Multiple Sclerosis

Multiple Sclerosis (MS) is an inflammatory disease of the Central Nervous System (CNS) - that's the brain and spinal cord. Predominantly, it is a disease of the "white matter" tissue. The white matter is made up of nerve fibres which are responsible for transmitting communication signals both internally within the

CNS and between the CNS and the nerves supplying rest of the body.
In people affected by MS, patches of damage called plaques or lesions appear in seemingly random areas of the CNS white matter. At the site of a lesion, a nerve insulating material, called myelin, is lost. I shall explain this process in more detail later. Clinically, MS is a hard condition to characterise because it is very unpredictable and variable. Depending on which areas of the CNS are affected and how badly they are damaged, the type and severity of symptoms can vary greatly.

No two people get MS in exactly the same way and the expression of each individual's disease is as unique as their fingerprints. However, the different courses of the disease, both within an individual and within the whole population, principally differ in their timing, location and severity. Underneath similar processes (including demyelination and sometimes other forms of nerve degeneration) are going on.

Although recent research indicates that the biochemical make-up of lesions may vary between different forms of the disease, this is not the reason why people with MS (PwMS) have such widely differing symptoms - it's because nerve damage to one site usually causes completely different symptoms than damage to another.

In general, people with MS can experience partial or complete loss of any function that is controlled by, or passes through, the brain or spinal cord.

Benign MS: This is a sub-group of relapsing/remitting. It is used to describe the disease in people who have had MS for fifteen or more years without picking up any serious and enduring disability. One of the neurologists that I saw put it at ten years. It's a bit of a false label really and people with benign MS are often reclassified as Secondary Progressive after a number of years

Malignant MS: Also known as Marburg's Variant and Acute Multiple Sclerosis. This is a label given to forms of MS where the disease progresses very rapidly from onset leading to severe disability within a relatively short period of time. Fortunately, this form of MS is extremely rare.

Chronic Progressive MS: Primary Progressive and Secondary Progressive used to be lumped together as Chronic Progressive (CPMS) but this term is no longer officially recognised although you will still see it referred to now and then.

Transitional/Progressive MS: Another form of the disease which is sometimes referred to but not widely used, is Transitional/Progressive (TPMS). This is characterised by a progressive course beginning many years after an isolated bout.

Devic's Disease: Also known as Neuromyelitis Optica, Devic's disease is a related condition to multiple sclerosis that is characterised by an attack of Optic Neuritis in both eyes followed by severe inflammation of the spinal cord (Transverse Myelopathy).

Balo's concentric sclerosis: This is another very rare disease that resembles multiple sclerosis. Clinically, it is very hard to distinguish Balo's concentric sclerosis from MS but MRI scans show the lesions in Balo's to be concentric rings of intact myelin and demyelinated zones. It is more common in China and the Philippines than elsewhere.