Multiple sclerosis (MS) is a chronic disease of the central nervous system that occurs worldwide. It is the most common cause of neurological changes in adolescents and middle-aged people, especially women.
The myelin sheath is made up of proteins and fats. It protects and covers the nerve fibers of the central nervous system, as well as facilitates the conduction of electrical impulses between them.
In people with multiple sclerosis, the myelin sheath is damaged. This damage can leave scars (sclerosis). Researchers call these damaged areas “plaque”.
The myelin sheath not only protects the nerve fibers, but also helps them function properly. Damage to the myelin sheath greatly reduces the nerve’s ability to conduct impulses. Fortunately, damage to the myelin sheath can often be repaired.
What causes multiple sclerosis?
The etiology of MS is unknown. Although its cause is not clear, we know several systems are involved in the disease. Causes include immune factors and hereditary factors, as well as infections.
The exact role of viral infection in the onset and progression of the disease is unknown. However, researchers have studied several disease-related viruses. Epstein-Barr virus has been linked to demyelination (destruction of myelin sheaths). There is also evidence that children exposed to this virus are more susceptible to the disease.
Scientists have studied the most viruses of all environmental factors. They believe they are one of the triggers or determinants of the disease. Experts believe that viruses shape oligodendrocytes during childhood, later causing an abnormal immune response in them. This changes myelination.
Hereditary susceptibility to the disease is relatively clear. In fact , studies in identical twins show a 31% risk of developing multiple sclerosis. In male twins, the risk is closer to 5%.
Symptoms of multiple sclerosis
The onset of symptoms may be so mild that the patient does not feel the need to see a doctor. At first, the most common symptoms are:
- weakness of one or more limbs
- blurred vision
- changes in touch sensitivity
- double images
- difficulties in coordinating movements (ataxia)
Weakness of the limbs is also common. Many patients with MS experience fatigue while exercising and have difficulty climbing stairs. Agility and muscle strength are also reduced. These symptoms usually appear gradually.
Exhaustion: the most common symptom
Exhaustion is the most common symptom of MS. It affects 2/3 of patients. Half of them describe it as the worst symptom as it has a significant impact on quality of life.
Exhaustion dramatically and significantly reduces the quality of life of people with MS, which is why it is so important to keep an eye on it. However, it is difficult to control and interpret because the feeling of exhaustion is always subjective.
Lack of energy affects both motor and cognitive abilities. A distinction must also be made between weakness, lack of energy and difficulty concentrating. For this reason, physicians must make a differential diagnosis between the exhaustion of MS and the exhaustion of other diseases. Depression, motor disorders, thyroid problems, and side effects of drugs that prevent seizures or reduce the immune response may have similar clinical features.
Stages of exacerbation
Recurrence or worsening of symptoms are very typical in multiple sclerosis. They are symptoms of nervous system disorders that last for more than 24 hours. These stages of exacerbation affect different parts of the central nervous system, and there is at least a month between symptoms.
Disappearance of symptoms, in turn, is classified as remission. Remission is the improvement or disappearance of symptoms for at least 24 hours.
The following symptoms support the diagnosis of MS when present clinically. They are:
- L’hermitten’s symptom : the patient feels an electric shock all over his spine. Sometimes it extends to the arms and legs. Tilting the neck forward triggers the sensation.
- Thermal sensitivity
- Uhthoff phenomenon: elevated body temperature. External factors (summer, hot shower, smoking) or internal factors (fever, strenuous exercise, menstruation) can trigger this symptom.
- Paroxysmal seizures: Paroxysmal movement disorders occur suddenly and intermittently. They do not last very long, but may reappear a few times or several times a day in short batches. The most common paroxysmal symptom is paroxysmal dystonia.
Treatment of multiple sclerosis
Unfortunately, there is currently no cure for MS. There is also no treatment that would positively affect the inherent clinical course of the disease.
The long-term goal is to reduce the number of exacerbations. Doctors also help patients alleviate the effects of the disease and the progression of the disability. Immunosuppressants (azathioprine, cyclophosphamide, methotrexate) and interferons (alpha) are used for this.
Doctors prescribe high doses of corticoids for short periods (3-5 days) to treat exacerbations. Identifying the stages of exacerbation is a key factor in making a diagnosis and finding the right medication.
In the exacerbation phase, the inflammatory process causes one or more lesions. This inflammatory process is located in the central nervous system. Corticosteroids are used to treat exacerbations because they target an inflammatory reaction.
Treatment of MS symptoms
Symptomatic treatment can be summarized as follows:
- Spasticity: baclofen, diazepam, dantrolene…
- Exhaustion: amantadine, modafinil, methylphenidate…
- Pain: carbamazepine, phenytoin, gabapentin, pregabalin…
- Bladder hyperreflexia: oxybutynin, betanecoline…
- Cognitive symptoms: donepezil, interferon beta, memantine…
Rehabilitation is extremely important. The essential goal is to prevent the patient’s inability, or at least reduce it as much as possible. Therapists teach patients new skills and maximize the capabilities of their healthy systems. In this way, they are able to maintain a certain independence.
It is also very important to adapt or change the social or work environment. In addition , the psychological support of the patient, family, and caregivers is very important.
Experts recommend a wide range of rehabilitation treatments designed for each patient individually. Patients with MS can improve their quality of life in terms of health and performance of daily activities. In fact, many organizations targeting MS patients offer such therapies that focus on holistic rehabilitation.
Poser CM, Brinar VV. Diagnostic Criteria for Multiple Sclerosis; FEDEM, Rev 14, 1–19.
Harrison: Principles of Internal Medicine, Vol. 2; Editorial Interamericana, 13th edition.