Multiple sclerosis is a disease in which the human immune system destroys the protective sheath covering the nerves (myelin sheath). This process violates the relationship between the brain and the rest of the body. In the end, the nerves themselves are damaged, and this is an irreversible process.
Symptoms of multiple sclerosis vary depending on the degree and location of damage to the nervous system. In severe cases, patients with a diagnosis of multiple sclerosis may lose the ability to walk and talk. Diagnosis of multiple sclerosis is difficult at early stages, because symptoms of the disease can appear and disappear – sometimes even for months.
Treatment of multiple sclerosis has not yet been developed, however, it is already possible to prevent the exacerbation of the disease, change the course of the disease and alleviate the symptoms.
The signs and symptoms of multiple sclerosis can vary considerably depending on the location of the damaged nerve fibers. Among the symptoms of multiple sclerosis are the following:
- Numbness or weakness of one or more limbs, usually on one side or the entire lower part of the body.
- Partial or complete loss of vision, usually in one eye, often accompanied by pain during eye movement (retrobulbar neuritis).
- Double or blur contours
- Tingling or pain in different parts of the body
- Electric shock sensations with certain head movements
- Nervous tremors, problems with coordination of movements or an unsteady gait
- Increased fatigue
Many patients with multiple sclerosis, especially in the initial stages of the disease, experience relapses of symptoms that are accompanied by periods of complete or partial remission. The signs and symptoms of multiple sclerosis often appear or increase with increasing body temperature.
The exact causes of multiple sclerosis are unknown. It is believed to be an autoimmune disease in which the immune system destroys its own tissues. In multiple sclerosis, during this process myelin is destroyed – a special layer that covers and protects the nerve fibers of the brain and spinal cord.
Myelin can be compared to the insulation on electrical cables. When the myelin layer is damaged, the transmission of impulses that travel along this nerve can be slowed down or blocked.
Doctors and researchers do not understand why some people develop multiple sclerosis and others do not. A combination of factors, such as genetic predisposition and childhood infections, may play a role.
The following factors may increase the risk of developing multiple sclerosis:
- Age from 20 to 40 years. Multiple sclerosis can appear at any age, but more often it occurs in this age interval.
- Female. Women suffer from this disease twice as often as men.
- Relatives with this diagnosis. If one of the parents or brother / sister suffered from multiple sclerosis, the probability that a person will become ill is 1–3 percent, while the risk of becoming ill in the general population is 0.1 percent. However, studies of the disease of twins show that heredity is not the only decisive factor. If multiple sclerosis were caused only by a genetic predisposition, then identical twins would have the same risk of developing the disease. However, in the identical twin, the probability of the onset of multiple sclerosis is only 30 percent, if his twin already suffers from this disease.
- Infections. Some viruses are associated with multiple sclerosis. To date, the greatest interest is the relationship of multiple sclerosis with Epstein-Barr virus, which is the causative agent of mononucleosis. How Epstein-Barr virus can increase the likelihood of multiple sclerosis remains unclear.
- White race. White people, especially those born in Northern Europe, are at the highest risk of contracting multiple sclerosis. Those born in Asia, Africa or America have the lowest risk.
- The presence of certain autoimmune diseases. The risk of multiple sclerosis in a person is increased if he suffers from thyroid disease, type 1 diabetes or intestinal inflammation.
In some cases, patients with multiple sclerosis may also have:
- Muscle stiffness or cramps
- Paralysis, most often of the legs
- Bladder, intestinal or sexual problems
- Changes in mental performance, such as forgetfulness or difficulty concentrating
Special tests to identify multiple sclerosis is not carried out. Ultimately, the diagnosis is based on the exclusion of other diseases that could cause similar symptoms. Your doctor may rely on the following when making a diagnosis:
A blood test can help eliminate some infectious and inflammatory diseases that have similar symptoms.
Spinal (lumbar) puncture
In this study, the doctor removes a small amount of cerebrospinal fluid from the spinal canal for laboratory analysis. In this sample, abnormalities associated with multiple sclerosis, such as abnormal levels of white blood cells and immunoglobulins, can be detected. This research method also eliminates viral infections and other diseases that can trigger neurological symptoms similar to those of multiple sclerosis.
This study uses a strong magnetic field and radio waves to obtain detailed images of internal organs. MRI can reveal lesions indicating the destruction of myelin in the brain and spinal cord. However, these types of damage can also be caused by other diseases, such as lupus or Lyme disease, so the presence of these damages is not clear evidence that a person has multiple sclerosis.
Analysis of evoked potentials.
This study measures the electrical signals sent by the brain in response to stimuli. Analysis of evoked potentials can use visual or electrical stimuli, with brief electrical impulses being sent to the legs or hands.
Multiple sclerosis is not curable. Treatment is usually aimed at combating attacks, changing the course of the disease and alleviating the symptoms. In some patients, the symptoms are so minor that they do not require treatment.
Tactics of treatment for attacks of multiple sclerosis
- Corticosteroids. The most common type of treatment for multiple sclerosis is the administration of corticosteroids, which helps to reduce the inflammatory process, which is exacerbated during an attack. Examples are treatment with oral prednisone and methylprednisolone intravenously. Side effects can manifest as high blood pressure, mood swings and weight gain. Long-term use can trigger cataracts, high blood sugar and an increased risk of viral infections.
- Plasmapheresis. The treatment method is similar to dialysis, since it mechanically separates blood corpuscles from plasma, the liquid part of the blood. Plasmapheresis is sometimes used to help cope with the severe symptoms of multiple sclerosis during crises in people who do not respond to steroids administered intravenously.
Strategies to change the course of the disease
- Beta interferons. Medications such as Avonex, Betaseron, Extavia and Rebif slow down the rate of worsening of the symptoms of multiple sclerosis. Interferons can cause certain side effects, including liver damage, so it will be necessary to perform blood tests to monitor hepatic enzymes.
- Glatiramer (Copaxone). Glatiramer (Copaxone). Doctors believe that Glatiramer blocks the action of the immune system to destroy the myelin nerve layer. It is administered once a day subcutaneously. Among the side effects are the occurrence of hyperemia and difficulty breathing after the injection.
- Fingolimod (Gilenya). Fingolimod (Gilinia). The drug is taken orally once a day, the action is based on the retention of immune cells in the lymph nodes. The drug reduces attacks of multiple sclerosis and short-term disability. When you take this drug, you need to monitor your heartbeat for six hours after the first dose, because the first dose may slow the heartbeat (bradycardia). You should also have immunity against chickenpox (varicella-zoster virus). Other side effects are high blood pressure and blurred vision.
- Natalizumab (Tysabri). Natalizumab (Tisabri). This drug is designed to resist the movement of immune cells from the blood flow to the brain and spinal cord. Tisabri is usually prescribed to people who do not have results from another treatment or to those who are not suited to other methods of treatment, because Tisabri increases the risk of progressive multi-leucoencephalopathy of a brain infection with a fatal outcome.
- Mitoxantrone (Novantrone). Mitoxantrone (Novantron). An immunosuppressant that can be harmful to the heart and is associated with the development of blood cancer, such as leukemia. Usually used only in severe cases of multiple sclerosis.
Symptom Treatment Strategy
- Physiotherapy. A physical therapist or occupational therapist will teach you muscle stretching exercises and strength training, show you how to use tools that will make your daily activities easier.
- Muscle relaxants. If a person suffers from multiple sclerosis, he may experience muscle rigidity or cramps, especially in the legs. Muscle relaxants, such as baclofen and tizanidine, reduce muscle spasticity. Baclofen will increase weakness in the legs. Tizanidine may cause lethargy or dry mouth.
- Ways to reduce fatigue. Drugs like amantadine can help reduce fatigue.
- Other medicines. Medications for depression, pain, or problems with controlling the bladder and intestines associated with multiple sclerosis can also be given.
- Some other drugs and treatments, such as stem cell transplantation for the treatment of multiple sclerosis, are still under study.
Lifestyle and home remedies
The following steps can alleviate some of the symptoms of multiple sclerosis: