Multiple Sclerosis (MS)

Multiple Sclerosis (MS)

So what is Multiple Sclerosis?

There are some really great definitions around – probably the best can be found from the MS Society.  In brief Multiple Sclerosis (MS) is a condition affecting the Central Nervous System (CNS).  The CNS is made up of the brain and the spinal cord.

The brain is the central hub that controls bodily activities and sends messages off to where they are required – both conscious actions (raising your hand to drink a cup of coffee) and unconscious actions (focusing your eyes on a computer screen)

The spinal cord is the actual message carrier – or the central message pathway. To carry messages to where they are needed you use a series of nerves that are protected by a fatty like skin called myelin.

In MS the myelin is damaged – and in cases stripped off nerves leaving scars (also known as sclerosis) – this can appear in multiple regions within the CNS.

The damage to the myelin can slow down, distort or even stop messages travelling through the central message pathway. The specific symptoms that appear depend upon which part of the CNS is affected.

Symptoms are very varied and complex. Initially symptoms can be subtle and include numbness and tingling, vertigo and fatigue, as a result MS is not easy to diagnose and does require an experienced Neurologist. Many of us suffer from some of these intermittent symptoms, but more often than not these symptoms are not due to MS.

MS can vary widely from patient to patient – for some patients MS has a progressive pattern for others it is typified by periods of relapse and remission with many years between attacks.

How is MS diagnosed?

Like all first meetings with me – a full medical history will be taken; including any history of MS within your family (although MS is not directly inherited a combination of genes within your family may make you more susceptible). I will ask lots of questions about any problems or symptoms you may be feeling.

There will then be a neurological examination, which will check for any nerve pathway abnormalities.

Magnetic Resonance Imaging (MRI) together with the medical history and physical examination may be sufficient to make a diagnosis of MS.

However, blood tests may also be performed to exclude other medical conditions that can produce similar neurological symptoms. For a few patients more specialised tests need to be carried out. These may include Evoked Potentials and a Lumbar Puncture and are usually carried out as a day case at Hurstwood Park Neurological Centre in Haywards Heath.

For some patients with early symptoms, it may not be possible to definitively come to a diagnosis after the initial tests, in which case the symptoms will be monitored and occasionally the MRI scans will need to be repeated after an interval.

Am I alone?

The simple answer is “No” –  MS is the most common neurological disease among young adults affecting twice as many women as men.  Roughly 85 000 people in the UK have MS.   For more information, and help and support available visit the MS Society Web site.

What treatments are available in Sussex?

Like most neurology conditions there is no cure for MS, but treatments have been vastly improved in the past few years allowing patients to achieve a much better quality and more normal way of life. The treatments offered will depend on your symptoms and the exact type of MS you have. After an acute attack (or relapse), steroids may be offered to help hasten recovery. Depending on your type of MS and the frequency and severity of relapses, I can prescribe or, where appropriate, recommend you to see colleagues (Dr Rashid/Dr Fisniku) who can offer you some of the newer and in some cases more potent medications that reduce the likelihood of future attacks or relapses. This applies to patients with relapsing remitting forms of MS. For all patients I would also consider treatments tailored around the symptoms that are manifest – for example dealing with fatigue, pain, mood, walking and urinary difficulties.

Some MS medications are licensed but have not been approved by NICE or commissioners for NHS funding – these currently include Sativex and Fampyra. So these medications can only be obtained privately (self-pay). For other therapies these can only be given within a Specialist MS Neuro-Rehabilitation Service (such as FES or Functional Electrical Stimulation for foot drop). For other therapies such as Low Dose Naltexone (LDN) and Vitamin D, the evidence of their benefit is not sufficient to recommend NHS prescription though patients are able purchase these medications directly (either over the counter or as a private prescription).

I work as part of a MS team with a number of MS Nurse Specialists supported by Specialist Physiotherapists and Rehabilitation Therapists. If you require more specialist MS disease modifying therapies (Gilenya, Tysabri, Campath for example) you will be referred to my colleagues who run the Sussex MS Centre at Hurstwood Park (Dr’s Rashid and Fisniku) and where appropriate you may also be afforded the opportunity to participate in clinical trials for some of the many exciting emerging MS therapies.

From a holistic perspective many of my patients also attend a MS Treatment Centre in Southwick, which can provide help and advice on both Conventional and Complimentary Therapies.

The future and clinical trials in Sussex

I regularly give talks to Local Patient Groups, Nurses, Therapists and GPs and have lead local initiatives to improve the health care offered to MS patients in Brighton and Hove.

Where appropriate you will also be afforded the opportunity to participate in clinical trials for some of the many exciting emerging MS therapies. These trials are being led by my colleague Dr Waqar Rashid at the Sussex MS Centre at Hurstwood Park.

Clinical trials are carried out at the Clinical Investigations and Research Unit based at the Royal Sussex County Hospital site in Brighton (www.bsms.ac.ukcir) and you can find out more information about the MS clinical trials from:

Dee Mullan/Fay Caddye
Neurology Lead Research Nurse/Administrator
Downsmere
Princess Royal Hospital
Lewes Road
Haywards Heath
RH16 4EX

Telephone: 01444 441881 x 5426 Monday-Thursday

For more information about MS see my Quick Links webpage

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