What Exactly is MS?

Signs and Symptoms of MS

Whatever the causes and mechanisms involved in MS may be, the main effects of MS are on the central nervous system - which means the brain and the spinal cord. This is why MS is classified as a neurological disease and is the specialty of neurologists. Symptoms can include any or all of the following: tingling, or pins and needles, anywhere in the body; difficulty in walking; dragging either foot; loss of co-ordination; loss of sensation or distorted sensation anywhere in the body; numbness in the hands, feet, limbs or other parts of the body; feeling like you are made of cotton wool; rubber or jelly; clumsiness; double or blurred vision or temporary blindness in an eye; slurred speech; an urgency to urinate or an inability to pass urine; loss of balance; unnatural fatigue; a feeling of tight bands around the trunk or lower limbs which can be itchy; sometimes pain; vertigo; tremors in the hands and arms; spasticity of the muscles or else muscles like jelly; a feeling of extreme cold like frostbite in the extremities; feeling like a wet rag in humid weather.

The Course of MS

Usually, the only type of MS mentioned is the relapsing-remitting type, where someone has an attack, followed by a remission, when the person goes back to the way he or she was before the last attack or slightly worse than before. Scientists have been trying to find out just what it is which switches people into a remission. Many have felt that if only they could solve the mystery of remission they could treat MS. The relapsing-remitting type is by no means the only course of MS. The other common type is described by scientists as 'chronic progressive'. In these cases, there are no clear-cut 'attacks' and the person just gets progressively worse. In some rare cases, it is possible to get a galloping form of MS, where the person degenerates rapidly and dies within a few years. But it is also possible to have one attack of MS, and then to have nothing happen to you ever again, and live to a ripe old age. Doctors sometimes say that the first five years of MS are a predictor of the future. Those who have hardly got worse in that time are said to have a 'benign' course. It would be nice to do something about the disease early on so that one is not faced with the horrible prospect of getting worse and worse, at whatever speed.

The Cause or Causes of MS

What causes MS, and what is going on in MS, are a complex puzzle. One scientist has described MS as 'baroque in its complexity'. As the years roll by, the puzzle just seems to grow more complex - immunoglobulins, abnormal IgC ratios, monoclonal antibodies, histocompatibility antigens . . . How all these pieces fit together has not yet been solved by scientists. However, this not the place to try and unravel the complex mechanisms going on in the disease. What is important to know is that there are some broadly undisputed facts about what is going on in MS. It  is useful to know the orthodox theories about MS as they now stand. The prevailing wisdom among orthodox doctors in the field of MS is that MS is a multi-factorial disease. They believe that a virus, or viruses may be the infecting agent, and there is some evidence that people with MS have an intrinsic inability to cope with such viruses. The immune system plays a complicated part in all this, perhaps causing the scattered damage to the nervous system. Epidemiological studies (studies done on different populations in different pants of the world) suggest that there may be some environmental agent at work in MS. Other studies point to some genetic component. Large amounts of money are being spent on medical research targeted at these areas. The aim is to find the cause or causes of MS first, so that a treatment or treatments can then be found, and finally a cure, or a prevention, or both. While all these global theories may well turn out to be true, a more holistic approach would be to look for more personal reasons for your disease, or dis-ease. There may be stress factors in your life, which triggered the first symptoms. There may also be environmental factors, which affect you in an individual way. You are the only person who can discover the more personal causes of why you have MS. A voyage of self-discovery may help answer deep questions about 'Why me?' and, once revealed, help you on your journey to health. The global theories about MS may take years to come to fruition. I believe we have enough knowledge now about what is happening in MS to start self-help treatment without losing precious time.

What is happening in MS?

There are some medical facts about MS which have been pieced together and which are for the most part undisputed, and helpful to know.

Myelin and Demyetination

The central thing that is happening in MS is that myelin is breaking down. Everyone agrees about that. But what scientists don't agree on is why the myelin breaks down and whether this breakdown of myelin is the primary event in MS, or whether it follows on from something else happening. MS is a disease which affects the central nervous system. The central nervous system is the brain and the spinal cord. In the white matter of the central nervous system (CNS) each nerve fibre (called an axon) is surrounded by a layer of insulation, called myelin. Nerve signals cannot travel normally without this insulating sheath, arid without myelin there may be faulty connections between adjacent nerve fibres. Think of these myelin-covered nerve fibres as if they were an electrical cable containing many wires. In a cable, it is very important that the wires should not make contact with each other To stop this from happening, each wire is covered by some insulating material - usually rubber or plastic. The insulation makes sure the electricity in the wire goes to its destination without short-circuiting. In Multiple Sclerosis, the myelin in the central nervous system suffers patches of demyelination. The damage to the brain and spinal cord occurs in many widely scattered areas. That is why it is called 'multiple' - there are many patches of damage. The damaged area becomes filled with hard material, or scars. 'Sclerosis' means scars. Multiple sclerosis means many scars. How your MS affects you may depend on where in the brain and spinal cord the scarring, or plaques, are. It is the white matter of the brain and spinal cord which is damaged in MS, rather than the grey matter. The white matter actually looks white to the naked eye. It consists of fibres, which carry messages from the sense organs - like the skin, eyes and ears - up to the higher parts of the brain. The white matter also sends messages from the brain down to the muscles. The white matter also links up various parts of the brain. It is the sort of 'wiring' of the brain. This explains why your ability to feel, move, and co-ordinate is affected in MS. Even though demyelination in MS still leaves many questions unanswered, more is known now about myelin and its breakdown than even five years ago. Seventy-eight per cent of myelin is made up of lipids, which are complex fats. Myelin also contains proteins. The best nutrition for MS is very rich in the kind of structural fats which go to make up myelin. MS only involves demyelination of the central nervous system. The nerve fibres in the peripheral nervous system do not get affected in MS. The myelin in both systems is similar in its lipid composition. But the two types of myelin are quite different in their protein composition. The other big difference is that in the central nervous system there are glial (special connective tissue) cells called oligodendrocytes which are responsible for producing myelin sheath, whereas in the peripheral nervous system there are other types of cells which do this, called the Schwann cells. Scientists are now able to see clearly for themselves what is going on when myelin breaks down. They have identified in particular something called a macrophage. In normal circumstances, macrophages are goodies. They are mobile white cells present in the blood, which infiltrate into damaged tissue. They aid other troops in the immune system to remove debris and bacteria by scavenging them, or gulping them up. It now seems that myelin breakdown only seems to occur in the presence of infiltrating macrophages. Under the microscope, these macrophages can be seen actually gobbling up the myelin. MS is called an auto-immune disease because components of the immune system turn against the body instead of defending it. These rogue macrophages are part of the auto-immune process in multiple sclerosis. Why the macrophages decide to turn on myelin is still a puzzle. Other bits of the immune system, such as the lymphocytes, are thought to behave in a hostile way too. Then there are the astrocytex. Astrocytes are the cells that form the scar after the myelin is destroyed. But they are turning out to be baddies too. They produce enzymes, which are a bit similar to macrophages in that they are garbage collectors - they clear away dead and waste products. It now seems that these enzymes may play an important role in damaging myelin in an area of inflammation. This inflammation itself is a key part of an acute attack in MS. Moreover; the myelin contains an enzyme system of its own which can digest myelin proteins and contribute to breakdown.The switch, or trigger, that switches these processes on is still open to debate. In any case, some scientists hold the view that it is futile to look for any trigger, as the process of demyelination is a purely degenerative one. This means that the myelin itself degenerates without any trigger because it was never properly built in the first place. The building blocks for laying down strong myelin were faulty and it did not have the strength to last a lifetime, as it normally should. The building blocks, which lay down strong and healthy myelin are largely made of structural fats.

Myelin Can Regenerate

Whatever the reason or reasons for myclin breaking down, the heartening thing to know is that myelin can regenerate. Not long ago, it was thought that myelin could not regenerate, but now this seems to be mistaken. Although myelin is a relatively stable structure, individual components do turn over, with old components being broken down and replaced with newly-formed components. This means that some of the damage sustained by the nervous system is in principle capable of recovery. MS plaques may not be fixed sites of permanent damage, but areas in which damaged tissues are attempting self-repair The trick is to know exactly what conditions aid that recovery. Some, or a combination, of therapies may be providing these conditions which aid myelin regeneration. For a long time, researchers have been saying that if only they could find out what made myelin regenerate, they could solve MS.

For further information : visit any of the Multiple Sclerosois sites on the Web.