The types of MS
- Relapsing remitting MS, the most common form, with flare-ups of symptoms followed by periods of partial or full recovery
- Primary progressive MS, affecting roughly 1 in 10 people, where symptoms gradually worsen from the outset without distinct attacks
- Secondary progressive MS, which develops in around half of relapsing remitting cases after about 10 years
- Clinically isolated syndrome, a first episode consistent with MS; more than one episode is required before a formal diagnosis
Risk factors
Family history, low vitamin D, prior Epstein-Barr virus infection, smoking, geographical latitude, and obesity in adolescence. MS is not directly inherited, though having a close relative with MS raises risk above the population level.
How MS is diagnosed
No single test can diagnose MS. Diagnosis is built from a neurological examination, MRI imaging that shows damage in the brain and spinal cord, and often analysis of cerebrospinal fluid taken by lumbar puncture. Evoked potential tests, which measure how quickly nerves conduct signals, are sometimes used.
Establishing the diagnosis requires evidence of damage separated in both location and time, which is why a first episode is generally classified as clinically isolated syndrome rather than MS.
How MS is usually managed in Australia
Management runs on two tracks, and most people are engaged with both at once. One works on the disease process itself, the other on the symptoms it produces day to day.
Disease-modifying therapies aim to reduce the frequency and severity of relapses and slow accumulation of damage. There are now many available in Australia, prescribed and monitored by a neurologist.
Symptom management addresses what people live with day to day: fatigue, spasticity, pain, bladder function, mobility and mood. This side typically involves a wider team including physiotherapists, occupational therapists, continence nurses, speech pathologists, psychologists and MS nurses.
There is no cure. The combination of disease-modifying therapy and structured symptom management has substantially changed the outlook compared with previous decades.
