The number of multiple sclerosis cases has continued to increase in recent years. More people than ever before are now affected by the autoimmune disease. You can find out everything about the causes, symptoms and treatment of this serious disease here.
Exhaustion, fatigue, difficulty walking – these are just some of the symptoms that 2.5 million people worldwide have to deal with. You have multiple sclerosis. The autoimmune disease is one of the most common neurological diseases, in Germany alone there are more than 200.000 people affected. According to "aerztezeitung.de", the number has doubled within the past 40 years.
What causes multiple sclerosis?
"The key cause is still unknown," explains Professor Judith Haas, president of the German Multiple Sclerosis Society (DMSG).
Gene variant plays a role
A certain gene variant apparently plays a role in the development of the disease multiple sclerosis, which is related to the chronic inflammations. This was discovered by researchers led by Danish immunologist Lars Fugger at the University of Oxford. The tumor necrosis factor receptor-1 (TNF-R1), a protein, is altered in patients. Professor Ralf Gold, member of the board of the German Society of Neurology (DGN) and director of the Neurological Clinic of the Ruhr University Bochum was also involved in the study. He explains: "This receptor variant is specific for MS patients and therefore a starting point for the development of improved therapies."The researchers found that a specific change in TNF-R1 occurs exclusively in multiple sclerosis disease. This change ensures that the protein is not bound as usual, but can penetrate through the intercellular spaces and bind the molecule TNF alpha.
This molecule, however, is an anti-inflammatory: if it is bound, it can no longer act. The chronic inflammations resulting from this binding are then the cause of the autoimmune reactions that are typical for the disease multiple sclerosis.
Many autoimmune diseases are treated with drugs that block TNF alpha – but multiple sclerosis has never responded with improvement to the drugs. On the contrary, Gold explains, in the case of MS, the drugs could increase the effect of the harmful gene defect.
Causal research under high prere
Since around 200.000 people suffer from the incurable disease in Germany according to current studies by the German Federal Health Office, research into the causes has been going on for years at full speed. The debate has already focused on the body's own vitamin D level, heredity, environmental influences and infections. Viral diseases, especially the Epstein-Barr virus, which causes glandular fever, are also suspected of causing MS. Today, research is being conducted in particular into the extent to which the composition of the intestinal flora has an influence on the risk of MS and the course of the disease.
What are the symptoms??
Various symptoms can occur with the insidious disease. The following are particularly common:
Coordination problems, an unsteady gait
Muscle weakness and paralysis
The transmission of pain is disturbed, feet may tingle or feel numb
Disruption of sexual function
"Sometimes a long phase of insufficient resilience precedes," Professor Haas further explains. In the early stages of multiple sclerosis, painful visual disturbances can also frequently occur. This is explained by the German Ophthalmological Society after a study of the Gottingen University Eye Hospital. The researchers analyzed 44 underage MS patients who had been examined at the University Eye Hospital between 1997 and 2001. The children often suffered from optic neuritis, which led to visual disturbances. This form of inflammation also occurs frequently in adults with MS. In addition, patients may suffer from rhythmic, uncontrollable eye movements in which the eyes abruptly move upward from their normal position. Weakening of the eye muscles due to multiple sclerosis is also not uncommon, explains the expert in eye muscle, eyelid and orbital surgery Professor Dr. Joachim Esser: "Because the disease often affects a specific cranial nerve, the abducens nerve."This nerve is responsible for the outward movement of the eyes. Affected patients see double images when they look to the side.
Study associates eye disease with MS
Another eye disease that can be associated with MS by the study is an inflammation of the iris. As a result, the eye is sensitive to light and reddened. The patient is in pain. A foreign body feeling in the eye. Anyone who discovers these symptoms in themselves or their children should consult an ophthalmologist. He can study the visual disturbances. In most cases, find a harmless cause.
If MS is suspected, he refers the patient to a neurologist, who makes the diagnosis and can initiate therapy at an early stage. The earlier it begins, the more positively it can influence the course of the disease.
Connection to headache?
According to a study, there is also a connection between headaches and multiple sclerosis. The finding that younger and female sufferers in particular suffer from pain in the head should have far-reaching consequences for the diagnosis and therapy of MS. Headache researcher Professor Dr. Peter Kropp of the Institute for Medical Psychology. Medical Sociology at the University Medical Center Rostock in a press release. Peter Kropp of the Institute of Medical Psychology. Medical Sociology at the University Medical Center Rostock in a press release.
Rather, the complaints would be related to the general clinical picture of multiple sclerosis. Professor Dr. Uwe Zettl from the clinic. Polyclinic for Neurology at the University Medical Center Rostock. Uwe Zettl of the Clinic and Polyclinic for Neurology at the Rostock University Medical Center.
It is noticeable that younger women in particular are affected. "This finding is groundbreaking in that until now headache and multiple sclerosis have not been considered in conjunction", reports Professor Zettl further. Since headaches were previously associated with other conditions, the study results offer new diagnostic possibilities for physicians and MS patients.
Symptoms are noticeable
Severe deficits such as double vision, gait unsteadiness, paralysis usually lead very quickly to the neurologist, says Professor Haas. In many cases, the diagnosis was already clear from the patient's medical history, they said. Facing the neurological examination. A magnetic resonance tomogram of the brain. The spinal cord then usually already shows typical changes.
How is multiple sclerosis treated?
According to Professor Haas, the treatment of MS is based on three pillars – immunotherapy, drug therapy of the symptoms and regular physiotherapy, occupational therapy and sport.
Immunotherapy of MS has made impressive progress in the past 25 years, he says. However, there are two to three years between symptom and diagnosis and even more between diagnosis and the beginning of immunotherapy. However, the earlier immunotherapy is started, the more successful it is. All immunotherapies have an inhibitory effect on the inflammatory process at different levels. While immunotherapy determines the fate of MS sufferers in the long term, treatment of symptoms is crucial for quality of life. Pain, spasticity, bladder disorders, and fatigue can be significantly improved by medication. Regular physical activity is very important: "Today, we encourage our patients to continue the sports they practice. This is a reversal from the earlier 'already you' warning about physical stress."
What limitations do patients have to expect?
There is good news here: The DMSG registry shows that many of those affected can walk largely unimpeded even 20 years after diagnosis. In most cases, patients become ill at around 30 years of age. "This means that in the best case scenario, the disease does not seriously interfere with occupation, family planning and leisure time behavior," Professor Haas says hopefully.
However, many of those affected complain of great exhaustion, which also restricts them in their everyday lives. Particularly in women with the double burden of work and children, this leads to an early restriction of the ability to work, according to Professor Haas. If further limitations occur at an older age, those affected may be able to retire earlier or in part.
Professor Haas can also offer hope for family planning: "Pregnancy after a diagnosis of MS is more likely to favor the long-term course of the disease."
Is there hope for a cure?
Multiple sclerosis cannot yet be cured. At the moment, however, various parties are researching immunotherapies that are intended to halt the progression of MS.
Research for clues
"Interest is currently focused on so-called markers for disease activity," explains Professor Haas. That means looking for signs in the blood, spinal fluid, back of the eye, MRI that predict disease activity.
Although MS is not yet curable, Professor Haas says there is already research underway to improve the symptoms she has already experienced. She hopes that more new possibilities for doing so will emerge in the next decade.
New therapy options?
An active substance – alemtuzumab – offers new therapeutic options for people suffering from relapsing-remitting multiple sclerosis. Relapsing-remitting multiple sclerosis always has an active course of the disease and more or less long breaks in between.
An active substance may be able to help these patients reduce the number of relapses and slow down the overall course of the disease. The corresponding drug is administered in two treatment phases. Initially, the active substance is administered by infusion for five consecutive days. After a break of twelve months, another series of infusions is given on three consecutive days. The new drug fights immune cells that destroy the protective sheath around the nerve fibers – known as myelin – which is supposed to transmit nerve impulses without interference.
However, side effects have also been observed. Upper respiratory tract infections. Of the urinary tract, as well as the reduction of white blood cells. In addition, autoimmune disorders may occur.
Nevertheless, it is a win for multiple sclerosis therapy when a new agent is approved. "The treatment of multiple sclerosis requires a highly individualized treatment approach. That's why the increasing variety of therapy options is a very positive development," emphasized Hans-Peter Hartung, Vice Chairman of the Medical Advisory Board of the German Multiple Sclerosis Society and Director of the Neurological Clinic at Heinrich Heine University in Dusseldorf.
These stars suffer from multiple sclerosis
Actress Selma Blair (47) announced in 2018 via Instagram that she suffers from MS (BUNTE.de reported). She described her symptoms: "I am disabled. I sometimes fall. I drop things. My memory is fogged. And my left side asks for instructions from a broken navigation system." Nevertheless, she remains optimistic. At public events, the actress can now be seen with a walking stick.