Multiple Sclerosis (MS)

Multiple sclerosis is a condition of the brain, spinal cord and optic nerves in which the immune system damages myelin, the coating around nerve fibres. That interrupts nerve signals. Day to day it can mean fatigue, tingling, blurred vision, or legs that feel unreliable.

What MS is, and what it is not

MS is not a muscle disease and it is not contagious. It is also not one predictable illness. MS Canada reports that 90% of people in Canada are first diagnosed with relapsing remitting MS, where symptoms flare then settle, and 10% with progressive forms. Severity differs a great deal between people.

Much of MS is not visible. MS Canada points out that many symptoms, fatigue and pain among them, are invisible to everyone but the person living with the disease, which is part of why MS is often misread as ordinary tiredness.

Signs and symptoms

• Fatigue out of proportion to activity, which rest does not fix
• Problems with balance, coordination and walking
• Weakness in one or more limbs
• Tingling, numbness or other changes in sensation
• Vision problems, including blurred or double vision and eye pain
• Bladder and bowel changes, and changes in memory, concentration or mood

Symptoms vary between people and over time.

What raises the risk

Some things cannot be changed:

• Being a woman. MS Canada says women are up to three times more likely to develop MS, and 75% of people with MS in Canada are women
• Age. About 60% of diagnoses happen between 20 and 49, though MS affects children and older adults too
• Genetics. MS Canada names the HLA-DRB1*1501 variation as the strongest genetic change linked to MS
• Where you live. Regions further from the equator have historically had more people with MS

Others can often be worked on, usually with support from a health care team:

• Low vitamin D, which MS Canada says can influence MS risk early in life
• Smoking, which MS Canada links to disability progression, so stopping is part of MS care
• Body weight during adolescence, which MS Canada describes as critical in dictating risk at that age
• Epstein-Barr virus and other herpes viruses, which MS Canada describes as implicated in the development of MS

How MS is diagnosed in Canada

MS is diagnosed by a specialist. A family doctor or nurse practitioner who suspects it refers you to a neurologist, who takes a detailed history and examines strength, reflexes, coordination, balance, sensation and eye movements. MS Canada says magnetic resonance imaging is used to detect tissue damage in the central nervous system, and MRI of the brain and often the spinal cord is central to the assessment. Blood tests rule out conditions that look similar, and a lumbar puncture or nerve signal tests may be used. Diagnosis generally requires damage in more than one part of the central nervous system, usually at more than one point in time, which is why some people are diagnosed only after follow-up.

Treatment and day-to-day management

MS Canada states plainly that MS is not curable, but that it is manageable. Treatment works on the disease, on relapses, and on symptoms. A health care team may discuss:

• Disease-modifying therapies, which MS Canada says aim to reduce the frequency and severity of relapses, reduce new lesions on MRI, and slow the accumulation of disability
• They come three ways: injections such as interferon beta, glatiramer acetate and ofatumumab; tablets such as fingolimod, dimethyl fumarate, teriflunomide and cladribine; and infusions such as ocrelizumab, natalizumab and alemtuzumab
• Steroids for acute relapses, to shorten them and speed recovery, though MS Canada notes longer term outcomes are not changed
• Stem cell transplantation, which MS Canada says can substantially reduce disease activity for some people
• Rehabilitation for fatigue, mobility, spasticity, pain and bladder symptoms

The therapies differ in how they are given and in their risks, so which one fits is a decision for you and your MS team.

When to talk to a doctor

• Call 911 for sudden weakness or numbness on one side, a drooping face, sudden trouble speaking or a sudden vision change. These are signs of a stroke, even in someone who has MS.
• Seek urgent care for sudden loss of vision in one eye, new eye pain with blurred vision, new difficulty passing urine, or rapidly worsening leg weakness. Book an appointment for unexplained tingling, numbness or balance changes lasting more than a few days.
• Contact your MS team promptly if you think you are having a relapse, meaning new or worse symptoms lasting more than a day, or if you have a fever while on a disease-modifying therapy, since some affect the immune system.

Why clinical research matters for MS

The therapies available in Canada work mainly on the relapsing side of MS. Options are far more limited for progressive forms, where disability builds without obvious relapses, and choosing between therapies is itself unsettled, which is why the Canadian MS working group publishes treatment optimisation recommendations. Canada has particular reason to be involved: one of the highest rates in the world, and an average age at diagnosis of 43 here against 32 globally. Open questions include why MS is so common at northern latitudes, the roles of vitamin D, smoking and Epstein-Barr virus, whether myelin can be repaired rather than only protected, and how to treat fatigue.

Studies are how those questions get answered. Taking part is voluntary, informed consent comes first, and you can stop at any time without affecting your regular care. No one can say whether a study will help you personally.

Learn more from Canadian sources

• MS Canada: what multiple sclerosis is
• MS Canada: treatments for MS
• MS Canada: risk and prognostic factors
• Public Health Agency of Canada: MS in Canada