In CPD modules
After completing this module, you should be more aware of:
- the nature of the disease
- initial symptoms and subsequent symptoms as the disease progresses
- the three main types of MS
- current ways to describe MS by activity
- possible causes and risk factors
- typical signs and symptoms the GP is presented with when first suspecting MS
- the various tests and criteria required for diagnosing MS by a specialist
- the updated NICE MS guidelines (2022) on pharmacological approaches to managing MS symptoms
- other NICE guidelines which can be used in managing symptom types in MS
- disease modifying drugs for MS targeting the immune system.
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease affecting the nerves of the central nervous system in the brain and spinal cord.1,2
In MS, the immune system targets myelin, the protective fatty protein sheath around nerve cells, causing it to detach from the nerve. This demyelination can be partial or complete, and causes nerve impulses to slow down, become distorted or be completely blocked.
As the effect can occur anywhere in the CNS, symptoms can vary. An initial episode involving inflammation and demyelination resulting in symptoms lasting 24 hours or more can be described as a clinically isolated syndrome(CIS).
Symptoms typically involve one or more of the following:3
- visual problems
- loss of sensation, eg in the face
- limb weakness (usually more on one side of the body)
- uncontrolled body movements (ataxia)
- bladder control problems.
While these symptoms are typical of MS, not everyone experiencing an episode of CIS will develop MS. As MS progresses, symptoms can increase in number, duration, frequency and severity. Additional symptoms can include:3,4,5,
- difficulty in walking or moving
- muscle stiffness and spasms
- balance and co-ordination problems
- numbness and tingling
- impaired cognitive skills – thinking, learning and planning
- changes in speech, hearing and/or taste