Benign MS is a term used to describe some patients’ presentations but appears mostly incorrect as almost all patients suffer a continual progression of their disability, in some cases without particular attacks. Truly benign episodes are those attacks which occur and then remit without repetition in the future, which is rare. It is vital to have a realistic viewpoint from the perspective of the doctors, relatives and patients so that the correct information can be given and the correct treatments followed. Patients report mental and physical tiredness which is different from the more typical tiredness of functional over effort or poor sleep.

Multiple sclerosis sufferers report they are sensitive to heat, even after a hot shower and often if they have to physically exert themselves in hot weather. How MS presents as a condition can be widely variable with patients complaining of poor coordination and balance, weakness on one side, weakness from the waist down, visual disturbance, depression and some with a preponderance of mental changes. If there is an ongoing illness at the same times such as an infection then this can worsen MS symptoms, with further negative effects also caused to a much lesser extent by stress and physical trauma.

Visual disturbance secondary to optic neuritis is a frequent symptom of onset as well as varying degrees of eye pain. The limbs can be the site of frequently reported tingling and numbness with varying levels of muscle weakness and sometimes leg or arm pain problems. Profound mental effects can also be present which can include depression and dementia and inappropriate actions or utterances with lability of emotions. Common urinary symptoms are retention (difficulty in passing water) and incontinence, with frequent disturbance of sexual function.

The identification and placing of the lesions responsible for multiple sclerosis can now be well imaged in MRI (magnetic resonance imaging) scanning of the brain and spinal cord. The nerve lesions frequent in MS are placed near the brain ventricles, the small cerebrospinal fluid reservoirs. These lesions occur in white matter, where the insulated nerves are packed together as they travel to their destinations. Inflammatory changes can be present in even what look like older lesions, which might still be expanding. More recent MRI studies may indicate involvement of the grey matter, which are the regions where the cell bodies reside, atrophy of which can lead to mental decline.

Even older looking lesions can have an area of inflammation around them indicating they may still be growing. The grey matter, the brain areas which house the nerve cell bodies, have also recently been suspected of involvement, which can result in decline of mental faculties.

Severe tiredness can be an important symptom in MS and can be treated to a degree with medications. Halting the disease’s progress is the overarching aim of medical treatment and this works best in the early disease stages where the condition is most responsive. With increasing disability levels patients suffer highly reduced quality of life and respond less well to drug therapy. Suicide risk is also raised, to a level 7.5 times that of the wider population and this effect is not wholly taken account of by the levels of depression. Drugs which moderate activity of the immune system are employed to retard disease progress and to cut the number of relapses.

To minimise the number of attacks a large arsenal of other drugs is used but these may have no more long term effect on the amount of disability or degree of neural degeneration. When an MS attack starts there is no highly effective way of treating it although steroids may limit the time until recovery occurs while having little effect on the level of recovery. It is not common to resort to surgery but division of nerve tracts for neuropathic pain and tendon release for contractures are two typical examples.

Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Bristol Physiotherapist visit his website.