What is multiple sclerosis?
Multiple sclerosis , also known as MS disease , is a rare autoimmune disease that can affect the brain and spinal cord, causing a wide variety of potential symptoms, including problems with vision, arm or leg movement, sensation, or balance.
Related article: What are autoimmune diseases?
Often times, MS comes with a sudden symptom, such as paralysis, visual impairment, or loss of sensitivity in a part of the body. The sudden onset of symptoms is called exacerbation of the disease . Post-relapse health problems may disappear completely or only partially.
It is typical for MS that inflammation reappears at different points in the nervous system at different time intervals. The name multiple sclerosis is caused by the formation of hardened scars (sclerosis) in many (multiple) places in the brain and spinal cord.
85% of all patients have a different course of symptom regression, disappearance, and then reappearance. Half of these patients experience a gradual deterioration after several years, called secondary progression . About 15% of patients have a gradual progression from the beginning without any significant exacerbation.
How long do MS patients live?
The average life expectancy of 25 to 35 years after multiple sclerosis is diagnosed is often cited. Some of the most common causes of death in MS patients are secondary complications from inactivity, chronic urinary tract infections, swallowing, and breathing.
What causes multiple sclerosis?
The disease is believed to be triggered by the interaction of several factors. It is known that MS disease can be genetic and therefore can occur frequently in a family. For example, if a person with a twin suffers from multiple sclerosis, there is a 30 percent chance that their twin will also develop the disease.
Some environmental influences and geographic conditions may also affect the risk of MS disease. The closer a person gets to the equator, the lower the risk of disease. The risk increases further in the south and north. Northern Europe and North America have the highest rates of disease.
There are also indications that prolonged contact with some viruses may increase the immune system’s self-aggression and indirectly increase the risk of MS disease. However, it is very unlikely that multiple sclerosis can be caused directly by a particular pathogen.
What are the symptoms of multiple sclerosis?
The symptoms of MS disease are very diverse. They may develop within hours or days and may partially or completely regress. They can also develop gradually over weeks and months.
Common symptoms in the disease state are generally as follows:
- Paralysis of the face, arms, legs, or one side of the body, often associated with muscle cramps
- Visual disturbances, such as blurred vision or significant visual impairment, sometimes associated with ocular pain
- Sensory disturbances in different parts of the body (tingling, numbness), feeling of electricity in the arms and legs when the neck is bent
- Instability, dizziness, balance problems, difficulty grasping or writing
- sudden urge to urinate, incontinence, or constipation
- Eye movement disorders such as double vision or involuntary jerky eye movements
- Speech disorders such as vague speech
- swallowing problems
Other symptoms of MS disease may include:
- Fatigue (increased fatigue, weakness, lack of concentration)
- Depression (impulsivity, restlessness, sleep disturbance, loss of interest, melancholic, suicidal thoughts)
- Cognitive disorders (concentration and attention problems, memory impairment)
How is multiple sclerosis diagnosed?
The doctor will ask about previous neurological problems (for example, impaired sensation in the limbs, impaired balance, and vision problems) and other complaints. He or she will also want to find out if the patient and his family have autoimmune diseases.
At the same time, he performs physical and neurological examinations and evaluates the results by requesting blood and urine tests. It also records the patient’s psychological state.
Electroencephalography (EEG), magnetic resonance imaging (MRI) , and removal of fluid from the spinal cord are required to identify the typical damage to the brain and to prove MS disease.
In addition, the doctor determines whether the patient’s gait and vision are impaired, to what extent, and whether there are bladder dysfunctions.
Nonspecific symptoms make diagnosis difficult
Because the symptoms are not very specific, it usually takes several months or even years for the doctor to recognize the disease. The early stages of the disease are called clinically isolated syndromes. Patients with clinically isolated syndrome already have the first early sign of the disease.
If the characteristic features of the disease and typical brain damage can be detected using magnetic resonance imaging in these patients, the doctor can diagnose MS at this early stage.
Early diagnosis is important so that treatment can be started as soon as possible. In this case, the earlier treatment is started, the better the progression of the disease can be slowed and an injury delayed or even prevented.
If new or unusual symptoms develop or the initial symptoms recur after the onset of the first symptoms, affected persons should in all cases consult their treating physician for clarification.
How is multiple sclerosis treated?
There is no definite cure for MS disease. Treatment can reduce discomfort during a relapse, prevent further relapses, slow disease progression, and prevent or delay the onset of serious disability.
Treatment of relapses
Acute attacks can be treated with high-dose cortisone, which the doctor injects into a vein. If cortisone therapy does not work well enough and symptoms persist or even increase, there is a possibility of blood washing (plasmapheresis) . The purpose of blood washing is to remove antibodies from the blood that contribute to nerve damage.
Another possibility is immunoadsorption . This is also a blood wash, in which the removal of antibodies and other components of the body’s defense system from the blood is at the forefront. Treatment is done only in specialized multiple sclerosis centers.
In very severe attacks, the doctor may use a drug that affects the immune system (immunosuppressive or immunomodulatory substances).
Immunomodulatory drugs (acting on the immune system) can have a positive effect on the course of the disease. They inhibit inflammation and can reduce the frequency and severity of relapses. Interferon preparations and glatiramer acetate , a protein molecule resembling the myelin sheaths of nerves, are used. Patients should inject these drugs intramuscularly or under the skin.
If these drugs don’t work well enough, the doctor may prescribe a biotechnologically produced antibody ( natalizumab ). Alternatively, an active ingredient ( fingolimod ) has been approved for the first time since 2011 and patients can take it as a tablet. Another option is treatment with an immunosuppressant.
Other drugs to prevent relapses will likely be available soon. Various active ingredients in tablet form as well as other biotechnologically produced antibodies for injection are currently in clinical development.
Treatment of complaints
Physiotherapy, occupational therapy, or speech therapy can also help relieve symptoms and improve the mobility of those affected. Attention and concentration training can improve memory performance. Bladder training or pelvic floor training can help with bladder problems.
Some complaints can also be alleviated with medication. For example, spasticity, fatigue, pain, bladder dysfunction, erectile dysfunction, tremors during certain movements, memory problems, depression, ability to walk can be alleviated with medications prescribed by the doctor.
Remember, your doctor will decide which medicine to take and how.
What can patients do for themselves?
A balanced lifestyle can have a beneficial effect on the disease. Patients should avoid stress as much as possible. It’s important to find a balance between too much and too little stress.
In addition, people with MS should minimize their risk of infection by, for example, getting a flu shot in the fall. Because infections and the defense processes they trigger can promote exacerbations.
A balanced diet and regular light fitness training can also have a positive effect. Relaxation procedures are also helpful.