New stem-cell treatment has brought hope that disability can be slowed or even reversed says Dr Mel Wynne-Jones
More than 100,000 people in the UK have multiple sclerosis (MS), a long-term condition
that affects the nervous system.
It occurs in three times as many women as men and often starts in young adulthood.
The cause isn’t known, although it’s more common in people of Caucasian ethnicity, in people who smoke, in more northerly parts of Europe, and there’s a hereditary element in some families.
MS is triggered by the body’s own immune system, which targets myelin, the fatty ‘insulating’ tissue that helps electrical signals to travel rapidly through the brain, spinal cord and along nerve fibres.
MS produces gaps, scars and nerve damage, slowing, distorting or blocking the signals, and interfering with sensation and/or movement.
These include numbness, pins and needles or pain, muscle stiffness, weakness or spasms, shaking, fatigue, dizziness, blurred vision, and problems with bladderand/or bowel function, swallowing or balance.
Memory, thinking and mood can also be affected.
But symptoms may appear in different places at different times, and early MS can
be hard to diagnose.
Most people develop the relapsing remitting form (called RRMS) where symptoms come on suddenly, last days or months, then disappear, flaring up again sooner or later – sometimes during an infection, stress or after pregnancy.
However, the underlying damage continues and, occasionally, relapses stop improving (this is called secondary progressive MS – SPMS).
More than one in 10 people develops the primary progressive form (PPMS), often in late middle age.
This tends to cause a slow deterioration, for example in walking. Some people have ‘benign MS’ – milder relapses which can disappear for many years.
It’s important to be under the care of an MS ‘team’ that may include a neurologist (doctor), MS specialist nurse, physiotherapist, occupational therapist, psychologist, speech and language therapist, continence adviser and social worker.
They can advise on coping with work, disability, benefits and all aspects of the condition, including the progressive forms, which are harder to treat.
Medication can help with symptoms such as muscle stiffness, fatigue, pain, incontinence, speech and/or swallowing problems and depression.
You can also get advice and emotional or family support from the MS Society (0808 800 8000).
It’s also important to not smoke, exercise to maintain fitness and a healthy weight, eat a balanced diet, including oily fish, and get 15 minutes’ daily exposure to sunshine on your arms and face to boost vitamin D levels.
MS specialists recently announced that it’s vital to start disease-modifying treatment (DMT) for relapsing forms as soon as possible after diagnosis DMTs target the immune system and can reduce the number of relapses, and delay/slow disability, although they don’t work for everyone and can have side effects.
An exciting, experimental treatment called autologous haematopoietic stem cell transplantation (AHSCT) ‘resets’ the immune system by freezing bone marrow stem cells, destroying the immune system with chemotherapy and antibodies, then putting back the stem cells to produce a new immune system.
Used for people with severe RRSM, it can produce marked improvement in disability, reduce relapses and new brain plaques (shown on MR scans).
But, like all powerful treatments, it can have powerful side effects, and so research is continuing into this, and other immune-system drugs.
4 tests you may need
1 Nervous system examination by a specialist (neurologist).
2 MR (magnetic resonance) scan of your brain and spinal cord.
3 Evoked potentials – external sensors that monitor the speed of your brainwaves.
4 Lumbar puncture – a small needle and local anaesthetic is used to take a sample of the fluid surrounding your spinal cord in your lower back.