Multiple sclerosis (MS, encephalomyelitis disseminata, ED): Chronic inflammatory disease of the brain and spinal cord characterized by a focal demyelination of nerve fibers, often occurring in relapses, with abrupt or gradual onset. The disease usually begins between the age of 20. and 40. Women are more likely to develop the disease than men. In western industrialized countries, multiple sclerosis is the most common chronic neurological disease in people under the age of 50; in Germany, there are around 120.000 people affected.
The course of the disease varies from (apparent) cures to rapid disability; on the whole, it is more favorable than is usually amed: two thirds of those affected do not require care even after a long course if treatment is started early, whereby the prognosis of the relapsing form of the disease is better than that of the progressive form.
Conduction complaints
– Sensory disturbances, especially numbness ("furriness"), tingling sensation ("formication"), decreased sense of touch – Visual disturbances (usually unilateral), especially blurred vision, double vision, often eye pain – Feeling of weakness and paralysis, Weakness and paralysis, often in the legs, possibly with unsteady, broad-stepped gait ("sailor's gait") – Persistent tiredness and fatigue – Speech disorders, especially slurred "choppy" movements Speech – Possible bladder and/or rectal dysfunction.
The type and intensity of symptoms vary from person to person, depending on which areas of the central nervous system are affected.
When to go to the doctor's office
The next day when
– unexplained sensory disturbances and/or feelings of weakness in the legs occur, or you or others think your speech or gait has changed.
Today still, if
– one suddenly has the feeling of seeing worse or (slight) paralysis occurs.
– severe visual disturbances occur or bladder or bowel control are impaired.
Show background information
The disease
Development of the disease
Information in the nervous system is transmitted through long, thin nerve cell processes that are surrounded by an insulating fatty Marksheath (myelin sheath) are surrounded. As a result of the autoimmune process, the body's own immune cells destroy these myelin sheaths (demyelination) and lead to inflammation at many sites in the brain and/or spinal cord. This makes it difficult or even impossible to direct information at these sites. Are critical points of this "information stop"? affected, there are deficits such as visual disturbances. However, it is also possible that the inflammation focus (plaque) remains completely unnoticed. In the further course, the inflammation subsides, the symptoms improve or even disappear again, until after months or years a new focus of inflammation develops with corresponding symptoms. In this case one speaks of Relapsing-remitting form of MS, which is the most common at around 85. What triggered the individual relapse usually remains unclear.
Over time, the nerve processes themselves can perish, but scarring as a reaction to the inflammation also worsens the transmission of information. This could explain why, after an initial relapsing course, the symptoms of quite a few patients increase after years without any relapses being detectable. Here the doctor speaks of secondary MS progressive MS, which always begins as a relapsing-remitting form and is therefore considered the second stage of the disease. If treatment is given in time, the transition to the secondary progressive stage can be delayed.
The second most common form (15% of all affected persons) is the primary progressive MS. First symptoms usually appear around the age of 40. Age of onset. In this case, the classic relapses are absent; instead, the symptoms increase slowly but steadily from the beginning of the disease. MS or Marburg variant is called. Especially young people suffer from this form of the disease. Typical is the rapid progression, which can lead to death within a few weeks or months.
Clinic
The symptoms that occur depend on the location of the focus of the inflammation. In principle, many signs of the disease are possible, but some disorders are particularly common, such as. B. Visual and sensory disturbances at the beginning of the disease. The symptoms are usually mild and last only a short time, so that they are often misinterpreted.
Over the years, more than 80 % of those affected experience paralysis of varying severity. Extremities farther from the trunk are affected more often than those near the trunk, the legs more than the arms. Typically, the muscle tension is too high (spastic paralysis), which makes movements even more difficult. The fine-tuning of movements is also disturbed; this can be seen z. B. by indistinct or "choppy" speech Speech, shaky or exaggerated movements.
Also rare at first, but more frequent as the disease progresses, are disturbances in bladder function, especially a sudden urge to urinate that can become so violent that the affected person can no longer reach the toilet in time. Sexual dysfunction is also typical.
Psychological changes such as euphoria, depressive moods and concentration disorders are possible and their frequency is more difficult to quantify than "measurable" ones Complaints. A characteristic feature of multiple sclerosis is fatigue – increased fatigue that can be so severe that sufferers are no longer able to work.
Causes and risk factors
The cause of multiple sclerosis is still unclear. According to current knowledge, external influences on the basis of a hereditary predisposition lead to autoimmune processes ("self-fighting processes") in the brain and spinal cord, which then lead to the disease 10-20 years later.
It is not possible to say exactly how much weight is assigned to hereditary predisposition and how much to external factors. Probably the hereditary predisposition plays a much smaller role. Although close relatives have a higher risk of disease, this is low in absolute terms (about 1%).
Little is also known about the external influences that set the autoimmune process in motion. Studies suggest that they act in the first 15-20 years of life. The most likely factors are infections, especially viral infections. For example, several studies indicate that infection with Epstein-Barr virus – the causative agent of glandular fever – in early childhood or adolescence increases the risk of developing MS. Clear evidence for this is missing so far.
Smoking and low vitamin D levels are also discussed as risk factors.
Confirming the diagnosis
If there is an initial suspicion after a neurological examination, the evoked potentials and a nuclear spin of the brain and/or the spinal cord should reveal further, until then unnoticed foci, whereby foci at different places of the central nervous system are an essential diagnostic criterion.
MRI of a 40-year-old man with an acute MS flare (left cross-section, middle longitudinal section through the brain). The large inflammatory foci can be seen as brightenings. The MRI on the right shows a longitudinal section through the spine and spinal cord. Here no inflammatory foci can be detected at the moment. Georg Thieme Publishing House, Stuttgart
Since the clinical picture is rarely really clear at first, and the diagnosis of multiple sclerosis is momentous, the definitive diagnosis is only made in practice if a number of criteria are fulfilled by follow-up examinations:
– Proven inflammation at different times in different places in the brain and/or spinal cord. There are quite a few people who have symptoms of multiple sclerosis only once in their lives and for whom it is not possible to determine the cause despite exhausting the current diagnostic possibilities. Here the doctors speak of a so-called clinically isolated syndrome (CIS) – The detection of a delayed excitation conduction in the evoked potentials, which corresponds to the MS-typical nerve damage – Cell proliferations in the cerebrospinal fluid (fluid that surrounds the brain and spinal cord) as an expression of the inflammation and/or immunoglobulins that are absent in the blood. Here, doctors refer to A:36e91oligoclonal bands of immunoglobulin G (IgG). These are certain distribution patterns that can be detected with a special examination procedure. Oligoclonal bands, however, are not definite proof of multiple sclerosis, but only mean that immunoglobulins have been formed in the central nervous system itself – The exclusion of other possible diseases, such as Lyme disease, by means of blood tests.
Treatment
The goals of the treatment are to reduce the symptoms of the relapse as quickly as possible, to suppress further relapses, to combat troublesome symptoms and to prevent complications. The most important pillar of therapy is the use of medication; physiotherapeutic measures help to reduce (residual) disturbances. Long-term treatment is oriented. To reduce both the frequency and the severity of the relapses. An early start of treatment is crucial to slow down the progression of the symptoms. Ideally, therapy is initiated immediately at the first MS flare.
Thrust therapy
are on standard medication in relapse therapy (glucocorticoids). Since cortisone and other glucocorticoids differ only in strength, but not in mode of action, we will stick to the term cortisone in the following. Cortisone often shortens an MS relapse by having an anti-inflammatory effect. Since an effect on the long-term course is not proven, but cortisone has side effects especially with continuous use, it is not used in the long-term treatment of MS.
In an acute episode, high-dose cortisone infusions are administered over a few days as soon as possible after the onset of symptoms. If the treatment is not successful, it can be repeated after two weeks. Afterwards tablets can be taken for about two weeks.
If the second series of infusions does not help either, or if the complaints even worsen, plasmapheresis (plasma exchange treatment) can be performed, but this is only possible in special centers. The patient's blood is passed through a machine, similar to dialysis, so that the liquid components of the blood (called plasma) are removed and replaced by a protein solution. In this method, harmful antibodies dissolved in the blood are removed.
Course-modifying therapy
The goal of course-modifying therapy is to both reduce the severity and frequency of relapses and improve long-term prognosis. Drugs are used that alter the immune system – and thus combat the presumed cause of MS. Again, treatment should be started as early as possible, ideally after the first episode. A number of drugs are approved for this purpose in Germany. Detailed information on the active ingredients and drug mechanisms can be found in the special text: course-modifying therapy for multiple sclerosis.
Reduction of symptoms and prevention of complications
It is possible that once symptoms have occurred, they do not completely disappear. However, a large part can be alleviated with medication, such as spasticity or a strong urge to urinate.
The drugs of first choice for the treatment of spasticity are baclofen and tizanidine . If these medications do not work, MS patients have access to a cannabis-containing spray ( Sativex® ), which is sprayed on the oral mucosa and helps with moderate to severe seizures. Sativex® contains THC (delta-9-tetrahydrocannabinol) – the psychoactive ingredient of the cannabis plant – but does not induce intoxication. The reason for this is the combination with the substance cannabidiol. Injections with botulinus toxin (Botox) are an additional option. However, these only make sense if the spasticity is very severe but localized (z. B. To improve walking ability. Walking distance aminopyridine has proven to be effective.
Pelvic floor exercises and a fixed drinking schedule help regain more control over bladder function. Under no circumstances should patients reduce their drinking too much just to be able to control their urge to urinate better.
In the case of coordination or speech disorders, it has proven useful to start early with accompanying measures such as physiotherapy, occupational therapy or speech therapy, as these can significantly improve the symptoms. Therapy is tailored to each patient's problems, with movement exercises integrated into daily life whenever possible.
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What you can do yourself
The two letters MS stand for fear and uncertainty: What effects will the disease have on my everyday life and my plans for the future?? Do I have to give up my job? What does my disease mean for the family? Will I become a nursing case sooner or later?? In fact, no one can predict which limitations and sequelae are to be expected in each individual case – the individual course of the disease is too different for this to be possible. This uncertainty is at least as stressful as coping with the symptoms.
– Try to accept your disease! Focus on your abilities, not on the impairments associated with the disease. Also in your professional and private life you should not impose more restrictions on yourself than absolutely necessary. – If you need support, do not hesitate to ask for it and accept it. – Stay as active as you can. It speaks z. B. nothing against doing sports or traveling regularly – but make sure that you do not exceed the limit of your resilience. – Stress can trigger relapses. Find out which stress factors are unfavorable for you. Relaxation techniques also help to reduce stress. – Multiple sclerosis is no reason to give up having children. In general, pregnancy should be planned in consultation with the neurologist and the gynecologist, because the MS drugs have to be changed or discontinued in time.
Talk to your relatives and friends about your feelings and concerns. Exchanging information with other sufferers can also help to solve practical problems.
Diet.
A varied and balanced diet with plenty of plant products, sufficient fish and little meat is the best diet for multiple sclerosis patients. Some alternative therapies prescribe rigid diets or expensive special foods, but so far neither a special (MS) diet nor the intake of highly concentrated plant extracts, vitamins or special dietary supplements have been able to bring about a lasting improvement or even a cure. If you still want to try certain diet programs: Make sure that your daily nutritional needs are met and that the diet does not involve an unacceptable reduction in your quality of life. If you are unsure, discuss with your doctor whether he or she is also in favor of a change in your eating habits.
Smoking should be taboo.
Regular nicotine use is not only harmful to the heart, circulation, and respiratory system, but also seems to worsen the course of multiple sclerosis.
Infections can trigger relapses.
Therefore, have yourself regularly vaccinated against influenza, if in doubt, refrain from visiting a host who is ill and avoid shaking hands too often in times of influenza. However, isolating oneself for fear of infection is not a good idea either.
Avoid heat.
Even if high temperatures cannot aggravate the disease itself, heat causes a temporary worsening of the symptoms in many sufferers. You should therefore avoid prolonged exposure to the sun, postpone particularly strenuous activities to cooler times of the day, avoid visits to the sauna and bathe or shower in lukewarm water. The temperature should also be taken into account when choosing a vacation destination.
Clarify vaccinations.
Although vaccinations influence the immune system, they do not have any effect on the course of the disease according to current knowledge. Nevertheless, you should discuss every vaccination with your doctor and the most favorable time – if the immune system is suppressed by medication, the vaccination may be ineffective or may not be carried out at all.
Tips for relatives: Relatives must also come to terms with the fact that the course of multiple sclerosis is not predictable and therefore cannot be "planned" is. Ideally, the patient is still so little affected years after the onset of the disease that he can continue to exercise his profession and fulfill his role in the family. However, he may become dependent on nursing care or even bedridden and need all-around care. As soon as such a development becomes apparent, you should find out what help is available to you. The spectrum ranges from outpatient services to partial inpatient day or night care to full inpatient care in a nursing home. A stay in a specialized rehabilitation center – for a limited period of time – can also be considered, but it should be clarified beforehand whether the health insurance company will cover the costs.
In general, you should – as long as possible and without overburdening the affected person – follow the principle of "help for self-help" follow: Always encourage the sick person to use his or her existing abilities to cope with everyday life, and take away only as much as is absolutely necessary.
Complementary medicine
Natural remedies, exercise and relaxation exercises have no effect on the course of multiple sclerosis disease. However, some have been shown to relieve certain symptoms. Improve the quality of life.
Herbal medicine.
Some sufferers report a favorable influence on the course of the disease through the regular intake of ginkgo extract (in drop or tablet form). In contrast, studies have concluded that ginkgo can neither reduce the relapse rate nor slow down the course of the disease. There are however indications that Ginkgo could have a positive effect on cognitive disturbances. Since highly concentrated plant extracts, like synthetically produced drugs, can have side effects, the relationship between benefit and risk must be carefully weighed.
Caution is advised when using cannabis on one's own, which u. a. are said to have a nerve-protective function. Various studies indicate that the plant has an undesirable pro-inflammatory effect in MS. Of course, this does not apply to medically tested medicines with cannabis active ingredients.
Foot reflex zone massages.
Foot reflexology has been shown to help with bladder, sensory, and motor disorders. Their therapeutic efficacy for these concomitant symptoms has now been scientifically confirmed.
MS patients whose physical fitness allows them to practice yoga regularly benefit especially from the exercises, which aim to improve body awareness and flexibility as well as reduce psychological tension. In addition, yoga is effective against fatigue and exhaustion. Breathing exercises can counteract a decreasing respiratory capacity. It is important that you know and accept your personal performance limit.
Qigong, Tai Chi and Feldenkrais.
Qigong, Tai Chi and Feldenkrais help to reduce stress, increase body awareness and maintain mobility.
Acupuncture.
Acupuncture can alleviate symptoms in the early stages of the disease. Which acupuncture points are needled depends on the individual symptoms.
Homeopathy.
Some patients report positive effects from individually tailored constitutional treatment from homeopathy. If it does good, there is nothing wrong with such an accompanying therapy – but it should never replace a therapy with proven conventional medicines.
All approaches that involve the injection of animal substances, such as "fresh cells", must be evaluated as extremely critical or thymus extracts. Here, as with all foreign proteins, there is the risk of an allergic reaction and, depending on the preparation, also the risk of animal infections being transferred to humans. Also "immune-stimulating Procedures appear to be more than questionable – it cannot be ruled out that destructive autoimmune processes are fueled in this way.
Further information
– G. Kramer; R. Better: Multiple sclerosis – answers to the most frequently asked questions. Triad, 2006. Fact-rich specialized medical councellor with extensive information and Tipps, everyday life and illness to master. Helpful initial information for affected persons, relatives and interested parties. – Initiative Self-Help for Multiple Sclerosis Sufferers e.V.Here MS patients can find information about therapies, acute and rehabilitation clinics, dealing with authorities and institutions.