injection teaching where necessary.

  • Treatment rather than cure

    Repairing the damage

    One of the reasons why MS is such a difficult disease to cure is that, once the CNS has been damaged, it would involve major repair of the often severe structural damage. Any further process of damage would have to be prevented as well as the previous structural damage being repaired. However, despite these difficulties, there is considerable interest in experimental work on drugs that may be able to ‘remyelinate’ damaged nerves, and drugs that may slow down or halt the process of further damage.

    Symptom remission

    Most claims for a cure for MS have been made on the basis that the symptoms seem to have disappeared, temporarily at least, but not that the structural damage of MS has been repaired. The problem is that symptoms of MS can be dormant for many years, or dramatic remissions in symptoms have occurred, but the damage to the CNS has not necessarily been repaired. Symptoms can reappear, and there is a significant
    possibility that they will do so, but without evidence that the underlying demyelination has been repaired, the disappearance of symptoms appears to be a temporary, although happy, coincidence; it is probably due to the absorption of fluid caused by the inflammatory response to demyelination. A number of newer drugs, particularly the beta-interferons and glatiramer acetate, may have some effects on modifying the disease process.
    At present therefore, treatment mainly consists of:

    • ameliorating a symptom or its effects;
    • preventing or lessening the degree or length of time of a ‘relapse’;
    • encouraging the early arrival of a ‘remission’;
    • changing various aspects of your lifestyle that will make life with the symptoms of MS easier to manage;
    • seeking to slow down the rate of progression of the disease.

    In many cases, up until recently, the treatment of MS has been on the basis of symptoms as they occur. Now, in addition to attempts to reduce the number of relapses in MS, there are increasingly promising efforts to alter the course of MS itself. There are some drugs that offer the promise of lower rates of disease progression for some people, although for how many people and for how long is a subject of major controversy. Indeed the acronym DMT is now being used quite widely in discussions of MS, but we are still not talking about a cure, just a possibility of slower pro- gression of the MS.

  • Types of Multiple Sclerosis

    There are almost as many different forms of Multiple Sclerosis as there are people with the disease. Each person with MS has a slightly different clinical (and symptom) profile; the precise course that any one person’s Multiple Sclerosis will take is not as predictable with the kind of detail that many people with the condition – as well as their doctors – may wish for. In this context, scientists and doctors are always trying to refine their classification of types of MS, as they get to know more and more about the condition and its symptoms. You may therefore come across several slightly different ways of describing types of MS.
    There are several main types usually described:

    • Relapsing-remitting Multiple Sclerosis. Many cases initially take the form of what is generally described as relapsing-remitting MS. especially in younger people. Symptoms worsen during an ‘attack’ or ‘relapse’ or ‘flare-up’, may be at their worst for several days or a little longer, and then gradually improve in the following weeks.
    • Chronic progressive (or primary progressive) MS. This describes another pattern where symptoms gradually worsen after the first ‘episode’ or ‘attack’, with a continuing increase in disability; often this will involve deterioration in bodily movement (described as motor symptoms) of one kind or another, or sensory performance (especially eyesight).
    • Benign Multiple Sclerosis. This is a term sometimes used to describe a course of MS in which symptoms are relatively minor, or progression is so slow that it is almost clinically imperceptible, or there are very few attacks or relapses over long periods of time – usually 15 years following diagnosis. There is growing evidence that the course of MS is likely to be initially more benign, almost irrespective of initial symptoms, for those people with fewer lesions (plaques) detectable in the CNS with a scan, compared to those who have a larger number. Unfortunately, the evidence from long-term research is that most benign ‘cases’ of MS do eventually result in significant symptoms and disability, even though this may not occur for 20 or 30 years after diagnosis.
    • Secondary progressive Multiple Sclerosis. MS can also change its form so that, for example, relapsing-remitting MS may change into what is called secondary progressive MS – when a relatively steady decline begins to occur and remissions grow less frequent.

    Finally, in case you hear this point from other sources (but don’t worry about it unduly), there is what some think to be a very, very rare variant of MS (others think it might be a separate disease), that can lead to death in a few months. This is sometimes, although completely misleadingly, described as malignant Multiple Sclerosis. There are also other rare types (for example, opticospinal MS).

  • What is Multiple Sclerosis(MS)?

    Damage to your nerves

    Multiple Sclerosis is a disease of the central nervous system (CNS); it damages the protective coating around the nerve fibres (Figure 1.1) which transmit messages to all parts of your body, especially those controlling muscular and sensory activity. It is thought to be an ‘autoimmune disease’: this is where your body’s own immune system appears to attack itself. As the damage to the protective coating around the nerve fibres – called
    ‘myelin’ – increases, it leads to a process known as ‘demyelination’ (Figure 1.2), where the coating is gradually destroyed. These nerves then become less and less efficient at transmitting messages. The messages, as it were, ‘leak’ from the nerve fibres where demyelination has occurred, rather like the loss of an electric current through a cable that is not insulated. As the messages ‘leak’, they become weaker and more erratic, thus leading to greater and greater difficulty in controlling muscles or certain sensory activities in various parts of your body.

    Healthy nerves

    Damages nerves

    Problems of repair

    Which nerve fibres are demyelinated, in which order, and at what rate, varies very widely between individuals, so the corresponding loss of muscular and sensory control also varies widely. Moreover, even when damage does occur to the myelin, it is sometimes gradually repaired (i.e. some remyelination occurs) through internal body repair mechanisms; also, what might be described as ‘inflammation’ at the site of the damage often becomes less over time. However, in Multiple Sclerosis the rate of repair is slower than the rate at which the myelin is damaged; so the damage tends to accumulate more and more throughout the CNS. This damage results in plaques or lesions, which take the form of patchy scarring (areas of multiple ‘sclerosis’) where the demyelination has occurred. Thus the name ‘multiple sclerosis’ has evolved.