The professor is right. We haven’t written at length about multiple sclerosis for more than 18 months, although it has cropped up from time to time when writing about other conditions.

Although the first case of MS was first described in the 14th century and it was recognised as a disease 150 years ago, research is still discovering new aspects of its causation.

Fortunately, our knowledge about MS, and of new treatments that have the potential to revolutionise the outlook for patients, is growing rapidly. MS is more common in people who have spent at least their first 15 years of life in a temperate zone. Apart from this long-term influence of climate on the incidence of MS, short-term extremes of weather may also either trigger the first episode, or induce relapse in someone in remission.

Exposure to very hot weather or heat is notoriously prone to cause deterioration. But any apparent effect of an extremely cold climate may be confused by the influence of exhaustion after vigorous exercise; becoming over-tired and exhausted can precipitate a relapse.

Long swims in cold seas have been known to cause trouble and it is noticeable that the first known case of MS described in 1396 followed ice skating.

Smoking exacerbates MS, as do infections. Urinary tract infections seem prone to do this but this may be more apparent than real as the nerve supply to the bladder is already often affected by MS. It is also known that some human leucocyte antigen (HLA) allotypes (factors involved in tissue typing) are more prone to MS than others. MS has ill-defined genetic links that don’t demonstrate any recognisable hereditary pattern.

The immuno modulators Avonex (interferon beta 1a), Betaferon (interferon beta 1b) and Copaxone (glatiramer) are drugs that reduce the frequency and severity of relapses. Copaxone acts in a different way from the interferons. Research has shown that a combination of Novan-trone and Onkotrone, the trade names of mitoxantrone, a drug more often used in the treatment of malignancies, with Copaxone, can be beneficial. When tried in a small study this combination reduced the number of relapses significantly, and induced some stabilisation in the patient’s disability.

Meanwhile another drug — Tysabri — has been licensed for use in the UK, the US and Europe. Tysabri has yet to receive its recommendation from the National Institute of Health and Clinical Excellence. So it is unlikely to be used as a front-line treat- ment, although it seems to be effective in treating people who have failed to improve with interferon and have a rapidly developing severe form of the relapsing and remitting type of the disease.

Tysabri is not a drug without side-effects, however, and wouldn’t be prescribed lightly or wantonly.

I suspect that the reader and I both disapprove of the difficulties patients with MS have in receiving treatment with interferon, or other new drugs.

SPONDYLOSIS of the neck has been diagnosed in a patient from Bedfordshire. What is this? Is it only a temporary condition that will pass? Or is it a problem that she will have to learn to live with? Could it have been triggered by surgery that she had previously had on her neck? Is it related to climate — it seems worse when it rains? Could it cause unrelated spasms of pain in her hands, legs and even her head?

There are several medical terms similar to spondylosis that have slightly different meanings but refer to spinal joint problems.

Spondylolisthesis is the term used to describe an abnormal movement between vertebrae, including the cervical spine in the neck, when one vertebra slips forward on the other. A simple example of this is the fate of a pile of bricks when a toddler builds one on top of another. Eventually one brick is misplaced, slips forward on the brick beneath it, and trouble is in the offing.

Spondylolisthesis may be the result of a spondylolysis in which there has been damage to a spinal joint, or possibly from a congenital abnormality. The other frequent cause of spondylolisthesis is spondylolysis from degenerative changes such as those following osteoarthritis of a spinal joint, or degeneration of the discs in between the joints.

Cervical spondylosis may also be referred to as cervical spondylarthritis, cervical spodylarthrosis, cervical osteoarthritis or cervical osteoar throsis.

Commonly, spondylosis causes pain in the back of the neck and up to the back of the head, or to shoulders and arms where it may reach the fingers. This pain may be associated with a loss of sensation or tingling with pins and needles in the hands and fingers. If the disc lesion causing the spondylosis is pressing on the cord, rather than the nerves leading from the spine, it could also result in troubles in the lower limb.

The extent of the damage to the neck following surgery, and its effect on the spinal nerves as well as the cord needs to be sorted out with MRI studies, and skilfully interpreted by a neurosurgeon or neurologist.

Post-operative instability and arthritis is a common problem after neck surgery and all degenerative arthritic problems are worse in wet weather.

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