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Multiple sclerosis: Awareness makes all the difference

Posted November 17, 2016 by myjoburg in My Joburg

In the past when people thought about multiple sclerosis (MS), they imagined someone in a wheelchair. Although this perception often remains, in reality it could not be further from the truth.

“I can give a lecture to a hundred patients with multiple sclerosis”, says Dr Dominic Giampaolo, a Johannesburg neurologist with a special interest in MS, “and none of them will be in a wheelchair. With modern treatments, people with MS are living a normal life, with the longevity they would have enjoyed had they never developed the disease. The key, however, is awareness and early diagnosis so that treatment can be started as soon as possible.”

Herein lies the challenge. Because MS can manifest in so many different ways, the clinical picture can be confusing. “MS is an autoimmune condition”, says Dr Giampaolo, “meaning that a person’s immune system attacks their own central nervous system. The immune cells destroy the fatty (myelin) sheath that surrounds and insulates the nerve cells in the brain and spinal cord, interrupting efficient communication between cells. Depending on where this occurs, the initial symptoms can be variable and seemingly unrelated. They include blurred or double vision; blindness; difficulties with co-ordination, balance and walking; spasticity; incontinence; cognitive problems and extreme tiredness. Symptoms may get worse with exercise, stress or heat.”

In most people with MS, especially early in the disease, symptoms come and go, getting better spontaneously within about 4 to 12 weeks. There are long periods in between these symptomatic episodes, sometimes months or even years, without development of new symptoms. This form of the disease, called ‘relapsing remitting MS’, occurs in about 90% of cases and responds extremely well to treatment. Without treatment, however, after some years the symptoms can become progressive and constant, and symptom-free periods disappear.1,2 1. p25a,b,c; 2. p430

In South Africa, the number of people with MS is unknown. However, it is estimated that there are

2.5 million people worldwide with the disease, most of whom are between the ages of 20 and 50. MS occurs more frequently in women than men, is most common among people of European ancestry, and is uncommon in people of African descent.1 p24a

The cause is unknown. Although genetics may play a role, MS is not considered to be primarily a hereditary disease. Other factors that are thought to contribute, compounding the effects of genetics and of each other, include lack of exposure to sunlight, low levels of vitamin D, smoking, and previous viral infection, especially with Epstein Barr virus. Curiously, the timing of exposure to these risk factors appears to be critical. Migrants who emigrate before adolescence acquire a risk of MS comparable to other people in the region where they settle, whereas those who migrate in adulthood retain the risk associated with their home region.3 p133

Because of the nonspecific symptoms interspersed by long periods of remission, it may take quite a long time before the diagnosis of MS is established. It is not uncommon for people to forget early symptoms once they get better, or to be misdiagnosed and treated for something else. “Without maintaining a high index of suspicion, it’s quite a difficult diagnosis to make”, says Dr Giampaolo. “One has to ask the right questions when seeing a person with new neurological impairments to jog their memory of past attacks. Thereafter, we would perform further diagnostic tests to objectively demonstrate lesions in the brain or spinal cord to confirm the diagnosis. The key is to seek medical advice as early as possible if you experience new, recurrent or worsening problems that worry you, especially where those symptoms affect your vision, or limit your activities or mobility.1 p25d Insist on seeing a neurologist if you don’t get a satisfactory explanation. MS is no longer something to be feared, but we need to catch it as early as possible, before the damage becomes irreversible.”

For more information, visit the Multiple Sclerosis Society of South Africa on the below branch details:

Multiple Sclerosis South Africa – Inland branch

Contact person: Collin Kudare

Tel: 011 477 3540

Email: or


Facebook Page: Multiple Sclerosis SA-Inland & My MS Heroes

Twitter Page: MSSA Inland

Multiple Sclerosis South Africa – Western Cape branch

Contact person: Non Smit

24/7 Support Line – 082 5505 486



1. Browning V, Joseph M, Sedrack M. Multiple sclerosis: A comprehensive review for the physician assistant. JAAPA 2012; 25(8): 24-29.

2. Mohammed K, Koriem M. Multiple sclerosis: New insights and trends. Asian Pacific J Trop Med 2016; 6(5): 429-440.

3. Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: Current knowledge and future outlook. Eur Neurol 2014; 72:132-141.


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