Multiple sclerosis is a chronic neurological condition that belongs to the category of demyelinating diseases. It is an autoimmune disease, with an unclear cause to date, in which lymphocytes “attack” the sheath of the neurons of the Central Nervous System, the so-called myelin, destroying it.
Myelin helps protect nerves and transmit nerve impulses. The result of the destruction suffered is the disturbance in the transmission of stimuli along a nerve axon. Sclerosis is called because it leaves multiple scars on the myelin.
After each episode of myelin destruction called “relapse”, until the damage is repaired by the body, losses occur in various functions such as strength, movement, sensation, vision, hearing. The repair by the body begins immediately but does not reach 100% restoration to the previous state. As such residual lesions remain.
From the moment the disease manifests itself, there will be continuous relapses and remissions. Relapses of the disease are usually unpredictable and can occur without warning.
Multiple sclerosis can affect many nervous system functions and to a varying degree. However, because there has been an impressive development with new treatments over the last few years, a large percentage of patients with multiple sclerosis live an almost completely normal life, with few problems. In severe cases the disease can cause disability, although quick and aggressive treatment can greatly prevent this.
Symptoms and diagnosis
Symptoms can vary greatly from person to person. However, the most common are changes in the sensation of the limbs or face, total or partial loss of vision, weakness, diplopia, balance problems and uncontrolled movements when walking, feeling of electric current in the back and fatigue.
If such symptoms occur, then patients should promptly see an experienced neurologist.
The diagnosis is based on clinical examination and supported by brain MRI. Also, a lumbar puncture may be required to collect cerebrospinal fluid, to better characterize the disease or exclude another disease such as Central Nervous System infections.
Treatment
Early diagnosis of multiple sclerosis allows the implementation of preventive treatment to reduce the number and severity of relapses.
There is a variety of treatment options and therapy is typically individualized.
Treatment of acute relapses is usually done with high doses of intravenous steroids.
Disease modifying treatments (interferons, glatiramer, natalizumab, mitoxandrone, as well as newer immunomodulatory treatments like fingolimod, dimethylfumarate, alemtazumab, ocrelizumab) are administered to prevent relapses.
Especially the newer immunomodulatory treatments, demonstrate high efficacy and a good safety profile, but require expertise in their use.
Additionally, a multidisciplinary approach using physiotherapy, occupational therapy and speech therapy may be necessary.
