Multiple sclerosis – causes, symptoms & therapy

Multiple sclerosis (MS) is an inflammation of the central nervous system (brain, spinal cord). It is not the nerve cells of the brain or spinal cord that are affected, but the so-called glial cells, which, as connective and supporting tissue, play a major role in the structure, nutrition and insulation of the nerve cell.

The symptoms and course of the disease in MS vary greatly. For this reason, it is difficult to predict prognoses or the success of therapy. The diagnosis can only be made by means of imaging of the skull ( CT or MRI ) when the individual symptoms are numerous and after multiple attacks. MRI shows demyelination foci.

In the course of the disease, so-called sclerosing foci form in various parts of the brain, which subsequently leads to the deterioration or failure of various brain functions. The foci of sclerotherapy remain, and the disease progresses. Many patients become bedridden and in need of care in middle age, but there are also mild cases.

About 70 out of 100,000 inhabitants in Germany are affected by MS. Overall, multiple sclerosis is a disease of the white population of northern countries.

The disease hardly plays a role in the black population of the USA, among Native Americans, Eskimos, Africans, Japanese or Indians. In two-thirds of cases, multiple sclerosis manifests itself between the ages of 20 and 40, and women are affected much more frequently. The causes of the disease are largely unexplored.

causes

Despite intensive scientific research, the cause of multiple sclerosis has not yet been found. The disease belongs to the group of autoimmune diseases , which means that misdirected antibodies attack the tissue of the body, in this case the myelin sheaths of the brain, and thus destroy the body.There are various theories and assumptions about the etiology – among other things, it is assumed that a viral infection in adolescence leads to the pathological malfunction of the autoantibodies, which then only become clinically noticeable 15 years later. A genetic component (heredity) is also known.

In addition, there are various risk factors that can favor an acute MS flare-up. Possible triggers include: stress, injuries, operations, hormonal imbalances, vaccinations, infectious diseases, allergies or certain medications.

symptoms and course

The symptoms and complaints of multiple sclerosis are very different and are characterized by various neurological deficits depending on the exact localization of the demyelination foci in the brain. However, there are certain typical first manifestations.

MS often begins in relapsing form with abnormal sensations or symptoms of paralysis in various parts of the body, coordination disorders, unsteady gait, and less often neurologically-related incontinence is also in the foreground. The cranial nerves are often involved. In almost a third of the cases, the disease begins with so-called optic neuritis, an inflammation of the cranial nerve supplying the eye, which leads to sudden visual disturbances for the patient . Facial pain also occurs.

The picture of MS is very diverse. Although there are symptoms that a relatively large number of those affected have, such as numbness in the limbs or inflammation of the optic nerves with limitations in the field of vision, there can also be unusual symptoms that are initially unknown to the treating neurologist. However, a person suffering from multiple sclerosis should never forget that the disease is incurable but not fatal and that the quality of life can be maintained for a long time with the help of appropriate therapies.

Diagnose

It is difficult to diagnose multiple sclerosis unequivocally because, as a “disease with 1000 faces”, it often occurs with ambiguous symptoms. The following three factors normally belong to the diagnosis: examination in the MRI (magnetic resonance imaging), liquor examination and confirmed occurrence of at least one relapse. The evoked potentials are usually also examined.

In an MRI examination, the brain and often also the cervical spine are examined and the lesions , i.e. inflamed MS foci and also dead nerve cells, are visible. The device used here, the magnetic resonance tomograph, looks like a large tube into which the patient is pushed. The examination itself takes about 20-30 minutes and is completely painless. Some patients find the narrowness of the tube and the noise caused by the switching on and off of the magnetic fields uncomfortable. Headphones or a light relaxation aid can help here.

During the cerebrospinal fluid examination, cerebrospinal fluid (= liquor) is removed from the vertebral canal of the spine with a lumbar puncture . The donor site is locally anesthetized and the puncture can hardly be felt. After the removal, a slight headache can occur because the body has to produce the nerve fluid. Certain proteins and antibodies can be detected in the liquor, which provide information about diseases of the brain. By examining the evoked potentials, the neurologist determines the conductivity of the nerves. A specific sensory organ or nerve is stimulated and the fluctuations in voltage on the surface of the brain are measured.

When examining the optic nerve (VEP = visually evoked potentials), for example, flashes of light are set as optical stimuli. Testing nerve conduction in the leg uses light electric shocks, which can sometimes be uncomfortable.

All tests are usually completely harmless. All together are essential, because MS cannot be diagnosed with just one test!

Multiple sclerosis is often not recognized until very late, because the person affected with temporary failure symptoms either does not go to the doctor at all, or because the doctor initially assigns the symptoms to diseases that occur more frequently.

complications

Most complications of multiple sclerosis occur due to the associated flare-ups and the effects of inflammation on various organ systems. If multiple sclerosis is progressive or progresses without recognizable relapses, it can also cause complications.

The most common symptoms of multiple sclerosis include muscle spasms and problems with coordination. Partial paralysis, restricted movement and cognitive limitations occur. The condition can cause depression, personality changes, or epilepsy. If the eyes are affected, vision can progressively deteriorate. The progressive weakening of the muscular system can result in early disability. This can progress to a complete need for care.

Many of those affected suffer from frequent respiratory infections as a result of the disease. Some MS sufferers also struggle with urinary and fecal incontinence. Complications caused by this can arise from ascending germs from a catheter. It comes from diaper pants to frequent soreness. The inflammatory processes in the central nervous system can ban those affected to the wheelchair and reduce their life expectancy. With better treatment options, however, this is less and less the case today.

Doctors assume that at best 10 percent of those affected die from the disease or the complications associated with it. However, early disability and retirement occurs in about a third of people with MS. The attacked nerve cell extensions increasingly refuse to work in these people.

treatment and therapy

After the diagnosis of multiple sclerosis, the neurologist will present treatment options. The usual therapy is the administration of high doses of cortisone in an acute attack. The cortisone can reduce the inflammation that caused the flare-up, so that the symptoms can also partially or completely disappear. With the help of a basic therapy, i.e. a long-term treatment with certain medication, the number and severity of attacks can be influenced.

In terms of therapy, the focus is on trying to prevent or at least slow down the progression of the disease. So far, there is no curative therapy. In the flare-up, the misguided immune system can be suppressed with high-dose glucocorticoids, which leads to a shortening of the flare-up and a better resolution of the symptoms.In the long term, immunosuppression or immune modulation with drugs such as beta-interferon, glatiramer acetate or azathioprine is sought in many patients. However, this depends on the individual course of the disease and the severity of the symptoms. A patient with multiple sclerosis definitely belongs in the hands of an experienced neurologist.

The psychosocial aspect of the disease is also of great importance. For those affected, the disease makes a massive cut in their quality of life and life planning. In many cases, psychological support is necessary to process this stroke of fate. In addition, the therapy includes movement therapy, physiotherapy, bladder training or visiting self-help groups.