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.
Sensitivity to heat is a common report from patients with multiple sclerosis and this may occur after something small such as having a hot shower or after undergoing physically difficult work in a hot environment.
Multiple sclerosis can present in a variety of ways as it evolves, with typical symptoms including vision problems, mental difficulties with depression, weakness of the lower body, weakness of one side and poor balance and coordination.
Exacerbation of MS symptoms can occur if the patient has a bacterial infection at the same time whilst it is thought there is little effect from physical trauma or mental stresses.
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.
Magnetic resonance imaging (MRI) scans of the head or the spinal column can be uses to identify the location of sclerotic lesions within the central nervous system.
Typical nerve lesions in MS are located close to the ventricles of the brain, small reservoirs for the cerebro-spinal fluid.
They are located in the white matter, the parts of the nervous system where the insulated nerve axons are packed together and where there are no, or very few, nerve cell bodies.
Even what seem like older lesions can have a surrounding area of inflammation as they advance outwards.
Some recent studies suggest that the grey matter (areas of nerve cell bodies) may be involved, with atrophy of the cortex and decline in mental ability.
The complexity and difficulty of treating multiple sclerosis is related to the widely varied and many sided requirements of the patients.
They may need providing with orthotics, drug treatment, information giving, mental counselling, access to rehabilitation facilities and assistance with placement.
Longer term steroid use plus being past the menopause means that bone density could be relevant and should be investigated.
High degrees of dependency develop in some patients and with a lack of support from a family this can challenge the ability to look after them in the long term.
In multiple sclerosis there can be high levels of fatigue which present a problem and are treatable to a degree with drugs.
The main aim of treatment is to prevent the disease progressing, particularly in its early stages where treatment with medication works best.
As patients become increasingly disabled they respond less well to drugs and their quality of life reduces significantly.
There is then an increased suicide risk which is calculated at seven and a half times the risk in the population and is not wholly explained by the patients being depressed.
Immune moderating medication is used to slow the progression of the disease and to attempt to reduce the number of relapses.
Many other drugs are used to suppress attacks but there is no agreement that this has a long term effect on the extent of neural degeneration or levels of disability.
Once an MS attack has started there is no particularly effective therapy, although a steroid may improve the time to recovery yet not affect the end result.
Surgery is not commonly used in multiple sclerosis but it can be employed to release contractures such as of the hip adductors or to treat severe neuropathic pain by cutting the nerve tracts responsible.