What causes MS?

That’s a more difficult question to answer. So I suppose in a way the categorical idea is that no one truly knows at the moment. So as I said it is thought of as an auto-immune disorder so there has to be something to trigger that. So the idea is that people might be exposed to something within a certain geographical area. So why certain populations in some parts of the world have more risk of MS is not entirely sure. So there are ideas that it might be exposure to a virus, a series of viruses and there are some that are more likely than others. Within populations you can argue that there might be a genetic predisposition to MS. So genes probably play some part to that. And then there are other ideas to do with environmental factors such as exposure to daylight sunlight hours and synthesis of vitamin D and so forth. So I would imagine that the answer is going to be that it’s a complicated jigsaw puzzle of lots of different factors that combine together to then allow the disease to develop.

So life expectancy, again it’s, there have been several studies that have tried to answer that question, if you like. There is a range of interpretation from those studies. If you looked at life expectancy in totality there is an argument that life expectancy for that population of people, so the whole group of people, might be reduced by in the region of somewhere between three and seven years. If you start to unpick that information what it looks like is that the vast majority of people with MS will lead a normal life expectancy. In other words, MS won’t adversely affect their particular life expectancy. For some people where there is very complicated and advanced disability life expectancy is probably shortened and it’s that group then skews the figures for the overall population. And again there is an argument about whether MS in itself is life limiting or whether it is complications that come with MS. So I would suggest that the major life-limiting risk would be what’s called as aspiration pneumonia. This is where people, their swallowing ability becomes unsafe and fluid can go down into the lungs, consolidate, causing pneumonia and that can be very serious and life limiting.

What happens when somebody goes and sees a consultant? What can they expect when they go for a visit to a consultant for the first time?

There is a set of international criteria, if you like, to help frame a diagnosis of MS and the current one is called, McDonald Criteria. That is freely available on the Internet. If people Google that they will find it. So what the neurologist is trying to do is see whether the person’s history, their experience of what has been happening to them leads them towards meeting that criteria, if you like. And again the vast majority of people with a diagnosis will meet that criteria, clearly some will be on the periphery, so on the edge of that criteria at some point.

What the neurologist is trying to do primarily is demonstrate what is called dissemination in time and space. So time as in months, days etc. Space as within the central nervous system. So if a person presented with a history of visual disturbance and that sounded very much like optic neuritis. Sometimes people are surprised that the neurologist will then start to examine their legs. So what they are trying to do is demonstrate dissemination into space within the nervous system. So if the person has already told the neurologist that they have a problem with their eyes so they accept that and they are looking for neurological evidence of damage to say the spinal cord or the brain. So they are trying to demonstrate dissemination in time and space.

They do that by listening to the person tell his story, taking a history, examination. So that’s moving limbs, looking into eyes, checking reflexes and then may arrange for further investigations. So that would be things like an MRI scan. So MRI provides a nice image of the structures of the central nervous system and you can see what looks like inflammation on there. They might do what’s called nerve conduction tests. So this is a test to measure the speed of a nerve, speed of the conduction along the nerve. So this might be sensory and the person might have to go and have electrodes placed on their skin. It might be to do with vision again and they’ll look at a chequered board and have little electrodes sitting on their head to measure the speed of conduction on their optic nerve. Also there is something called a lumbar puncture. The lumbar puncture is to try and remove some of the fluid that encases the brain and spinal cord to see whether there are markers of inflammation that have made their way into that fluid. So again MS is an inflammatory condition so when there is active inflammation going on within the body the body produces by-products of that if you like. They make their way into the fluid that circulates around and that will be seen in the lab, they will be able to identify that. The test is called oligoclonal banding.