Multiple sclerosis is a chronic debilitating immune-mediated disease that affects the myelin sheath of the nervous system. It is a very prevalent disease affecting about 400,000 Americans annually. The symptoms depend on the types of nerves affected. The central nervous system consists of the brain and spinal cord. The myelin sheath are supporting structures that help in transmitting information to and from the brain. Women are more affected than men in the ratio 2 to 1.
In multiple sclerosis, the myelin is damaged by the immune system, forming a plaque or lesion (an area representing the absence of myelin). The lesion created by the damaged myelin leads to interruption of electric signals in the brain. This sudden disruption in the electrical activity in the brain is responsible for the numerous symptoms experienced in multiple sclerosis. The damaged myelin forms scars (sclerosis) after a prolonged period.
Clinically Isolated syndrome (CIS) is a course of multiple sclerosis characterized by demyelination induced neurological symptoms that last for about 24 hours. It is often the first neurological symptoms experienced by multiple sclerosis patients.
What is the Cause of Multiple Sclerosis?
The primary etiology of multiple sclerosis is unknown. However, there are numerous risk factors that increase the chances of someone having multiple sclerosis. The most common risk factor includes:
- Age: multiple sclerosis is not an age-specific disease, it can occur during any period of our lives. However, it is more frequent I n people within the age range of 15 and 60 years.
- Gender: It is more common in women than men Irrespective of their age. Research has proven, that it is twice more common in women than in men.
- Family History: people with relatives or siblings with a history of multiple sclerosis are at higher risk of developing the disease.
- Race: It has been discovered that Asians, Africans, and Native Americans are at lower risk of developing multiple sclerosis, whereas, people living in northern Europe are more predisposed to the disease.
- Infections: Some bacteria and virus especially Epstein –Barr virus predisposes people to have multiple sclerosis.
- Lifestyle: Individuals that smoke or drink excessive alcohol are more predisposed to having multiple sclerosis
- Climate: Most people living in temperate regions often develop multiple sclerosis during their lifetime.
- Underlying Diseases: People suffering from some autoimmune or endocrinological disease such as thyroid disorder, inflammatory bowel disease, and diabetes mellitus 1 are at higher risk of developing multiple sclerosis.
Types of Multiple Sclerosis
There are different types of multiple sclerosis. However, most people develop multiple sclerosis either through individual relapse or progression of the disease. The 2 main forms of multiple sclerosis are:
- Relapsing-Remitting Multiple Sclerosis: This type of multiple sclerosis is characterized by multiple periods of new or worsening multiple sclerosis. The \the period between each attack is called remission; In most cases, the relapsing-remitting multiple sclerosis could disappear by itself or progress to secondary progressive multiple sclerosis. About 80 percent of the world’s population suffering from multiple sclerosis has a relapsing-remitting However, 2 out of 10 people with this type of multiple sclerosis develop secondary progressive multiple sclerosis
- Primary Progressive Sclerosis: About 10 percent of multiple sclerosis patients develop primary progressive sclerosis; it is characterized by worsening multiple sclerosis with no period of
Signs and Symptoms of Multiple Sclerosis
The sign and symptoms of multiple sclerosis depend on the nerve affected; the symptoms could arise from any part of the body. The most common signs and symptoms of multiple sclerosis include:
- Fatigue
- Gait: Most people experience difficulty walking especially when the nerves responsible for locomotion are affected.
- Visual Disturbance: Most people affected by multiple sclerosis experiences blurry vision and slurred speech. Sometimes, they experience double vision, partial or total loss of vision.
- Dizziness
- Nephrological Symptoms: Multiple sclerosis patients have problems with controlling bowel and bladder function.
- Tingling sensation in the body
- Tremor
- Slurred Speech
- Numbness on one side of the body especially the leg and trunk.
- Lhermitte “s Sign: This is an electric tingling sensation expereinced by multiple sclerosis patients during specific body movement especially bending of the neck.
Multiple Sclerosis Treatment Guidelines
The guideline for multip; le sclerosis is centered around patient care and gives to the physician to offer the best possible treatment for multiple sclerosis patients. The following organizations are responsible for forming the guidelines:
- A consortium of Multiple Sclerosis Centers (CMSC)
- MAGNIMS (Magnetic Resonance Imaging in MS) Network
- European Academy of Neurology (EAN)
It takes a combination of different diagnostic methods to diagnose multiple sclerosis, but MRI is the primary imaging device used for diagnosing multiple sclerosis. Brain MRI is used as a base; one for the treatment of multiple sclerosis, there are some specific situations where different types of MRI e used such as:
- Spinal Cord MRI: This type of MRI is used in specific conditions such as transverse myelitis, or in people older than 40 years or with inconclusive MRI result.
- Cervical Cord MRI: Most patients with or without transverse myelitis benefit more from the combination of cervical cord MRI, and Brain MRI are performed
- Orbital MRI: This is performed in patients with complications such as optic neuritis.
The guideline also recommends specific follow up for CIS or multiple sclerosis patients after MRI examination. The guideline for follow up after MRI includes:
- People with high risk for the clinically isolated syndrome (CIS) should be followed up for 6-12 months, especially, if they have ≥2 ovoid lesions on first MRI.
- A low-risk group for CIS and multiple sclerosis should be monitored for 1 -2 years
There are specific situations when following up brain MRI with gadolinium is required such as:
- No previous imaging
- In postpartum patient
- Before starting disease-modifying therapy
- During unexpected clinical deterioration
- Every 12-24 months while using disease-modifying therapy
- 6 months after switching disease modified therapy
Multiple Sclerosis Medications
There are numerous medications used for treating multiple sclerosis depending on the nerves affected. The most common medications include:
- Immunomodulators
- Immunosuppressants
- Muscle relaxants
- Dopamine Agonist
- Corticosteroids
- Antineoplastic agents
- Anticonvulsants
- Benzodiazepines
- Non-steroid anti-inflammatory Drugs (NSAID)
- laxatives
- Potassium channel blockers
Best Doctors for Multiple Sclerosis
The best doctors for multiple sclerosis are a team or neurologist, neuropsychologist, general practician, nurse, psychiatrist, and physiotherapist.
References
Deborah Weatherspoon, C. (2018). Multiple sclerosis: Symptoms, causes, and treatment. Medical News Today. Retrieved 5 April 2018, from https://www.medicalnewstoday.com/articles/37556.php
Multiple sclerosis. (2018). Nhs .uk. Retrieved 5 April 2018, from https://www.nhs.uk/conditions/multiple-sclerosis/
What Causes MS?. (2018). National Multiple Sclerosis Society. Retrieved 5 April 2018, from https://www.nationalmssociety.org/What-is-MS/What-Causes-MS