Multiple sclerosis is an incurable but treatable disease that affects more than 100,000 people.000 people are affected in Germany alone.
The symptoms of multiple sclerosis are manifold. The signs of the disease, a chronic inflammation of the central nervous system, are very individual. Some sufferers experience sensory disturbances and muscle paralysis, but the disease is also accompanied by visual disturbances, while others experience pain and paralysis in the face. Because of the multitude of its symptoms, MS is also known as the "disease with 1000 faces". This makes the diagnosis costly and lengthy.
The following article presents all the important information about the MS disease, starting with the definition, causes, symptoms, diagnosis, progression and treatment, as well as the life expectancy of those affected.
What is multiple sclerosis?
Multiple sclerosis is a chronic inflammatory disease of the central nervous tie. The brain, optic nerves and spinal cord are usually affected.
Symptoms and complaints often occur in episodes and can already begin at the age of young adults.
In Germany, more than 100.000 people with MS. Without proven cause, the disease is more common in cooler climates such as northern Europe, southern Canada or New Zealand.
Women are affected twice as often as men. In most cases, the disease manifests itself between the ages of 20 and 40.
The facts at a glance:
– Multiple sclerosis is incurable but treatable – Over 100.000 people are affected in Germany – Women suffer from MS twice as often as men – Symptoms of the disease usually appear between the ages of 20 and 40
Multiple sclerosis – causes
Until today unfortunately unexplored are the proven causes of multiple sclerosis. Various amptions suggest that it is an autoimmune reaction. The body's own structures are mistakenly attacked by immune cells, whereupon a degradation of the nerve fiber protective sheath begins. As a result, nerve fibers are damaged and nerve impulses and stimuli are no longer fully transmitted or are transmitted less effectively.
The facts at a glance:
– The causes are as yet unclear and unexplored – It is thought to be an autoimmune reaction – immune cells mistakenly destroy nerve fiber protective sheaths, leading to dysfunction
In the following, we present the various suspected causes.
Autoimmune disease
Many experts suspect an erroneous reaction of the body's own immune system, i.e. an autoimmune disease, as the cause of multiple sclerosis. In an autoimmune disease, the body's immune cells begin to turn against the structures of its own body. They actually fight invading viruses or bacteria. In multiple sclerosis, white blood cells, also called leukocytes, attack nerve tie and cause inflammation. The sheaths of the nerve fibers, the myelin sheaths, are destroyed in the process. This is also called demyelination. During this process, the nerve fibers and the nerve cells themselves are damaged.
MS patients have areas of myelin damage in the brain and spinal cord, called plaques, which develop into scars. As a result, nerve signals cannot be transmitted at all or hardly at all and nerve failures occur. Nerve loss is evident through various reactions throughout the body, as the entire nervous system can be affected.
To date, experts do not know exactly why the immune system attacks the nerve tie in MS. Several factors are suspected to trigger the disease in combination with each other.
Genetic factors
Some experts believe that multiple sclerosis may be partially hereditary. For example, studies of twins show that the risk of multiple sclerosis in children of people with MS who are identical twins is 25-30% higher than in the general population. If it is fraternal twins, the risk is 5% higher. The parents and children of a person with MS have a double to triple increased risk of also developing the disease. The less related you are to an affected person, the lower your risk of developing the disease yourself.
It is still not clear which genes are involved in the development of multiple sclerosis. Changes in the HLA-DRB1 antigen, the apolipoprotein E or the interferon gamma gene are suspected, among others. It is generally agreed that not only a single gene is the cause of the disease, but that a large number of genes are involved.
Infections
There is also debate about whether infections can cause multiple sclerosis. Possible infections are, for example, the measles virus, the human herpes virus 6 (HHV-6 for short) and the Epstein-Barr virus (EBV for short). EBV triggers glandular fever and antibodies against EBV are found in the blood of most multiple sclerosis patients, although in the normal population this is only the case in about 60%.
Certain chlamydia bacteria, such as Chalmydia pneumoniae, are also associated with MS. However, the results of this study have not been confirmed in subsequent studies.
It is not amed that there is only one particular infectious disease that can trigger multiple sclerosis. Instead, MS is thought to be caused by the immune system's response to infection when people are already predisposed to it.
Lifestyle and environmental factors
Another possible cause of multiple sclerosis is environmental factors and a certain lifestyle – however, this does not mean that one can generally trigger multiple sclerosis through an unhealthy lifestyle.
Smoking is one of the possible triggering environmental factors. Allegedly, this increases the risk. Accelerates the progression of MS.
Vitamin D is also suspected to be a risk factor for multiple sclerosis. If people were exposed to the sun more as children, their bodies produced more vitamin D accordingly. Compared to people with a low vitamin D level, they develop MS much less often. This risk factor was noticed after it became apparent that MS could be associated with latitude. This means that the more you move away from the equator, towards the north or south, the more MS cases there are. This is due to sun exposure.
Gender
Another possible cause is gender. As a rule, women suffer from multiple sclerosis much more often than men. However, no plausible explanation has been found yet. It is just said that women go to the doctor more often, and therefore the disease can be detected more frequently. However, the difference between the sexes could also be caused by as yet unknown environmental factors.
Other causes
There are other suspected causes that can lead to the development of multiple sclerosis:
– Overweight – Excessive consumption of cooking salt – Intestinal flora
Multiple sclerosis – symptoms
Worldwide, about 2.5 million people suffer from the chronic inflammatory nerve disease multiple sclerosis (MS). In Germany there are about 200.000 affected persons, 70 percent of them women. Every year in Germany alone, approximately 2.500 new cases added. Typically, the first multiple sclerosis symptoms appear between the age of 20. and the 40. Year of life. The disease progresses in relapses. The first signs as well as the severity. The course of multiple sclerosis is very individual. MS is considered a disease with many faces. Nevertheless, there are some typical early symptoms that can be an indication of MS.
The following early symptoms occur in multiple sclerosis:
– Visual disturbances (ca. 30% of patients) such as blurred vision or loss of vision – Sensory disturbances such as numbness in the arms or legs (formication) – Cramp-like paralysis – Constant, rapid fatigue and difficulty concentrating
The early symptoms can indicate many diseases, d.h. there does not have to be multiple sclerosis. The determination of the disease can only be done by a doctor individually per patient.
Main symptoms
In addition to the early symptoms, there are other MS symptoms. A study by Hemmett, Holmes, Barnes has found over 2.Followed 000 MS patients for more than 10 years and evaluated the most common symptoms. The most common MS symptoms are fatigue syndrome, balance and coordination disorders, loss of mobility, sensory disturbances, visual disturbances and paralysis of the muscles.
MS symptoms according to Hemmett, Holmes, Barnes: What drives quality of life in multiple sclerosis?
The following is a detailed explanation of the individual symptoms.
Fatigue syndrome
Fatigue syndrome is with 96% one of the most common MS symptoms. Affected persons feel permanently tired, exhausted and lacking in energy. Fatigue syndrome has two components. There is both mental (cognitive) exhaustion and physical fatigue. Yes according to the patient the components are different. The permanent lack of drive and energy leads to severe limitations in everyday life, both in mental and physical activities.
Balance and coordination disorders
With 92%, balance and coordination disorders are the second most common sign of MS. The cerebellum in the central nervous system is affected in this case in the form of damaged nerve fibers. If the sense of balance is disturbed, this often results in dizziness and tremor as well as gait disturbances. This can cause problems during sports activities. Stairs run in addition, already with the simple going lead.
Loss of mobility
Almost 91% of the MS patients complain about a loss of mobility, which leads to a restriction of movement of the affected persons. Muscle weakness in particular is one of the most common causes, leading to loss of mobility. In particular, muscle weakness in the legs leads to problems in everyday life, such as difficulty walking. If this occurs in both legs, it is called paraparesis; if it occurs in only one leg, it is called monoparesis.
Sensory disturbances
Sensory disturbances occur very frequently (88%) as MS symptoms. Sensory disturbances typically manifest as numbness or tingling in the arms and legs or as decreased sensitivity, for example to hot and cold temperatures. Also feelings of tension in the joints. The hip region is often. Joint pain may also occur. The sensory disturbances often first appear in the fingertips or feet and then spread to the entire arms and legs.
A common symptom is also the neck flexion sign: When bending the head forward, the affected person feels a sharp blow along the spine.
Visual disturbances
In more than three-quarters of all cases (82%), visual disturbances occur during the course of the disease. Often these are connected with an inflamed optic nerve. The eyes hurt, affected people perceive their surroundings as if through a veil or fog. In some cases, flashes of light or visual field loss occur. MS can also cause paralysis of the eye muscles, which is manifested by seeing double images.
Muscle paralysis
Muscle paralysis is also a typical symptom of multiple sclerosis that occurs in many patients. Frequently, these are paralysis symptoms in the arms and legs. In addition to paralysis of the muscles, there is often muscle weakness. Muscles, especially in the limbs, tire quickly, tense frequently, or feel stiff and immobile.
Other MS symptoms
In addition to sensory, muscle and visual disturbances, the following multiple sclerosis symptoms are also common:
– Pain and paralysis in the face – Impaired taste – Bladder dysfunction (as a result of the disease)
If MS damages the cerebellum, further symptoms are unsteady gait, trembling hands and speech disorders. In some cases, multiple sclerosis also affects the psyche. Some sufferers are more prone to mood swings and depressive moods. Others, however, show a very euphoric behavior.
Multiple Sclerosis – Diagnosis
A diagnosis of multiple sclerosis is not easy, because many of the MS symptoms are not clear-cut. Because the signs that can indicate multiple sclerosis also occur in other neurological diseases. Some early symptoms may also simply be a signal of too much stress in everyday life. Therefore, a detailed multiple sclerosis test is important for the diagnosis.
Those who notice symptoms that may indicate MS may want to perform a self-test before consulting a physician. But there is no MS self-test. The chronic inflammation of the nerves manifests itself differently in each affected person and always shows a different face. If you notice the symptoms described, such as muscle weakness, paralysis, sensory or visual disturbances, or even more than one of these signs, you should therefore consult a doctor as soon as possible.
The first point of contact for clarification of MS symptoms is the family doctor. After a thorough history, this patient is likely to be referred to a neurologist (specialist in neurology). Only a neurologically trained physician has the expertise to diagnose multiple sclerosis.
Neurological examination
Also with the neurologist the first part of the MS test consists of the anamnesis, the patient conversation. The doctor inquires about the symptoms, their duration and frequency. But this is not sufficient for MS diagnosis. In the next step, the doctor performs a neurological examination. He tests reflexes, sensations and muscle strength. In addition, the patient's mental state is determined.
Then the doctor measures the conductivity of the cranial nerves. Electroencephalography (EEG) is used to measure the nerve impulses that are generated in response to visual and auditory stimuli. To identify the inflammatory foci characteristic of MS, imaging techniques such as magnetic resonance imaging (MRI) aid in diagnosis. In addition, a puncture of the spinal cord, the so-called cerebrospinal fluid puncture, is helpful. In the case of inflammatory diseases of the nervous system, the cerebrospinal fluid shows an elevated level of certain immune cells and antibodies.
During diagnosis, the doctor also checks whether the criteria for an MS relapse are met:
– New or previously experienced symptoms persist for at least 24 hours. – Symptoms appeared at least 30 days after the onset of the last relapse. – Other infections or an altered body temperature do not explain the symptoms.
Apparative investigations
An apparative examination is used to determine the spread of multiple sclerosis in the patient's body. For this purpose, evoked potentials (EP) are recorded. This involves electrical voltages in the nerve and muscle cells that are generated when an external stimulus is applied to them. Electrodes are used to derive and record these voltages.
For understanding: visual evoked potentials, short VEPs, can be triggered with a checkerboard pattern, if its squares light up fast one after the other in different brightness. The patient must look at the pattern here. His head derives the potentials. In addition to the evoked potentials, the head is examined. The patient's spinal cord with an MRI scan. Here, special attention is paid to inflammatory foci or plaques in the brain. If these are already larger than two millimeters, they can be detected in the early stages of the disease. The big advantage of an MRI is that it can reveal disease-related changes in the central nervous system even though there have been no symptoms or signs of MS yet.
Another apparative examination takes place if the patient has problems with urination. Here the doctor recommends a micturition protocol, in which the patient must record how often he or she urinates. The doctor also determines the amount of urine that remains in the bladder despite urination. This procedure is also called residual urine determination. This may be followed by urodynamic testing. This is a measurement procedure that examines the functioning of the urinary bladder with prere probes and electrodes.
Laboratory tests
Other helpful examinations to determine a multiple sclerosis disease are laboratory tests.
Particularly important here is the examination of the cerebrospinal fluid, or CSF. To examine the cerebrospinal fluid, a fine needle is inserted into the area between the vertebrae of the middle lumbar spine and a nerve fluid sample is taken. The evaluation can determine whether an inflammation is present in the brain or in the spinal cord. This is detected by an increased number of immune cells, such as lymphocytes and plasma cells, and antibodies, such as immunoglobulin. The CSF puncture can also determine whether any inflammation is caused by germs and possibly not by MS.
In addition to the examination of the cerebrospinal fluid, the blood of the affected person is also examined. Here the following values are determined:
Another laboratory test that is performed is urinalysis.
Ultimately, most laboratory values in MS patients are within the normal range. Therefore, they are not performed to detect multiple sclerosis, but to rule out other diseases. In order to differentiate the disease completely with certainty, further laboratory examinations are often important. For example, extractable nuclear antigens are determined in order to differentiate from other autoimmune diseases, such as HIV antibodies, mycoplasma antibodies and antibodies for the detection of syphilis.
MS Test
The multitude and ambiguity of MS symptoms make the diagnosis difficult. Doctors and research institutes are therefore working on new tests to simplify the current procedure. This year, the Ruhr-Uni Bochum and the Hannover Medical School have presented a new multiple sclerosis test, which is supposed to confirm suspected MS more quickly and even more precisely.
Like the usual diagnostic procedure, the new MS test also relies on the puncture of the spinal cord. Instead of looking at defense cells, however, the researchers examined ribonecule acids, short protein chains that control cell development, cell proliferation and cell functions. In patients suffering from MS, the ribonucleic acids show altered profiles. These profiles are not only supposed to detect MS, they are also supposed to give clues about the course of the disease.
It will take about five to ten years before the new MS test can be used in practice. Initially, further phases of investigation. Mastering the evidence.
Meanwhile, scientists at the Hannover Medical School are working on another research project for the early detection of acute MS relapses. They have discovered an autoantibody in the blood of MS patients with current relapses, which is directed against the protein alpha-fodrin. When the relapse subsides, this autoantibody also disappears. Based on the results, an alpha-fodrin blood test has been developed that can detect a relapse even before MS symptoms appear. This should increase the early detection rate from 25 percent to 80 percent.
Multiple sclerosis – course
As described at the beginning, this disease progresses in relapses. Thus, at irregular intervals, the above symptoms occur with varying duration and severity. In many cases, these relapses can be reduced or prevented with appropriate therapy. In about half of those affected, relapses increase in severity. Symptoms unfortunately increase in the course of the disease.
Multiple sclerosis can take three different forms:
1. Relapses of varying severity and complete regression of symptoms – this is how the disease begins in about 80 percent of those affected 2. Secondary chronic progressive course, in which the disease progresses in addition to the relapses – affects about 40% of those with the disease 3. Primary progressive course, in which the clinical picture worsens continuously – affects about 10 % – 15 % of those with the disease from the start
Relapsing course
About 80 to 85 percent of all patients experience a relapsing course at the beginning of their disease. A relapse is the emergence of new symptoms within at least 24 hours that cannot be explained. More than 30 days must have passed since the onset of the last episode. The first episode of multiple sclerosis is called a "clinically isolated syndrome". In the period between relapses, the disease state does not change. If a relapse occurs, already existing symptoms worsen or even new complaints and symptoms are added. During a relapse, deterioration occurs after only a few hours. Such an episode lasts at least 24 hours to a few days. The length of time between relapses also varies and can last several weeks, months or years.
Such relapses are triggered by an acute inflammatory focus located in the nervous system. The focus itself does not lead to a relapse. During inflammation, destruction of nerve sheaths, or myelin sheaths, occurs. After the relapse, this can only be rebuilt to a limited extent, which is why complaints and symptoms after a relapse will disappear completely or only partially. In some cases, usually at a later stage of the disease, they also persist.
Experts speak of a benign course if the symptoms disappear after a relapse and no disability has developed after a period of ten years.
It is a malignant multiple sclerosis, when after some time a severe relapse occurs, which causes a permanent disability. In addition, the course of the disease is very fast here. The symptoms continue to increase. They trigger severe impairments that can be fatal.
An MS relapse can be triggered by various factors. These factors can also worsen the disease itself. These include:
– Infections, e.g. flu-like infection – Major surgery – Hormonal changes – Vaccinations, e.g. with live vaccines – Severe physical stress – Severe psychological stress – Hyposensitization – Immunostimulatory drugs
Pseudo relapse
One must distinguish a multiple sclerosis relapse from a pseudo relapse. Such a relapse also worsens the disease state, but it is not triggered by an acute inflammatory focus in the nervous system, but by febrile infections, hot baths, hyperventilation or diseases that trigger pain.
Progressive course
The progressive course is divided into two types. On the one hand there is the secondary chronic-progressive multiple sclerosis. At first there are relapses of the disease. In 50 percent of patients, the course of the disease changes. The relapses become less frequent, but the symptoms continue to increase.
Second, there is primary chronic progressive multiple sclerosis, which affects 10 to 15 percent of MS patients. From the beginning, the symptoms and the state of the disease worsen, but there are no relapses of the disease. But even here the MS can stagnate for some time.
Is MS curable?
Multiple sclerosis is not curable yet, but the disease can be treated well. In drug therapy the most important goals are to prevent relapses and to delay the onset of possible disabilities as far as possible, to slow their progression or even to stop them.
Multiple Sclerosis – Treatment
Multiple sclerosis is incurable to date, but treatable by drug approaches. For example, the use of medication ensures that relapses are reduced or even prevented. Treatment is based on the symptom-. Course variety individual.
The treatment is based on three pillars, which are explained in more detail below.
1. Acute treatment of relapses
In the case of an acute relapse with the onset of symptoms, a cortisone preparation is usually used for a few days. This is done intravenously. Should curb the inflammatory reaction. Thereby the complaints are reduced or even prevented.
This process can be repeated and the dose increased if symptoms do not disappear. However, treatment with cortisone can cause severe side effects such as stomach problems, sleep disturbances or an increase in blood prere.
The next sensible step would therefore be a blood wash, in which blood is taken, purified and fed back. This treatment is successful in half of the cases. Is carried out at special MS centers.
So, in summary, the following is used as acute treatment:
– Treatment with cortisone – Repeated treatment with cortisone if necessary – Carrying out blood washing
2. Long-term immunomodulatory treatment
Long-term immunomodulatory treatment can be divided into three different types of therapy:
1. Course-modifying therapy of the moderate course of the disease 2. Reserve basic therapy 3. Course-modified therapy of active disease progression
Different treatments or medications are used in different forms of therapy. For example, interferon-beta preparations or the active ingredients glatiramer acetate, teriflunomide or dimetyhilfumarate are used in course-modified therapy for moderate disease progression.
Agents such as azathioprine or the antibodies immunoglobulins, which were frequently used in the past, are now considered only as reserve agents for basic therapy in exceptional situations due to lack of approval or severe side effects.
In the active course of the disease, after sufferers no longer respond to basic therapy, the use of stronger medications and treatments is begun. Approval have for this among other things Alemtuzumab, Cyclophosphamid, Fingolimod, Natalizumab and Mitoxantron.
3. Symptomatic treatment
To keep the quality of life of people affected by multiple sclerosis upright and high, symptomatic treatment is very important in many cases. The focus is on the treatment and relief of pain and discomfort during the course of the disease.
These complaints, which have already been listed in detail in a previous chapter, include not only physical pain but also psychological complaints such as depression. As varied as the symptoms are, as varied are the treatments here. This includes dietary changes, occupational therapy, speech therapy, physiotherapy, psychotherapy or additional medication.
Alternative medicine
Not scientifically recognized, but increasingly popular is the use of alternative medicine. This includes acupuncture, autogenic training, homeopathy or traditional Chinese medicine in general. However, these can not be a substitute for conventional treatment, but rather a support or an addition.
Nutrition in MS
It is not certain whether a certain diet or nutrition has an effect on multiple sclerosis, because the disease is characterized by improvements as well as worsening depending on the daily condition. No diet could really influence the course or the symptoms, but a balanced and low-fat diet is recommended.
It is amed that the diet has an effect on MS through the intestinal flora and this already during the development and possibly also during the progression of the disease. In the intestinal flora metabolic products are formed, which have an influence on the immune system. Among other things, they fight foreign invaders, dead cells and inflammatory reactions. By changing the diet, the intestinal flora also changes. A confirmation for the effect of nutrition on MS is the example with Japan. Since the lifestyle and diet of the Japanese has become more westernized, the number of MS cases has increased.
Now the question arises, what kind of nutrition could be helpful?. In the next sections, we will present three possible supportive diets. However, to date there is no dietary form explicitly recommended by physicians, but only indications of its advantages and disadvantages.
Vegan diet
A diet without animal products is recommended. However, one should be careful to take vitamin B12 in addition, as this ingredient is less common in the vegan diet. Individuals are enthusiastic about the diet, but no studies are yet available to confirm the effect of vegan diet on MS disease. If you are thinking about going vegan, you should first discuss it with your doctor.
Anti-inflammatory diet
It is believed that an anti-inflammatory diet can counteract the inflammation of MS. This diet pays special attention to omega-3 and omega-6 fatty acids. Omega-6 assists in the formation of pro-inflammatory substances. Omega-3 in the formation of anti-inflammatory substances. If one now consumes more omega-3 fatty acids, the balance in the body may shift in such a way that more anti-inflammatory substances are produced. Found in hemp oil, rapeseed oil, linseed oil and in fatty fish. A varied diet is helpful here and one should avoid red meat and animal fats as far as possible, since these contain omega-6 fatty acids. This diet could have a positive effect on the course of multiple sclerosis.
Low carb diet
Carbohydrates are considered problematic because of the hormone insulin. Low carb diet or ketogenic diet lowers insulin levels to a low and constant level. The diet itself contains as few carbohydrates as possible, but places a lot of emphasis on proteins of plant origin. So far, positive effects from diet have been found, but not yet confirmed with studies.
Vitamin D
Especially during the winter months it is important to pay attention to one's vitamin D levels. A single dose of 20.000 units of vitamin D3 per week recommended during the winter period. However, care should be taken as vitamin D can also be overdosed and should only be taken under medical supervision.
Multiple sclerosis – life expectancy
Despite the incurable disease and potentially severe symptoms, this disease is not fatal. According to Canadian researchers, MS patients live to be 77 years old on average. These numbers came from a study with over 7.000 patients with multiple sclerosis. Women live to an average age of 79 years and men to 74 years. This is not significantly shorter than, for example, the average life expectancy in Germany. Until recently, this was 79.1 years in men and 84.1 years in women.