Multiple sclerosis (MS) is a chronic, progressive, non-contagious, neurological disease. Inflammation in the nervous system leads to damage or destruction of parts of the nerve fibers that are largely responsible for transmitting impulses in the nerve pathways. This can lead to a variety of symptoms.
The diagnosis of multiple sclerosis is associated with many questions, uncertainties and fears for everyone. Knowledge about multiple sclerosis can help you to better understand the disease and what it means for your life.
Understanding MS disease
What exactly is multiple sclerosis (MS)?? MS is the most common
Autoimmune disease of the central nervous system (CNS = brain and spinal cord). This means that your immune system suddenly turns against your own body when it should be protecting it.
This "overreaction" of the immune system leads to the following symptoms inflammatory foci in the CNS. The inflammation in turn damages the Protective sheath of the nerve fibers (myelin layer) at different (multiple) sites in the CNS. Typical for MS are Disease relapses. Multiple inflammatory foci can be seen in a relapse. Scars (sclerosis). So that impairments leave. 1
In Germany, about 240,000 people live with multiple sclerosis. Women are two to three times more likely to develop MS than men. 2
What happens to the nerves when you have MS?
The brain consists of billions and billions of nerves that are interconnected and constantly communicate with each other via electrical impulses – even when you are asleep. So that the connection between nerve cells To ensure that the central nervous system remains stable and communication is reliable, many of the cells are protected by the myelin layer (see Figure 1). a layer of fats like insulation. 3
This shift provides:
Canalization of information: The impulses run in the intended direction. Speed of informationThe information can skip places of the isolation, creates over it more distance in shorter time and the processing of the information runs faster. Inflammation caused by multiple sclerosis destroys this protective layer. Communication is no longer as orderly (see Figure 2). As a result, commands from the brain or spinal cord can no longer be transmitted quickly or clearly enough to muscles or other nerves.
Typical for multiple sclerosis – the relapse
A relapse is a typical sign of disease in multiple sclerosis. 4
A MS relapse is characterized due to the fact that :
– symptoms appear for the first time or recur, – they last for at least 24 hours, – they completely or partially disappear within days, weeks or months.
Figure 1
Figure 2
Although these criteria sound clear, it is still often difficult to clearly recognize a relapse. From there the medicine defines more Features:
– There must be at least 30 days between two episodes. – It must be ruled out that the symptoms have other causes, e.g. B. external influences. Examples are: Infection, fever, high stress (physical or psychological).
If external factors can be detected parallel to the signs of a relapse, medicine speaks of a Pseudo-thrust. Then the symptoms pass quickly.
Common signs of a relapse are z. B.:
– disturbed sensitivity in arms and legs – paralysis symptoms – visual disturbances – dizziness – trembling and unsteady gait – disturbances of coordination and balance – speech disturbances
Multiple sclerosis: Causes
Consequential (causal) and clear causes for multiple sclerosis cannot be clearly determined until today. This is the case with most autoimmune diseases.
Multiple sclerosis is thought to be caused by:
– genetic factors – environmental influences – possible. viral inflammation
Multiple sclerosis: progression
The courses of MS are as different as its symptoms. Therefore, no reliable statement can be made about the course of the disease.
It is important to know that multiple sclerosis is not always severe. Only ca. Five percent of patients develop severe disabilities within a few years. 1
Typically, MS disease progresses in relapses. There can sometimes be several years between relapses. Frequency, duration and severity of the relapses as well as the speed with which the disease progresses are different for each affected person.
Course forms of the multiple sclerosis
MS is divided into three courses: 5, 8, 9
Relapsing remitting MS (RRMS)Symptoms start suddenly, a cause is not recognizable. Usually at the beginning of the disease, there are long pauses, sometimes lasting several years, until the next relapse. Primary progressive MS (PPMS): The course develops continuously, relapses cannot be delimited. This form of MS usually occurs in people from ca. 40 years on. Secondary progressive MS (SPMS)Damage does not regress, MS continues to develop even without relapses.
Symptoms of Multiple Sclerosis 5,6,7
The symptoms of MS are manifold. They depend on which areas of the central nervous system (brain and spinal cord) are inflamed or altered.
Visual disturbancesVisual acuity is diminished. One sees as if through frosted glass or double vision. Paralysis symptoms show up on arms and/or legs. tingling, Disabling sensations, Numbness occur – especially in the arms and legs. – The Go is unsafe, the Grasp according to objects less unerring. Bladder disorders, resulting in involuntary leakage of urine. Fatigue: This means deep fatigue for no apparent reason.
In a later stage may be added:
spasticity and related symptoms such as z. B. muscle spasms, disturbances in gait quality, pain, sleep disturbances or bladder weakness, cognitive disorders like slowed thinking or decreasing concentration, pain: Possible are pains, directly caused by the multiple sclerosis (neuropathic pain) or as a consequence of, for example, incorrect posture (nociceptive pain).
How the pain is treated depends on what the reason for the pain is.
Symptoms of MS
Multiple sclerosis test: How to make the diagnosis?
The diagnosis of MS is often somewhat difficult and lengthy. This is due to the fact that the course and symptoms are so different. There is no single test that can diagnose multiple sclerosis.
The diagnosis of multiple sclerosis is a so-called
Diagnosis of exclusion. Only when characteristic signs are present and at the same time other causes than MS are excluded, the diagnosis MS is made.
McDonald criteria – the MS test? 11
Research has nevertheless developed an instrument that can be used to make a diagnosis relatively reliably:the McDonald criteria. However, the McDonald instrument also requires the results of various examinations and findings.
McDonald criteria:
From certain constellations of symptoms and relapses, the duration of symptoms and signs in imaging techniques (example: magnetic resonance imaging), this scale derives the diagnosis of multiple sclerosis.
Therefore, in order to make the diagnosis of MS, various examinations and tests are carried out, for example.:
neurological examination: z. B. Reflexes and reactions, evoked potentials (EP): examination of how electrical impulses are transmitted, Magnetic resonance imaging (MRI): makes the structure of the brain visible, Lumbar puncture: Extracting cerebrospinal fluid from the canal of the spinal cord. 12
Multiple Sclerosis: Therapy
The treatment of MS is based on three pillars: 13
– Relapse therapy – course-modifying therapy (z. B. antibodies) – symptomatic therapy
Relapse therapy
A Relapse therapy consists of high doses of cortisone (corticosteroids) over several days. Usually symptoms of the episode resolve. So that the inflammation) within a few days from. If the relapse persists, the relapse or Pulse therapy be repeated.
Course-modifying multiple sclerosis therapy
Since in MS the immune system is directed against its own body, the drugs of the course-modifying therapy to better balance this so important system of the body.
A distinction is made between:
Immunosuppressive (weakening) substances: reduce the activity of the immune system. Immunomodulating (modifying) substances: They are used to bring the immune system back into balance. 14
Multiple sclerosis: Is cure possible?
According to current knowledge, multiple sclerosis is not yet curable, but it can be treated well! The primary goal of therapy is to attenuate and slow down relapses and possible disabilities, and to slow or stop the progression of MS.