Multiple Sclerosis: Symptoms, Course and TherapyMultiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system. The transmission of signals is disturbed – brain, spinal cord and optic nerves can be affected. The symptoms vary, which is why it is also referred to as a "disease with 1" syndrome.000 faces" is called. Everything about symptoms, diagnostics, course, treatment and life with MS.
© iStockphoto.com/Moyo Studio
Multiple sclerosis (MS) or encephalomyelitis disseminata, as the disease of the central nervous system (CNS) is called in medical jargon, refers to small inflammatory changes in various parts of the CNS. The inflammatory lesions lead to functional disorders, for example in the transmission and processing of nerve impulses.
Thus, multiple sclerosis can cause visual disturbances, limitations of motor function or various sensory disturbances. The large number of symptoms, which can vary greatly from person to person, is characteristic of this disease.
In MS patients, their own immune system mistakenly targets the body's own structures. If the resulting inflammation of the nerves subsides, scars remain in the affected areas, which harden. In the majority of patients, MS progresses in relapses. This means that symptoms of the disease appear at certain intervals, which can, however, disappear completely or at least partially.
Who and how many are affected by multiple sclerosis?
According to the treatment guideline for physicians, approximately 2.5 million people worldwide are living with MS. According to the latest figures, more than 250 people in Germany have multiple sclerosis.000 people are affected by multiple sclerosis. As a rule, MS is diagnosed between the age of 20. and 40. The peak of the disease occurs around the age of 30. The age of onset is around. Rarely the disease starts under the age of ten or beyond the age of 60. The first symptoms of MS occur around the age of 50, although these age groups are also becoming more frequently affected. Especially among women, the frequency of multiple sclerosis is increasing.
Causes of multiple sclerosis
In multiple sclerosis, the body's own immune cells attack the myelin sheath, a protective sheath that surrounds the nerves. This happens because the antibodies confuse the body's own cell structures with those of bacteria or viruses, which they are actually there to fight. The immune system thus attacks its own body. Thus MS is an autoimmune disease.
Exactly how MS develops and what causes the immune system to attack the protective sheath of the nerves has not yet been clarified. There are different theories and amptions, but none has yet been scientifically confirmed. According to current knowledge, many different factors are thought to play a role in the development of multiple sclerosis. It seems certain that genetic predisposition and environmental factors influence the risk of the disease and the course of the autoimmune disease. Factors such as viral infections, for example measles, herpes or the Epstein-Barr virus, and the influence of sunlight exposure and nicotine are also discussed.
Symptoms of MS
Signs of multiple sclerosis vary widely. This is explained by the numerous tasks of the nervous system. Almost every symptom can be understood as a failure or impairment of a function in the central nervous system. In the majority of patients, MS progresses in relapses. If previously non-existent disturbances and deficits occur due to one (or more) acute inflammatory foci that persist for at least 24 to 48 hours, this is called a relapse. This does not come suddenly, like for example an epileptic seizure, but develops over several days or weeks.
After a relapse, the affected person can become symptom-free again. Symptoms may also remain due to the inflammation of the nerve tie that has healed with scarring. How often relapses occur and how long they last cannot be predicted, but the longer the disease lasts, the more likely it is that some of the symptoms will persist. In some patients, the relapsing-remitting course may eventually change to a progressive course. This means that the impairments increase slowly but steadily and do not disappear. However, there are also people with multiple sclerosis who do not feel particularly affected by the disease throughout their lives.
The following are typical signs, but not everyone with the disease may experience them. In addition, the symptoms can vary in severity.
Severe fatigue: It is one of the most common symptoms, affecting about two-thirds of patients. Leaden fatigue can last for months and occur as early as the morning, usually increasing as the day progresses.
Muscle weakness: Initially, it may simply manifest as not being able to lift a leg with normal effort at the end of the day. In advanced stages, a walking aid is sometimes required.
Sensory disturbances, misperceptions: Some patients have numb feet, others have tingling fingers. They feel as if ants are running over their skin or walking feels as if they are walking on absorbent cotton. Sometimes there is also a painful burning sensation of the limbs.
Sudden visual disturbances: They may be episodes lasting a few days with veiling vision or fog in front of mostly one eye. Color vision disorders are also possible. Sometimes there is even temporary blindness. Another form of visual impairment is double vision, which is due to a (temporary) paralysis of one or more eye muscles. Many patients also suffer from optic neuritis. Cramping due to damage to the central nervous system. Tense muscles (spastic paresis). Depending on the severity, affected persons are only slightly restricted in their movement or, in extreme cases, severely impaired.
Concentration and memory disorders
Involuntary eye movements
Coordination and gait disorders: They are due to impaired function of the motor center in the central nervous system, which gives instructions to the muscles. A staggering gait may be the result, as well as tremors. Coordination disorders often also affect the speech muscles, so that affected persons speak slowly, in a choppy and slurred manner (chanting speech).
Disorders of bladder and bowel function: Very strong urge to urinate, which can no longer be controlled, is typical. Constipation can be caused by the disease itself or by lack of exercise. Cramped muscles. Postural defects can be the cause. Trigeminal neuralgia is the term used to describe pain that is triggered by the facial nerve.
Depression in multiple sclerosis can have two causes. Sometimes they occur as a reaction to the disease itself, in other cases they are a direct consequence of the inflammatory foci in the central nervous system.
Sexual dysfunction: Erectile dysfunction in men and reduced sensitivity, pain during sexual intercourse and dry vagina in women – these can also be consequences of multiple sclerosis.
Progressive forms of multiple sclerosis
The course of MS is usually divided into three types:
Relapsing course: The most common form of multiple sclerosis manifests itself in relapses. Women are affected two to three times more often than men. In most patients, the symptoms of a relapse disappear within six to eight weeks. If the disease is not treated, the relapse rate at the onset of the disease averages 1.8 relapses per year. Several weeks, months or even years may pass before the next relapse occurs. The recurrence of the relapses is also referred to as relapsing-remitting course. In the early stages of MS, physicians speak of clinically isolated syndrome (CIS). After ten or more years, this course usually changes to a chronic-progressive course.
Chronic progressive courseIf left untreated, at least 50 percent of patients will develop chronic progressive multiple sclerosis after an average of 10 years. It stands for the gradual increase of symptoms (secondary chronic progression). In this case, the limitations no longer completely regress, but also continue to increase independently of the occurrence of an attack. This form is often referred to as the second stage of multiple sclerosis.
Primary chronic Progression: It affects about ten percent of sufferers. In this case, symptoms worsen continuously from the beginning without clearly delineated relapses. This form is also called primary progressive disease (PPMS). Affects patients with later onset of disease, 40 years of age and older.
Course of multiple sclerosis
About one third of patients with MS retire early. Affected persons today have a normal life expectancy due to medical care. The available aids have a normal life expectancy. Only in very rare cases, when inflammation causes respiratory paralysis, does it lead to death. However, a therapy that cures the disease does not yet exist. Sufferers must live with the disease and the resulting limitations, since only the symptoms can be alleviated. For many sufferers, the unpredictability of the disease is an enormous burden. In Germany, as in many other European countries, there are numerous associations and self-help groups where affected persons can exchange information and also find help with legal matters.
Diagnosis of multiple sclerosis
Diagnosing multiple sclerosis is not easy. The symptoms can have numerous other causes: Tumors of the spinal cord, infectious diseases such as Lyme disease and toxoplasmosis, and genetic myelin disorders all show similar signs of disease. Diagnosis by exclusion is often lengthy, with an average of three to four years passing from the first symptom to diagnosis.
To make or rule out a diagnosis of multiple sclerosis, the doctor will first ask during an interview what symptoms the patient is experiencing. It is also important for the doctor to know if autoimmune diseases run in the family. If the symptoms indicate MS, a series of tests and examinations are initiated.
The most important examination methods include:
During the neurological examination, the doctor tests the cranial nerves by assessing muscle strength, fine motor skills, sense of touch, coordination, sensitivity, muscle tension, reflexes, visual acuity, sense of smell, swallowing and speech. For all these functions, it is important that the body transmits nerve signals correctly. The ability to conduct electrical impulses in the central nervous system is reduced in multiple sclerosis. The doctor can determine this conductivity by stimulating the nerves using certain stimuli and using electrodes to derive the information transmitted by the nerve in another part of the brain. This is also referred to as measurement of nerve conduction velocity. The following neurological examination methods are distinguished:
Visual evoked potentials (VEP): the eye is stimulated by a monitor. Electrodes at the back of the head measure the time until the nerve impulse arrives and thus the conductivity of the optic nerve.
somatosensitive evoked potentials (SEP): By means of weak electrical stimuli in the wrist or ankle, the conductivity of sensitive pathways is tested. Here, too, the electrodes are applied to the head for conduction.
acoustic evoked potentials (AEP): An acoustic signal is used to trigger a nerve impulse, which is also conducted from the head.
Lumbar puncture (cerebrospinal fluid examination)
Cerebrospinal fluid (CSF) is removed from the affected person. In the process, certain changes typical of multiple sclerosis can be detected. However, this is not true in all cases.
magnetic resonance imaging (MRI)
Magnetic resonance imaging can be used to detect lesions in the brain and spinal cord. Small inflammations and scarring in the brain are clearly visible on it. MRI can also detect active foci of inflammation during a relapse. Other examinations that can provide information about multiple sclerosis include:
– Perimetry: method for determining the visual field – Myelography: examination for visualizing the space between the spinal cord and the meninges – Electroencephalography: measurement of potentials in the brain – Optical coherence tomography (OCT): method for examining the retina in the eye
How MS is treated
MS cannot be cured yet. The treatment serves to alleviate the inflammation. Prevent the progression of symptoms. The therapy options are divided into:
– Relapse therapy: For acute relief of the relapse and inflammation. Basic therapy: To prevent the progression of the disease. To prolong the relapse-free period (immunoprophylaxis). – Escalation therapy: For the treatment of the active course form, which does not respond to other medications.
An MS relapse should ideally be treated in an inpatient setting. In an acute episode, cortisone therapy is the drug of choice. Cortisone has both an anti-inflammatory and an immunosuppressive effect. Cortisone (also glucocorticosteroids or glucocorticoids) restores the blood-brain barrier, which, according to recent findings, becomes permeable to certain immune cells during disease episodes. In contrast to the continuous cortisone therapy, the shock therapy is usually well tolerated during a relapse. The procedure is also called GKS pulse therapy or GKS shock therapy.
Plasmapheresis is another option for the treatment of multiple sclerosis relapses. This is a type of blood washing: blood is taken from the body through the neck or arm vein. The liquid plasma is separated from the blood cells in a centrifuge. Plasma is replaced by foreign plasma or human albumin. Then returned to the body. The aim is to remove components of the blood that damage the sheath of the nerve fibers, the myelin. This treatment is usually used when no improvement can be achieved with GKS pulse therapy.
Basic therapy for MS
Favorable influence on the immune system is the main goal of long-term therapy in MS with immunosuppressants. For the basic therapy of multiple sclerosis, beta interferons or glatiramer acetate are used for this purpose. Beta interferons have an anti-inflammatory effect, among other things. Regulating the immune system. Beta-interferons have to be injected under the skin like glatiramer acetate.
Symptomatic therapy for multiple sclerosis
Symptomatic therapy, which is designed to relieve the symptoms of multiple sclerosis, also plays an important role. In this case, for example, complications arising from the inactivity of the patient, such as respiratory and urinary tract infections, are treated with medication. Spasticity can also be inhibited by drugs, so-called muscle relaxants such as baclofen. Here, the so-called intrathecal baclofen therapy is an option.
An important part of the therapy is the conservative treatment with physiotherapy, occupational therapy and speech therapy. These can alleviate, correct or prevent muscular problems. Consequences by immobility should be prevented. Still existing abilities can be preserved. There are a number of special types of therapy, such as the Bobath concept (based on neurophysiology), hippotherapy (therapeutic horseback riding) and pelvic floor gymnastics, but also relaxation techniques such as yoga or autogenic training.
Involve other specialists
The neurologist will examine in the course of the therapy in regular intervals whether and how the illness progresses. Based on the findings, a classification of the disease can be made on an internationally used scale such as the EDSS (Expanded Disability Status Scale). In all subsequent examinations, it can then be determined whether and to what extent the disease has changed.
In addition to the neurologist, other specialists should also be involved in the treatment of multiple sclerosis. In the case of vision problems, the ophthalmologist should be consulted, and in the case of bladder dysfunction or sexual dysfunction, the urologist or gynecologist should be consulted. The relationship of trust between patient. Physician is critical to treatment success. The affected person should be able to discuss all questions that concern him/her in detail.
Prevention and living with MS
Since the causes of MS are still unclear, it is not possible to prevent it. However, the earlier adequate therapy measures are implemented, the better the progression of the disease can be delayed. Equally decisive is one's own cooperation in the therapy and the way one deals with the disease. Lifestyle influences the course immensely. Thus, a healthy, balanced diet has a positive effect. Factors such as stress, overexertion and a negative attitude to life, on the other hand, promote the development of a new relapse. Heat is also not good for sufferers. In hot summer months, cool showers provide relief.
Influence of nutrition and weight on the course of MS
Again and again the influence of nutrition on multiple sclerosis is discussed. Current studies suggest that diet has an influence on the course of the disease, but scientifically proven results do not exist. Experts nevertheless agree that a change in diet could be worthwhile in MS.
Preference should be given to foods with anti-inflammatory properties. For example, omega-3 fatty acids and the Mediterranean diet should be preferred and animal fats should be reduced. Industrially manufactured foods and convenience foods should be avoided as much as possible, as well as a lot of salt, sugar and white flour. The ketogenic diet and fasting also seem to have a positive effect on multiple sclerosis.
What to eat with MS:
– Fresh fruits (berries are especially recommended), vegetables, and herbs – Vegetable oils, such as olive oil, and nuts (unsalted and except peanuts) – Fatty sea fish, such as salmon, not breaded – Whole grains with complex carbohydrates
Dietary supplements do not help MS patients according to studies. The only exception is vitamin D, which should only be taken if the vitamin D level in the blood has been determined beforehand, as it can also be overdosed.
Living with multiple sclerosis
People with multiple sclerosis are often uncertain about their future lives. However, a self-determined life is possible, if the disease is accepted and the own limits are respected and kept. The support of a self-help group can be useful to learn how to deal with the disease, to discover hidden potentials and, if necessary, to develop a new self-image. The knowledge about the disease MS and the different therapy options make a self-determined handling of the disease possible. Learning to accept help can make it easier to cope and provide support where needed.