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| printer friendly | MULTIPLE SCLEROSIS | ||||||||||||||||||||
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Multiple sclerosis is the most common potentially disabling disease of the central nervous system affecting young adults. The lifetime risk is about 1 in 500 in the UK and there is a slight excess risk in females (it affects three times more females than males). In most patients the pattern is initially episodic but the disorder moves through characteristic phases of attacks which recover, episodes leaving persistent deficits and then slow progression; occasionally, multiple sclerosis is progressive from onset. This natural history usually evolves over many years and life expectancy is not significantly reduced. Disability relates to onset and duration of the progressive phase. Focal inflammation causes acute injury of the myelin sheath that coats many nerve fibres in the brain and spinal cord disrupting the normal rapid passage of electrical impulses (saltatory conduction). The symptoms and signs of multiple sclerosis reflect the functional anatomy of impaired saltatory conduction at the sites affected - the cerebrum, optic nerves, brain stem and cerebellum, and spinal cord - producing alterations in vision, balance and co-ordination, sensation, movement and control of the bowel and bladder. Although these effects are initially reversible, due to resolution of inflammation and (perhaps) remyelination, with time there is persistent demyelination, axonal (nerve fibre) loss and astrocytes (small star shaped cells) scarring causing the sclerosed (hardened) plaques from which the disease gets its name. The cause of the disease is unknown but epidemiological studies indicate an interplay between genetic susceptibility factors and environmental triggers. Multiple sclerosis is usually perceived as a disorder of adulthood but children and adolescents can be affected. Although childhood and adolescent onset is not common, it is thought that two point seven to four point four per cent of people with Multiple sclerosis have onset before the age of sixteen. Of this figure, zero point two to one point six per cent are affected before the age of ten years. The relapsing remitting form of Multiple sclerosis is more common in those having childhood onset. Common features in childhood onset Multiple sclerosis are sensory problems, movement difficulties such as poor co-ordination and tremor, and visual problems. Inheritance patterns Prenatal diagnosis Medical text written November 2002 by Professor A Compston. Last updated June 2005 by Contact a Family and approved by Professor A Compston, Professor of Neurology, University of Cambridge, Cambridge, UK. Further Online Resources
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