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Multiple Sclerosis

What is Multiple Sclerosis?
MS is thought to be an autoimmune disease that affects the central nervous system (CNS). The CNS consists of the brain, spinal cord, and the optic nerves. Surrounding and protecting the nerve fibers of the CNS is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses.

In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. These damaged areas are also known as plaques or lesions. Sometimes the nerve fiber itself is damaged or broken.

Myelin not only protects nerve fibers, but makes their job possible. When myelin or the nerve fiber is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, and this produces the various symptoms of MS.

The most common symptoms of MS include:
  • Fatigue (also called MS lassitude to differentiate it from tiredness resulting from other causes)
  • Problems with walking
  • Bowel and/or bladder disturbances
  • Visual problems
  • Changes in cognitive function, including problems with memory, attention, and problem-solving
  • Abnormal sensations such as numbness or "pins and needles"
  • Changes in sexual function
  • Pain
  • Depression and/or mood swings

Less common symptoms include:

  • Tremor
  • Incoordination
  • Speech and swallowing problems
  • Impaired hearing

Mimics DCS

The main problem that might be seen with scuba diving with MS is that many of the symptoms of MS are similar to those of neurological DCS, such as patchy numbness, pain over peripheral nerves and fatigue. This would make it very difficult for a diving doctor to examine you and properly diagnose and treat an early case of DCS. Early diagnosis and treatment are necessary for best results with recompression treatment for neurological DCS.

No Studies

This having been said - it's going to be very difficult convincing divers not to return to diving if they had dived previously. I am not aware of any studies concerning the effects of pressure on the demyelinating effects of MS, nor am I aware of any ill effects regarding the use of certain medications for MS. If the diver is not taking drugs that alter the consciousness then there should be no problem in that area.
There are many medications used in the treatment of symptoms of multiple sclerosis. Some of theses drugs have sedation as a side effect and these should be considered when deciding if the person is 'fit to dive'. 

As long as a diver is no danger to him/herself and poses no danger to his/her buddy I would have no problem allowing diving, particularly if it were done in warm waters with little stress and at no-deco depths. As far as I know, there are no pluses or minuses in regard to the effects of pressure on the demyelinating process.

You should be aware however, of the possibility of delay in diagnosis should you ever have a problem with decompression sickness. Have all neurological deficits recorded in an up-to-date fashion in the diver's log book---just in case!

Diver's Alert Network has the following to say about MS:

"
This immunologic disease occurring in young and middle-aged people is characterized by episodes of neurologic dysfunction, often separated by remission. The extent of disability is quite variable. Treatment has improved in recent years."

Fitness & Diving:

  1. There is no evidence that diving in itself has an effect on the disease. About 20 years ago an unsuccessful effort was made to treat MS with hyperbaric oxygen. Patients neither suffered nor benefited from this treatment series.
  2. Persons with MS are advised not to exercise to the point of exhaustion and to avoid becoming chilled or overheated. Diving candidates with MS should respect that advice.
  3. In each individual case, consider whether the candidate can handle the physical load and master the water skills. Diving candidates should talk to their neurologist about diving.



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