Multiple sclerosis

Definition

Multiple sclerosis (MS) is a chronic, progressive, inflammatory disease of the central nervous system (brain and spinal cord). Doctors also call the disease Encephalomyelitis disseminata: “dispersed inflammation of the brain and spinal cord”.

The brain is a sort of control centre that sends signals through the spinal cord to the body or receives these from the body. The signals are transmitted by various nerve fibres that are surrounded by a protective, insulating layer (myelin), like an electric cable.
If there is inflammation around this protective layer, the necessary messages can no longer be correctly conveyed. This can lead to paraesthesia (burning, prickling or tingling) on the skin, coordination difficulties (tripping up more) or visual disorders.

For most MS sufferers, the course of the disease is relapsing-remitting. The prognosis can vary widely: some MS sufferers have lasting damage very early on, others only have disabilities after several years with the disease.

Women aged 20 to 40 are the most frequently affected. Only half as many men as women suffer from MS. Children or older people very rarely get MS.

To date, there is no cure for MS; however, this does not automatically mean that MS sufferers must use a wheelchair. The current treatment options can have a positive effect on the course and progress of the disease and, therefore, sufferers’ quality of life.

Causes

Multiple sclerosis is being intensively researched. Nonetheless, the causes behind the disease are not yet clear. Only factors that affect the risk of developing MS have been determined.

·         Autoimmune diseases: the body is no longer able to distinguish between its own cells and foreign cells, so its defences are turned against its own tissue. In the case of MS, the myelin sheaths that surround nerve fibres are the target of the attacks. The attacks are by white blood cells (T and B lymphocytes and macrophages), which normally destroy foreign bodies or pathogens. The body produces antibodies that are used against its own cells. If these antibodies remain in the blood, various chronic illnesses can result, such as MS, lupus erythematosus or rheumatoid arthritis.

·         Infections: there is much to suggest that viruses contribute to the development of multiple sclerosis. However, to date, there is no clear evidence to support this.

·         Genetic causes: MS is not hereditary. However, the risk of MS in close relatives (e.g. children and siblings) seems to be slightly higher.

Risk factors for an acute relapse:

·         Mental or physical stress

·         Hormonal variations (e.g. during the menopause)

·         Infections (e.g. influenza)

·         Desensitisation therapies for allergies (e.g. hay fever)

·         Medication that strengthens the immune system

Symptoms

Multiple sclerosis does not necessarily take a severe course; the initial symptoms may subside completely or have only a very limited effect on the sufferer.

Common symptoms and side effects of multiple sclerosis:

·         Visual disorders (blurred vision, uncontrolled eye movements) and partial loss of vision through inflammation of optic nerves (optic neuritis); mainly temporary

·         Coordination and balance difficulties, and associated dizziness

·         Muscular paraesthesia; muscle coordination failure, rigidity in the extremities (fingers and toes), muscle contraction and spasms

·         Skin paraesthesia: itching, prickling, pain

·         Growing weakness and fatigue

·         Trembling (tremor)

·         Facial pain

·         Constipation, incontinence

A relapsing-remitting course is typical of the commonest form of multiple sclerosis:

This is defined as the unpredictable occurrence of a new symptom or recurrence of a previous symptom that lasts more than 24 hours. In most cases, the symptoms develop within days, remain constant for 3 to 4 weeks and then subside gradually over a period of one month.

Symptom progression

The course of MS is unpredictable. The type, severity and timing of the progress of the disease vary from patient to patient. Based on the appearance and frequency of symptoms, five general categories of the disease have, however, been identified:

·         Benign MS (approx. 10% of those affected): hardly any disability, complete recovery from relapses

·         Relapsing-remitting MS: unpredictable appearance of new symptoms and worsening of existing symptoms; the symptoms may recur completely or partly; the disease does not worsen

·         Secondary-progressive multiple sclerosis: symptoms do not subside and disability increases

·         Primary-progressive multiple sclerosis: gradual worsening of the condition, without relapses or remissions

Diagnosis (tests)

Diagnosing multiple sclerosis is not straightforward, as there is no MS test to establish the diagnosis. It can sometimes take weeks, months or even years for a clear diagnosis to be established.

Other medical symptoms and diseases, e.g. inflammation of blood vessels, strokes, vitamin deficiencies or brain inflammation must first be excluded.

The first step is basically to establish the medical history, taking symptoms into account.

Diagnostic procedure:

·         Neurological investigations: motor and sensory tests, optic nerve examination (checkerboard pattern test), coordination of extremities, stability of balance, skin sensitivity, speech and reflexes

·         Magnetic resonance imaging (MRI): this can detect damage and scar tissue from chronic inflammation of the brain and spinal cord

·         X-rays

·         Cerebrospinal fluid investigation

·         Special reaction tests of nerve pathways

The final diagnosis must put together various pieces of the puzzle: the more pieces fit, the more secure the diagnosis.

The degree of disability and the progress of the disease are categorised according to a special scale: expanded Disability Status Scale (EDSS).

Treatment

Multiple sclerosis cannot currently be cured. Various treatment methods are used to alleviate the symptoms, limit worsening of the disease, mitigate relapses or even prevent them.

Basic medication

Various drugs are currently available for long-term therapy:

·         Interferons: interferons are proteins that are naturally present in the body; they transmit messages between cells and play a key role in the immune system. They inhibit inflammation and help stabilise or slow down the development of MS.

·         Immunoglobulins: immunoglobulins are proteins in the blood that are involved as antibodies in the immune reactions of the body. It is not really known whether long-term treatment with immunoglobulins is successful or not.

·         Glatiramer acetate: used mainly for patients with limited symptoms.

·         Immunosuppressants: immunosuppressants are drugs that suppress the immune defences.

There is a great deal of research in the field of MS. Other medicines are currently only at the evaluation stage.

Treatment of acute relapses

Anti-inflammatories (cortisone, glucocorticoids) are mainly used here.

Treatment of accompanying symptoms of MS

To maintain quality of life, accompanying symptoms such as visual disorders, fatigue, muscle cramps or muscular paralysis, trembling, dizziness, urinary disorders, pain, loss of libido or depression must be carefully monitored and specifically treated.

Medication or alternative therapies such as movement and coordination exercises, massage, relaxation therapies, pelvic-floor exercises or acupressure may be helpful here. Psychotherapeutic support is also important.

Prevention

As the causes are unclear, prevention of MS is not possible. However, early basic treatment seems to mitigate the course of the disease and lower the frequency of relapses.

Avoid at all costs: stress, immunostimulating medication (e.g. no echinacea preparations to strengthen immunity).