Multiple Sclerosis

Multiple Sclerosis is a type of demyelinating disease, a disease in which the nervous system is damaged by the deterioration of the outer layer of the neurons, called myelin. This phenomenon affects the transmission of the nerve impulses between neurons, which results in a variety of symptoms of multiple sclerosis, which may impair the sufferer to a certain degree.  These symptoms may vary from physical, psychiatric and even mental issues. Specific symptoms of multiple sclerosis include double vision, weak muscles, and blindness in one or both eyes, difficulties with coordination or difficulties with sensations. Patients with multiple sclerosis usually experience one or more symptoms, in some cases these episodes being isolated. Between these episodes, the symptoms usually disappear completely. Nevertheless, the condition continues to develop, leaving permanent neurological damage, as the nerves continue to deteriorate. Up until the present time, the exact cause of multiple sclerosis remains unknown, but many think that it is caused by an immune response which causes the body to attack the myelin cells, or the failure of those cells to regenerate. There is no known cure for multiple sclerosis, which leaves the sufferers to manage their condition with drugs that work on a relative level.

Multiple Sclerosis Overview & Facts

Multiple Sclerosis is a neurodegenerative disease in which the myelin, a layer of the neurons is damaged. The causes of this phenomenon are yet to be determined, but specialists think that a series of variables, starting with geographic coordinates, genetic factors and infectious diseases may trigger the development and evolution of the condition. More prevalent in women than in men, the disease is more frequent farther from the Equator. However, this is not a pattern to follow in determining the exact causes of multiple sclerosis. Infections with the human herpes virus seem to be associated with the debut of MS.  In terms of treatment, the costs associated with a suitable management therapy are high, while all medications used up until the present time seem to have severe side-effects. An association of physical, mental and psychological symptoms and imaging are the frequently used diagnosis methods. The symptoms are severe and worsen over time, as MS’s evolution cannot be stopped.

Multiple Sclerosis Symptoms & Diagnosis

Multiple Sclerosis Symptoms

Multiple sclerosis is ranked as one of the most common autoimmune disorders of the central nervous system. By 2016, more than two million people were diagnosed with multiple sclerosis worldwide. In the same year, just about 19.000 people died from multiple sclerosis. The condition usually starts to manifest around the age of 20 or 40, and women seem to be more prone to develop it. Currently, specialists in the medical field and leading companies in the pharmaceutical industry are trying to develop new diagnosis and management therapies. However, a cure is yet to be discovered. In terms of symptoms, multiple sclerosis is quite an unpredictable disease. The symptoms vary from individual to individual, but they mainly revolve around the deterioration of various functions.

  • Numbness in the members;
  • Vision issues;
  • Weak, stiff or numb muscles;
  • Extreme fatigue;
  • Pain;
  • Mobility issues;
  • Anxiety, depression;
  • Speech impediments;
  • Swallowing difficulties;
  • Bowel and bladder-related issues;
  • Problems with thinking, speaking and planning;
  • Uhthoff’s phenomenon, which means that in higher temperatures, the symptoms tend to worsen.

Multiple Sclerosis Diagnosis 

The diagnosis methods used to identify the presence of multiple sclerosis is a combination of the presence of the symptoms above and a series of imaging and laboratory tests. Confirming the diagnosis can be difficult, especially at early signs of onset. With initial development similar to dementia or Alzheimer’s the early stage of MS can be problematic to diagnose. One of the most commonly used methods of diagnosis is the McDonald criteria, a mix of laboratory and imaging tests, showing signs of MS at different times, in different areas of the brain. The McDonald criteria are a non-invasive method of diagnosis. However, in certain cases there might be requested and autopsy or biopsy of the damaged area of the brain. In most of the cases, clinical data is enough to determine the presence of MS in a patient, especially after an episode. The most common diagnosis methods are as it follows.

  • Neuroimaging;
  • Cerebrospinal fluid analysis;
  • Evoked potentials analysis.

 

Causes of Multiple Sclerosis

The multiple sclerosis causes remain unknown, but it is believed that a blend of genetic and environmental factors. Infections are thought to be one of the agents that can lead to MS. However, a certain cause of multiple sclerosis is yet to be determined, as specialists are tirelessly trying to combine data into a potential explanation.  However, there have been identified some potential factors that may lead this condition.

  • GEOGRAPHY – recent data has shown that people who live farther from the Equator have more chances of developing MS. However, there are certainly exceptions, various ethnic groups being at risk to develop this condition. This makes the geographical pattern difficult to interpret and create a clear definition of it. Many think that northern populations have more chances to develop this disease because of the reduced amount of sunlight, thus Vitamin D they receive.
  • GENETICS – although specialists do not think that multiple sclerosis is a genetic disease, certain variations in genetic sequences seem to influence the appearance and development of MS. It has been proven that close relatives of those with MS have higher chances of developing the same condition. Moreover, it has been proven that if both parents suffered from MS, the children’s chances of developing the condition are ten times bigger. Certain genes, like the abnormal human leukocyte antigen or the HLA system seem to be guilty of the development of MS. The same system has been proven to be guilty of the development of several other autoimmune diseases, such as lupus and type I diabetes. In up to 60% of the cases, a change in the HLA system was guilty of multiple sclerosis.
  • INFECTIOUS AGENTS – although there have been proposed multiple microbes and infections as a potential cause of trigger of the disease, there is insufficient proof for it. A hypothesis is that certain common microbes are guilty of the diseases’ debut. However, the encounter with such agents, usually not harmful, must be present later in life, not early, when the immune system is adapting to the environment. Usually, individuals infected with the human herpes virus or that were infected by the Epstein–Barr virus seem to have more chances of developing MS.
  • OTHER RISK FACTORS – Smoking seems to be a common habit of those with MS, thus specialists think that it may influence the development of the disease to a degree or another. Exposure to toxins, such as solvents also seems to increase the risk of multiple sclerosis.

 

Types of Multiple Sclerosis

Specialists differentiate several progression patterns of multiple sclerosis, or simply put, types of multiple sclerosis.

  • CIS or clinically isolated syndrome;
  • RRMS or relapsing-remitting multiple sclerosis;
  • PPMS or primary progressive multiple sclerosis;
  • SPMS or secondary progressive multiple sclerosis.

 

Multiple Sclerosis Treatment & Care

Multiple sclerosis has no known cure. However, certain management therapies are available for the sufferers. The main purposes of the known management therapies for multiple sclerosis are preventing disability, recovering from an attack and preventing further attacks. Depending on the types of attacks of each MS patient, there has been outlined a treatment for multiple sclerosis, but like any other medical therapy, almost all of these have side effects.

  • Management therapies for ACUTE ATTACKS – during an attack the main purpose of the medication administered is to decrease the duration of the attack. One of the most effective treatments is the administration of a high dose of intravenous corticosteroids. Recent data has shown that oral administration of the same corticosteroids seems to have similar effects on acute attacks. While showing great effects on short-term perspectives, the treatment seems to be ineffective on long-term perspectives.
  • Management therapy for RRMS – a list of various medications has been approved in 2017 as a treatment method for RRMS, but as many think, it may represent an enormous financial effort. The drugs proposed vary from dimethyl fumarate, to interferon beta 1-a and beta 1-b, daclizumab, glatiramer acetate, fingolimod and the list goes on. These drugs seem to be more effective in decreasing the number of attacks in RRMS. Interferon is the first drug on which MS patients are put under, showing great effects in reducing the number of relapses, by 30%. Natalizumab seems to reduce even by more the number of relapses, but unlike interferon, it has severe adverse effects, being used only on the patients who don’t respond to interferon. The third line of defense for those who don’t respond to Natalizumab either is Mitoxantrone. Also, the use of Mitoxantreone is also limited by the severe reactions patients usually show. Ultimately, a therapy with rituximab became widely used for real-life conditions in patients with MS.
  • PPMS management methods – the same rituximab seems to also show significant effects in PPMS. Recently, ocrelizumab, has been approved across the USA by the FDA as a first line management therapy. However, like any other type of medication for modifying a certain disease, therapies have side-effects that usually consist of inflammation and irritation of the injection area. In time, the tissue is damage at the site of the subcutaneous or intra muscular injections and a slight dent appears. More severe symptoms seem to be a poor general state, resembling the flu in case of interferon administration. In some cases, right after administration, patients report chest tightness, flushes, palpitations and anxiety.

 

Prognosis for Patients with Multiple Sclerosis

Generally, those suffering from multiple sclerosis have a reserved prognosis to a normal life. The prognosis for multiple sclerosis depends strongly on the patient’s sex, age, development, type of sclerosis they have and level of disability caused by the condition. However, specialists are never optimistic when it comes to MS. The life expectancy in multiple sclerosis is about 30 years from the moment the first symptoms appear. The patient will, however, experience a degrading development of their health. Approximately 40% of the patients with MS will comfortably reach and pass the age of 70.

 

Multiple Sclerosis

 

Living with Multiple Sclerosis

Certain wellness strategies have been proven to improve the life of the patients with MS. Living with multiple sclerosis means that the patient must pay increased attention to their diet and exercise habits, as well as their cognitive health.

  • Physical wellness in multiple sclerosis involves more than increased attention to the medication administered in order to reduce the symptoms and relapses intervals. It means that each patient should adapt their living habits in order to boost the efficacy of the medical therapy. These modifications involve, usually, better eating habits, meaning an increased intake of Vitamin D and biotin (a natural enzyme that resembles the Vitamin B’s characteristics). As previously said, a deficiency of Vitamin D is linked to the evolution and debut of the condition, and multiple studies have shown that a higher intake has the potential to decrease the number of relapses.
  • Exercising seems to be the key to a general well-being, but its advantages have also been proven in decreasing the intensity of MS. Physical exercising has been proven to improve cognitive function, bowel and bladder movement, strength, social interaction and eliminate the general state of anxiety and fatigue usually experienced by individuals with MS. Recommended activities for those with MS are gardening, cooking and various household chores.
  • Cognitive health can be improved by participating in various social games, crossed words and puzzles. These seem to increase concentration and the capacity to increase the concentration levels in patients with MS.

 

Multiple Sclerosis Conclusions

Multiple sclerosis is a condition without a cure. However, certain management therapies and adaptation actions can be taken in order to improve the quality of life and to decrease the side effects of the medication administered. Although no certain cause can be linked to the condition’s debut or development, certain variables seem to trigger the condition. Infectious diseases, geography and a genetic predisposition seem to accentuate the chances of developing MS at a point in time.

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