MULTIPLE SCLEROSIS

Multiple Sclerosis: Causes, Symptoms, and Treatment Options

Considered the most common disabling neurological condition in young adults, multiple sclerosis is a chronic, complex, and unpredictable disease, whose exact causes are not fully known and which cannot be cured. However, there are a variety of treatments that can help manage symptoms and the progression of the disease.[1] You will learn more about all these below!

What is multiple sclerosis?

Multiple sclerosis, also known as MS, is a chronic autoimmune neurological condition that occurs when the immune system attacks the myelin sheath - a vital protective layer for axons, the long fibers of neurons that transmit electrical signals to and from the brain. When myelin is damaged, these signals can be slowed or completely stopped, leading to a wide range of symptoms.[1]

Types of multiple sclerosis

Depending on the progression of symptoms, four main types of multiple sclerosis are distinguished:

• relapsing-remitting multiple sclerosis - the most common form, affecting about 85% of patients at the onset of the disease; it is characterized by attacks (relapses) of new or worsening symptoms, followed by periods of remission where symptoms improve completely or partially;
• secondary progressive multiple sclerosis - usually occurs after the relapsing-remitting form and involves a constant progression of symptoms from the start;
• primary progressive multiple sclerosis - less common and characterized by a progressive worsening of symptoms from the start; there are no relapses or visible exacerbations of the disease, although there may be temporary or minor improvement in symptoms;
• progressive-relapsing multiple sclerosis - the rarest form, combining a constant progression of symptoms with acute relapses.[1]

What are the causes of multiple sclerosis?

The exact causes of multiple sclerosis are not fully known. However, it is believed that this condition is caused by a combination of genetic and environmental factors. Primarily, the immune system starts attacking the myelin sheath, which is essential for transmitting nerve signals, but it is unclear what triggers this autoimmune response.[2][3]

Although multiple sclerosis is not strictly a hereditary disease, there is evidence suggesting that inherited genes can increase susceptibility to this condition - the risk of having this disease is higher if a parent or sibling has been diagnosed with it.

Besides genetic factors, there are also external factors that can contribute to the development of the disease. These include:

• vitamin D deficiency and low sun exposure;
• smoking;
• obesity during adolescence;
• certain infections (e.g., including Epstein-Barr virus infection, which is responsible for infectious mononucleosis).[2][3]

Other risk factors for multiple sclerosis include:

• gender - women are 2 to 3 times more likely than men to develop relapsing-remitting multiple sclerosis;
• age - symptom onset usually occurs between the ages of 20 and 40; however, the disease can occur at any age.[2][3]

What are the symptoms of multiple sclerosis?

The symptoms of multiple sclerosis can vary considerably from person to person and can fluctuate in severity from day to day. The most common signs of this disease include:

• persistent fatigue;
• clumsiness;
• dizziness;
• urinary tract problems;
• loss of balance and coordination;
• cognitive problems such as foggy thinking, poor memory, reduced concentration, difficulties in learning and judgment;
• mood changes;
• muscle stiffness;
• muscle spasms.[2][3]

Symptoms such as muscle weakness, stiffness, and spasms can become so severe that they affect a person's ability to walk or stand. In extreme cases, multiple sclerosis can lead to partial or complete paralysis, and the use of a wheelchair may become necessary, especially for untreated individuals or those in an advanced stage of the disease.

Pain is not usually the first sign of multiple sclerosis, but it can occur in cases of optic neuritis and trigeminal neuralgia, conditions associated with multiple sclerosis.[2][3]

What are the early symptoms of multiple sclerosis?

The early signs and symptoms of multiple sclerosis often include:

• vision problems such as blurred or double vision or optic neuritis;
• muscle weakness, often in the arms and legs;
• muscle stiffness accompanied by painful muscle spasms;
• tingling, numbness, or pain in the arms, legs, trunk, or face;
• clumsiness, especially difficulty maintaining balance while walking;
• bladder control problems;
• intermittent or constant dizziness.[1][2]

What complications can multiple sclerosis lead to?

Multiple sclerosis can lead to complications such as:

• difficulty walking without assistance;
• loss of bowel or bladder control;
• memory loss;
• sexual dysfunction;
• depression and anxiety.[1][2]

How is multiple sclerosis diagnosed?

Diagnosing multiple sclerosis can be complex and challenging, as the symptoms presented by patients can be confused with those of other conditions. Therefore, a series of clinical, imaging, and laboratory investigations are necessary for a correct diagnosis.

The process begins with a detailed medical history, which involves an in-depth discussion with the patient about their symptoms, duration, and severity, as well as their personal and family medical history. This step is essential for understanding the context of symptom onset and guiding the doctor in subsequent investigations.[1][2]

Then, a complete neurological exam will be used to evaluate the patient's reflexes, muscle strength, coordination, sensitivity, and vision. These tests can help identify specific abnormalities of multiple sclerosis, although further investigations are often needed for a definitive diagnosis.[1][2]

Among the imaging methods used in diagnosing multiple sclerosis is magnetic resonance imaging (MRI). This is a complex technique that allows the identification of specific lesions of this disease in the white matter of the brain. Also, cerebrospinal fluid (CSF) analysis may be useful, a procedure in which a small amount of fluid is taken from the spinal canal and analyzed in the laboratory. Another type of useful investigation in diagnosing multiple sclerosis is evoked potentials, tests that measure the brain's response time to various stimuli. These can help identify specific anomalies of the disease, even in the absence of obvious symptoms.[1][2]

What treatment options for multiple sclerosis are available?

Currently, there is no cure for multiple sclerosis, but there are various treatment options that can help control symptoms and slow the progression of the disease. Treatment is personalized depending on the stage of the disease and the specific symptoms of each person.[1][2][3]

An important category of treatment is disease-modifying therapies. These medications can reduce the frequency and severity of relapses and slow the progression of disability and are available in various forms, from injectables to oral and infusible.[1][2][3]

Besides disease-modifying therapies, symptomatic treatment plays a crucial role in managing multiple sclerosis. It focuses on alleviating specific symptoms such as fatigue, pain, or muscle spasms. Physical therapy, occupational therapy, and speech therapy can help improve mobility, coordination, and cognitive functions. Psychological counseling can offer emotional support and help patients cope with the challenges of the disease.[1][2][3]

In addition, there are measures that patients can take to improve their quality of life. Adequate rest, regular physical exercise, avoiding heat, adopting a balanced diet, and reducing stress can have a significant impact on overall well-being. For example, regular physical exercise can help improve strength, muscle tone, balance, and coordination, and a healthy diet can help improve overall health.[2]

Multiple sclerosis is a complex autoimmune neurological disease with unknown causes and varied symptoms. Diagnosis is made through clinical examination and paraclinical investigations, and treatment is based on immunomodulatory and symptomatic medications, physical therapy, and psychotherapy. Although the disease has no curative treatment, through early and adapted therapeutic interventions, the quality of life of patients can be significantly improved.

References:

1. „Multiple Sclerosis”, National Institute of Neurological Disorders and Stroke, 2024, www.ninds.nih.gov/health-information/disorders/multiple-sclerosis. Accessed on July 29, 2024.
2. „Multiple Sclerosis”, Mayo Clinic, 2022, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269. Accessed on July 29, 2024.
3. „Multiple Sclerosis”, NHS Choices, 2024, www.nhs.uk/conditions/multiple-sclerosis/. Accessed on July 29, 2024.