Multiple sclerosis (MS) is the most common neurological disorder among young adults. It affects about 1 in 2000 people in Britain. MS can occur at any age, but it is rare before puberty and after the age of 60. In most cases it starts between the ages of 20 and 40. In spite of extensive research the exact cause remains unknown.
In multiple sclerosis, nerve fibres anywhere in the brain, spinal cord and optic nerve are damaged. Most nerve fibres are insulated with a sheath of fatty tissue called myelin. In MS, there is patchy loss of this myelin sheath (demyelination). Although the exact cause is unknown there is some evidence to suggest that factors involved include an environmental factor, such as a virus, and an autoimmune factor (the body attacks and destroys its own tissue).
Demyelination blocks nerve impulse transmission along the affected nerve fibres. MS shows up differently in each person. Some people have an attack and then are free of symptoms for up to ten years or longer. Some people never even realise that they have the condition. MS can affect some people only very mildly, while others can deteriorate very quickly.
There are four main types of MS:
Relapsing-remitting type is the most common type. This means the person has relapses (a flare up of symptoms), followed by remissions (periods of recovery). These tend to be unpredictable and their cause is unclear. They can last for days, weeks or months and vary from mild to severe. Over time, MS may progress further causing disability, poor co-ordination and other symptoms.
Benign MS that starts with a small number of mild attacks followed by complete recovery.
Primary progressive MS is the next common type, affecting around 40% of people with MS. The person does not have relapses and remissions but instead has steadily worse symptoms over time.
Many people who start out with relapsing-remitting MS later develop a form known as secondary progressive MS. This means that the disability does not go away after a relapse and progressively worsens between attacks, or that the cycle of attack followed by remission is replaced by a steady progression of disability
Depression is a serious illness.Health professionals use the terms 'depression', 'depressive illness' or clinical depression to refer to something very different from the common experience of feeling miserable or fed up for a short period of time.
In depression there are feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with daily life, and can last for weeks or months rather than days.
Depression is common, about 15% of people will have a bout of major depression at some point in their lives and it is the fourth most common cause of disability worldwide. The figures are very difficult to estimate as many people live with depression without seeking help or being formally diagnosed.
Most of the 4,000 suicides committed each year in England are attributed to depression. On average, 15% of people with recurrent depression (repeated attacks) have an increased risk of suicide.
Women seem to be twice as likely to suffer from depression as men, although this could be because men are less likely to seek help. Depression may appear at any age. Depression occurs in every Western country. There is some debate about whether it is seen in every culture across the world, although it now seems likely that depression is a universal human condition.
People with a family history of depression are more likely to experience depression themselves. Depression affects people in many different ways and can cause a wide variety of physical, psychological and social symptoms.
Doctors describe depression in the following three ways:
By difference in severity. Depression can be: a. mild, in which there is some impact of daily life b. moderate, in which there is significant impact in daily lifec. severe, in which activities of daily life are virtually impossible.
By presence or absence of physical symptoms. Most patients with depression have one or two physical ('biological' or 'somatic') symptoms, however some have several.
By presence or absence of psychotic symptoms such as hallucinations or delusions. Most people with depression do not have psychotic symptoms, but some do. See also the sections on specific types of depression e.g. Manic-depression illness, and Seasonal Affective Disorder (SAD).
There are a wide variety of symptoms associated with MS. Most people will not experience all of these. Symptoms may occur once or be repeated during the course of the illness. If someone is experiencing a symptom that is associated with MS, they should consult first with their GP who can refer them to a neurologist (a doctor who specialised in brain-related conditions). Seeing a neurologist is particularly important, as many MS symptoms can also be symptoms of other neurological conditions. The neurologist may not always prescribe medications for symptoms but may refer to other specialists more able to help.
The wide range of symptoms include:
Visual disturbances - blurred or double vision, loss of vision or colour, blind spots, pains behind the eyes, jerking eyes
Altered sensations - pins and needles, numbness, tingling, burning
Incontinence - unable to empty the bladder, unable to store urine, loss of bladder control, constipation or diarrhoea
Cognitive difficulties - memory problems, concentration problems, reasoning problems, mood swings, untypical emotional outbursts
Fatigue, vertigo, and speech or swallowing difficulties
Muscle spasm, weakness. loss of coordination (spasticity).
Apart from the GP and Neurologist there will be many other specialists involved with the care of a person with MS:
MS nurse - for MS specific support and information
Neurological-psychologist - to assess cognitive function and identify whether cognitive problems are from the MS or a persons own personality
Neurological-physiotherapist or physiotherapists with knowledge of MS can design an exercise programme
Occupational therapists can provide aids and equipment
Continence advisors can help with bladder and bowel problems
Dieticians can advise on sensible nutrition
Social workers can advise on benefits and access to other services.