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MS information for health and social care professionals Introduction

As many as 100,000 people in the UK are estimated to have multiple sclerosis (MS), a chronic neurological disorder, sometimes benign, frequently remitting, but often progressive with gradually increasing disability. Although a cause of varying degrees of disability and distress, for most, MS does not have a significant effect on lifespan. Between 3 and 7 people per 100,000 are diagnosed per year. Although it was first described in the 1860s by a French neurologist named Jean Martin Charcot, for virtually a century little research was carried out into the condition. Whilst the cause of MS is unproven and a cure is elusive, much can be done to manage symptoms and, with the advent of disease modifying drugs, it is believed that incremental disability can be significantly slowed.

Good management of MS is a huge challenge to health and social care professionals because the disease course is unpredictable, symptoms endlessly variable and the psychosocial effects can have as heavy an impact as physical symptoms. People continually have to readapt to changes in their condition and live with the uncertainty that multiple sclerosis brings. For this reason, it is essential that a holistic and multidisciplinary approach is adopted, one in which the person with MS and their family are partners in any management programme.

Prevalence

MS is the most common condition of the central nervous system (CNS) affecting people between the age of 20 and 40, with women diagnosed outnumbering men in a ratio of about 3:1[1]. Though MS can be diagnosed in children as young as five and in people over 65, this is unusual.

It is possible to identify regions of low, medium and high prevalence of MS. It is commonest in temperate countries (50- 120/100,000) decreasing with proximity to the equator (<5/100,000)[2]. In the UK, prevalence is approximately 100 - 120 per 100,000[3]. This figure is higher still in Scotland, especially Shetland and Orkney, where the highest known prevalence has been recorded[4].

Cause

The cause of MS is unproven, but evidence increasingly suggests that it is the result of an interplay between as yet unknown environmental factors (possibly viral agents) and genetic susceptibility. This results in triggering the engagement of the immune system to produce an autoimmune response by the body upon its own myelin.

In the healthy state, our bodies are protected from invasion or viral attack by a complex system of defences. In MS the myelin sheath around the nerve cells is attacked as though it were a foreign threat, the nerves become demyelinated, axons may be destroyed and may not function as they should.

There is almost certainly a genetic component though MS is not hereditary in the conventional sense. Families who already have a member with MS have a greater risk of developing the condition than families where no one has MS. If a parent has MS, the risk for their children is 15-20 times greater than that of the general population though the risk is still relatively low. So far there is no research that has shown conclusively what the hereditary process could be, though there is ongoing work in this area[5].

The most common, but still speculative, explanation is that some environmental agent (probably infective) gains access to the genetically susceptible person before puberty. Evidence supporting this theory is that an individual living in the tropics is unlikely to develop MS but if that person moves to a temperate environment before the age of puberty they then take on the risk of that area.

References

  1. Orton SM, Herrera BM, Yee IM et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurology 2006;5(11):932-936.
  2. Paty DW, Ebers GC. Multiple sclerosis. Philadelphia: F.A. Davis; 1998. p7
  3. Richards RG, Sampson FC, Beard SM et al. A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models. Health Technol Ass 2002;6(10).
  4. Cook SD, MacDonald J, Tapp W et al. Multiple sclerosis in the Shetland Islands: an update. Acta Neurol Scand 1988;77:148-151.
  5. Compston A. The genetic epidemiology of multiple sclerosis. Philos Trans R Soc Lond B Biol Sci 1999;354(1390):1623-1634.

Bibliography

  • Jones C. Multiple sclerosis. Prim Health Care 2004;10(4):29-34.
  • Miller D, McDonald W, Smith K. The diagnsosis of MS. In: Compston A, Confavreux C, Lassman H et al. editors. McAlpine's Multiple Sclerosis. 4th ed. Churchill Livingstone: Philadelphia; 2006.