Multiple Sclerosis: Causes, Symptoms & Treatment

Multiple sclerosis, or MS for short, is a previously incurable inflammatory and chronic disease. It involves the destruction of nerve fibers in the central nervous system, i.e. in the brain or spinal cord. Typical of the disease are the relapses with their symptoms, which in the long term leads to motor and sensory disturbances.

What is multiple sclerosis?

Infographic on the symptomatology and diagnosis of multiple sclerosis. Multiple sclerosis, or MS, is a disease of the central nervous system. It involves chronic inflammation of the spinal cord and brain, in which parts of the nerve fibers (myelin sheaths) are destroyed. In addition, there is damage to the body’s own defense cells, which normally fight foreign pathogens. Therefore, multiple sclerosis is also known as an autoimmune disease. Oddly enough, multiple sclerosis is more common in areas and countries farther from the equator. But even within different countries, there are distinctive distribution patterns of the frequency of multiple sclerosis. After epilepsy, MS is the most common chronic inflammatory disease of the human nervous system. In Germany, approximately 0.15 percent of the population has multiple sclerosis. Women at a younger age are more frequently affected than men. Due to the destruction of the nerve fibers, those affected almost always suffer from motor problems or disturbances in physical movement. In addition, physical sensations are severely affected.

Causes

Three main reasons have been considered for the causes of multiple sclerosis. The first cause may be an autoimmune disease. In this case, the immune system attacks the body’s own tissue. As a result, antibodies are formed that can trigger chronic diseases in the blood and are directed against the body’s own cells. In multiple sclerosis, these antibodies are directed against the nerve tissue of the brain and spinal cord. The second cause of multiple sclerosis is based on genetic or hereditary causes. Thus, people whose close relatives suffer from this disease are at higher risk of MS. Nevertheless, multiple sclerosis is not considered a hereditary disease. Environmental factors can also cause genetic changes in humans, which can then lead to this disease. The last known cause of multiple sclerosis is infection. Here, pathogens such as chlamydia, herpes viruses and Epstein-Barr virus are considered possible causes of inflammation of the nerve fibers. If a patient is already suffering from multiple sclerosis, various other influences can also lead to the well-known relapses of the disease. In particular, stress, hormone imbalances, infections, vaccinations, and medications are then considered triggers.

Symptoms, complaints and signs

Multiple sclerosis is associated with many different symptoms. The disease also progresses at different rates, and the order in which symptoms appear is not fixed. However, difficulty walking, numbness in the legs, problems with bowel movements, vision problems in one or both eyes, and severe fatigue are particularly common in the beginning. However, there are many other symptoms – for example, facial paralysis and sensory disturbances in the arms – that can occur at the beginning. In this case, the symptoms of multiple sclerosis usually appear suddenly and show few signs. The other symptoms usually appear during the course of the disease. Thus, spasticity in the legs or lack of strength in them occurs in 90 percent of cases. Most of those affected are unsteady when walking or can no longer do so. Other common symptoms (occurring in at least two-thirds of sufferers) include bladder emptying disorders, concentration problems and visual disturbances. In about half of the cases, there are mental disorders (such as depression or psychosis), speech disorders, and difficulties in grasping or pointing. In one third of cases, facial paralysis occurs. In general, there may be pain and tingling sensations on the body. In rare cases, paralysis of the cranial nerves occurs.

Disease process

The course of multiple sclerosis depends on early detection and treatment by a physician. Unfortunately, MS cannot yet be completely cured. Since the course of multiple sclerosis can be very individual and different, a blanket description is not readily available.Nevertheless, three major courses can often be identified. The first typical phase is the recurrent and relapsing MS. Here the symptoms or complaints occur several days in a row. In between sometimes several years can pass without further complications. The longer a relapse lasts, the higher the probability that residual damage to the nerve fibers remains,

The second phase or form of progression is called progressive and chronic. In this case, the symptoms usually occur gradually but persist. Relapses, as in the recurrent phase, do not occur. The third form is also progressive and chronic. Here the relapses become less and less, although the disturbances of the nervous system remain the same. In summary, multiple sclerosis can take a benign course, in which the affected person has various complaints, but does not die from them. However, in rare cases, there is also a severe form of MS, which unfortunately ends in death because the nerve fibers of the brain have been damaged too much.

Complications

Chronic urinary tract infection caused by neurogenic bladder emptying dysfunction is among the most common complications of multiple sclerosis. Recurrent urinary bladder infections that are untreated or inadequately treated can spread to the kidneys and, in the worst cases, lead to blood poisoning (urosepsis). Gait instability caused by the disease is often the cause of falls resulting in broken bones. Patients with multiple sclerosis who are bedridden or confined to a wheelchair often suffer from pressure ulcers, joint stiffness and muscle cramps due to their limited mobility; the risk of thrombosis is also increased. Osteoporosis and respiratory diseases such as bronchitis or pneumonia are also the result of inactivity caused by multiple sclerosis in many cases. Further complications of the disease may include constipation and urinary and fecal incontinence. A reduced ability to concentrate, memory disorders and depressive moods often result in a change in personality, which also affects social behavior. The drugs needed to treat multiple sclerosis may weaken the immune system and make the organism susceptible to infections caused by viruses, fungi or bacteria. Therapy with interferon is often accompanied by flu-like symptoms, and allergic reactions are also possible. Sleep disturbances and problems in sexual life may occur as a result of the disease itself or the drug treatment.

When should you see a doctor?

Multiple sclerosis is a disease that may require repeated visits to the doctor due to its chronic nature and progression in episodes. However, the first visits to the doctor serve to confirm the diagnosis and also to rule out other possible causes in the event of signs such as weakness, tingling or sensory disturbances, and paralysis. The first point of contact in this context is the family doctor, who will issue any necessary referrals to a neurologist or radiologist. Once the diagnosis has been made and, if necessary, medication has been administered, visits to the doctor are not absolutely necessary. The relapse marks a sudden change in the course of multiple sclerosis, which may remain stable for a long time and then attract attention with new symptoms. In this case, it makes sense to see the doctor in order to be able to manage any symptoms that occur as well as possible. This often succeeds in cooperation with medical specialties such as speech therapy, occupational therapy or physiotherapy. Psychological problems can also make it necessary to see a doctor or psychotherapist. If affected persons cope poorly with multiple sclerosis, a professional contact from the medical field is also useful here. He or she can support the affected person in his or her psychological condition and provide valuable tips for coping with the disease. Family caregivers can also be involved here.

Treatment and therapy

If multiple sclerosis is diagnosed during an examination by a doctor, therapy should be started as soon as possible. Because MS currently has no cure, the goal of treatment is to slow or stop the destruction of nerve fibers in the brain and spinal cord. In this context, the therapy of multiple sclerosis depends on its course.Relapse therapy:

Relapse therapy is primarily intended to combat the discomfort or symptoms associated with relapses of MS. Drugs are used to strengthen the immune system and try to prevent the body’s own cells from being attacked. Furthermore, anti-inflammatory drugs or cortisone are administered. Side effects are often: sleep disorders, restlessness, palpitations and cravings. Basic therapy:

The basic therapy is intended to slow down the progression of the body motor and senses and to weaken or prevent emerging relapses. It also aims to maintain quality of life by treating symptoms of discomfort. Medications here include glatiramer acetate or interferon beta, which slow the duration and frequency of multiple sclerosis relapses. Therapy of symptoms:

In addition to basic therapy and relapse therapy, concomitant symptoms or complaints are also treated in order to reduce the suffering of those affected and to enable them to live a life worth living. Physiotherapy, massages, pelvic floor training and relaxation methods are particularly successful in this respect. Typical symptoms of discomfort, such as dizziness, tremors, frequent urination and potency problems can be treated sustainably with medication as well as with the above-mentioned measures and often lead to an improvement in the quality of life of multiple sclerosis patients.

Aftercare

Many people with multiple sclerosis suffer from the heteronomy that the disease brings. This is because often each relapse leaves one or more limitations in daily life. The focus of aftercare is therefore on guidance, training and advice. People should be able to do everything that is still possible for them themselves and only receive support when it is necessary. In the area of washing and dressing, relatives or caregivers can therefore work in a resource-oriented way. This means, for example, taking over the preparation and follow-up of daily morning hygiene or providing help with spasticity-related movement deficits. If patients suffer from polyneuropathy, relatives should inspect the feet and pressure-exposed areas for skin damage so that decubital ulcers or injuries can be recognized and treated at an early stage. Relatives also provide assistance with eating and drinking only if limited coordination, tremor, or spasticity restrict mobility to such an extent that eating would not be possible. Special dishes or cutlery make it easier for those affected to eat and drink independently. When people with multiple sclerosis suffer from incontinence, therapists make a valuable contribution in bladder training or instruction in self-catheterization. This is because adequate incontinence care can prevent infections and improve quality of life. Due to limited mobility, carpets, doorsteps or other potential sources of tripping in the living space must be eliminated. Before any mobilization, muscle-relaxing massage and moving through the joints is recommended to maintain mobility and normalize tone.

Outlook and prognosis

The prognosis in multiple sclerosis is very individual and, accordingly, only general statements can be made and favoring factors named. First, it should be noted that the disease leads to severe disability in approximately one-third of those affected. Another third suffers from neurological limitations, which, however, are still partly compatible with a professional life and also preserve independence for the most part. The last third can spend their entire lives without major restrictions, but various minor disabilities or other ailments are possible. The independence remains to this last group, however, in any case. Furthermore, people with multiple sclerosis who suffer exclusively from a relapsing course always have a better prognosis with regard to the development of further limitations. In the chronic-progressive course, severe limitations occur far more frequently and also almost never regress. It has also been shown that female individuals have a better prognosis for a good life expectancy. This also applies to people who develop the disease before their 40th birthday and to people with a relapsing form of the disease with few relapses. Modern therapies, the preservation of possible independence as well as psychological care and a stable environment are decisive for the quality of life of those affected. In many cases, life expectancy is scarcely less than for people who are not ill.

You can do it yourself

Multiple sclerosis is not curable, but the course of the disease can be positively influenced. In addition to long-term drug treatment, sufferers have other options for alleviating symptoms and avoiding complications. The doctor will first recommend a change in lifestyle. Exercise and a balanced and healthy diet support the immune system and other organs that have a significant influence on the course of multiple sclerosis. Support from friends and family members is also important. Social support can contribute significantly to well-being and therefore health. A healthy life also protects against concomitant diseases of the cardiovascular system. Everyday ailments can be reduced by following some basic recommendations. It is important to take medication regularly, because only consistent treatment will bring the desired success. If side effects occur or there is a desire to change the medication for other reasons, the responsible physician must be consulted. In principle, regular visits to the doctor are indicated so that any deterioration in health can be detected quickly. Measures such as physiotherapy and sport also help to combat the typical symptoms. Sufferers should also drink plenty of fluids and avoid or reduce any excess weight. Accompanying this, attendance at a self-help group can be useful.