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.

Heat can be an aggravating factor and many patients report they are worse in hot weather, especially if they have to perform physical exertion or even after having a hot shower. The presentation of MS can vary widely with some patients suffering a majority of mental changes, whilst others suffer incoordination, one sided weakness, lower body weakness, depression or symptoms with vision. Symptoms can be worse if the patient has another illness at the same time such as bacterial infections, while trauma and emotional stresses are not thought to have a high level of effect.

The onset of MS can include the presence of optic neuritis with disturbance of sight and pain in the eye or around it. The arms and legs may suffer from tingling and numbness, weakness of the muscle groups or degrees of pain syndromes. There can also be significant mental effects including inappropriate speech and actions, depression and dementia and difficulty in controlling the emotions. Urinary symptoms are common with incontinence and retention (problems passing water) and sexual function is often interfered with.

The lesions which are responsible for the neurological changes in this condition can now be imaged in MRI or magnetic resonance imaging scanning of the nervous system. The ventricles within the brain, reservoirs of the cerebrospinal fluid, are the areas where the lesions are closest to, with the lesions occurring inside the white matter of the brain. The white matter consists of the insulated nerve sheaths of thousands or millions of nerve tubes on their way to parts of the nervous system they are serving.

Treatment of MS is difficult and complex and such patients usually have multifactorial needs and requirements. Medical treatment, psychological counselling, information, rehabilitation access, provision of orthotics and housing issues are all frequent requirements when dealing with patients with this disease. If patients have been on steroids for long periods or are immobile or past the menopause then bone density may need evaluation. Some patients are very dependent and have little or no family support and so present problems with long term housing and care.

Fatigue can be a very strong symptom in MS and can be treated with medication. Overall the aim is to prevent the progression of the disease especially if it diagnosed early on in its progress when drug treatment can be most effective. If patients become more disabled they are less responsive to current medical treatments and suffer a significant impact upon their quality of life. This leads to an increased incidence of suicide, around 7.5 times higher than the general population and not explained simply by reactive depression. The immune moderating drugs related to interferon are used to prevent relapses and slow disease progression.

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, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and Physiotherapists in Bristol. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.