Symptoms
Possible symptoms of multiple sclerosis include:
- Weakness, numbness of the extremities.
- Visual disturbances, eye pain, optic neuritis.
- Paresthesias (eg, formication, tingling), pain, nerve pain.
- Tremor, coordination / balance disorders.
- Speech and swallowing disorders
- Dizziness, lightheadedness
- Fatigue
- Urinary incontinence, constipation
- Sexual function disorders, erectile dysfunction
The disease is often relapsing and recurrent (relapsing-remitting multiple sclerosis), but can also progress continuously without relapses (primary progressive multiple sclerosis). Severe complications include muscle spasms, paralysis, cognitive decline, depression, and epilepsy.
Causes
Multiple sclerosis is a degenerative, progressive, and inflammatory autoimmune disease of the central nervous system (brain, spinal cord) in which the myelin sheaths of nerve cells are attacked and the nerves are damaged. Myelin is an insulating and protective layer consisting of lipids and proteins that surrounds the axons of the nerves and enables rapid signal conduction. The inflammatory lesions lead to disturbances or failures of nerve function. The disease often affects young women between the ages of 20 and 45.
Diagnosis
Diagnosis is made during medical treatment by a neurologist on the basis of the patient’s history, physical examination, imaging techniques (magnetic resonance imaging), and laboratory tests (lumbar puncture, blood tests), among others. Other diseases causing a similar clinical picture must be excluded.
Drug treatment
There is currently no cure for multiple sclerosis. However, numerous medications are available to relieve symptoms and reduce the frequency of relapses. Medications used include: Relapse treatment: glucocorticoids to immunosuppress and reduce inflammation during a relapse:
- Methylprednisolone (Solu-Medrol).
Basic therapy (disease-modifying drugs): interferons:
- Interferon beta-1a (Avonex, Rebif).
- Peginterferon beta-1a (Plegridy)
- Interferon beta-1b (Betaferon)
Immunomodulators:
- Glatiramer acetate (Copaxone).
- Teriflunomide (Aubagio)
Sphingosine-1-phosphate receptor modulators:
- Fingolimod (Gilenya)
- Ozanimod (Zeposia)
- Siponimod (Mayzent)
Fumarate:
- Dimethyl fumarate (Tecfidera).
- Diroximelfumarate (Vumerity)
Purine analogs:
- Cladribine (Mavenclad).
Anthracyclines:
- Mitoxantrone (Novantrone, generic).
Monoclonal antibodies:
- Alemtuzumab (Lemtrada)
- Daclizumab (Zinbryta, off label).
- Natalizumab (Tysabri)
- Ocrelizumab (Ocrevus)
- Ofatumumab (Kesimpta)
Symptomatic therapy:
- Muscle relaxants
- Potassium channel blockers: fampridine (Fampyra).
- Others, e.g., antidepressants, anticonvulsants, parasympatholytics, cannabis oral spray, cannabis.