Multiple Sclerosis: Symptoms, Causes, Treatment

In multiple sclerosis (MS) (synonyms: Disseminated demyelinating encephalomyelitis; Encephalomyelitis disseminata; Encephalitis disseminata (MS); MS; Multiple sclerosis; Multiple sclerosis (MS); Multiple sclerosis; Polysclerosis; ICD-10-GM G35.-: Multiple sclerosis [encephalomyelitis disseminata]) is a chronic inflammatory demyelinating disease (demyelination of nerves by inflammatory processes) of the central nervous system (CNS) that causes progressive physical impairment. It is the most common neurological disease leading to permanent disability and early retirement in young people. The disease is classified into the following courses:

  • Clinically isolated symptom (CIS; Clinically isolated syndrome, CIS) – e.g., optic neuritis (inflammation of the optic nerve), brainstem syndrome, or transverse myelitis (neurologic syndrome caused by inflammation of the spinal cord).
  • Relapsing-remitting (RRMS) form of MS – relapsing-remitting (intermittent) MS; occurs in 85% of early-stage cases; lower risk of disability progression compared with the forms of progression described below
  • Secondary (chronic) progressive (progressive) course (SPMS) form of MS – In this form, the disease begins relapsing but later progresses to a progressive course
  • Primary (chronic) progressive course form (PPMS) of MS – continuous course; occurs in 15% of cases.

If there is a first multifocal CNS disease with a probable inflammatory genesis, with encephalopathy (disease of the brain; not fever-induced), it is called acute disseminated encephalitis (ADEM). Most often, children are affected. Above the age of 40, the disease is rare. An episode is defined by the onset of new symptoms or a flare-up of previously known symptoms:

  • Lasting at least 24 hours
  • With a time interval between two relapses of at least 30 days; usually a relapse lasts a few days to a few weeks.
  • With clinical deficits and symptoms that cannot be explained by an increase in body temperature (Uhthoff phenomenon) or in the context of infections.

Note: Uhthoff’s phenomenon, which is specific but occurs in only half of patients, occurs mainly in the decay phase of optic neuritis or in chronic course. Sex ratio: Women are affected by relapsing-remitting multiple sclerosis about three times more often than men. Frequency peak: The disease occurs predominantly between the 20th and 40th year of life; the disease peak is around the 30th year of life. Prevalence (disease incidence) increases with distance from the equator. The highest prevalence is 250 patients per 100,000 inhabitants in the north of Scotland. In Germany, the prevalence is about 149 patients per 100,000 inhabitants. According to estimates, a total of 122,000 people are affected in Germany. Worldwide, approximately 2 million people suffer from multiple sclerosis. The incidence (frequency of new cases) is about 3.5-5 cases per 100,000 inhabitants per year (in Germany). Course and prognosis: MS patients seek medical help with striking frequency already in the five years before diagnosis (increase in the number of visits to doctors and clinics and in the number of prescriptions for medication).It is not uncommon for the disease to begin with an isolated symptom (e.g. optic neuritis, brain stem syndrome or transverse myelitis), for which the English term “clinically isolated syndrome (CIS)” has become established. In the majority of patients, the symptoms of an episode resolve within 6-8 weeks. Early initiation of therapy for clinically isolated syndrome (CIS) can slow the progression of the disease and limit disability.These patients were 33% less likely to develop definite multiple sclerosis than those with delayed initiation of therapy (hazard ratio 0.67; 95 percent confidence interval 0.53-0.85).If a second relapsing event occurs in another neurological functional system in the further course, this is referred to as clinically definite relapsing-remitting multiple sclerosis (RRMS). Children: Over 95% of children and adolescents experience a primary relapsing-remitting course with remission or symptom-free intervals.Adults: If early symptoms do not resolve within six months, the probability of relapse decreases to less than 5%. Multiple sclerosis (MS) usually progresses in relapses. In MS patients who recovered well from relapses during the first five years of disease, MS progression sets in significantly later than in patients with poor recovery tendencies, with a mean of 12.7 years for those with good recovery and 8.0 years for those with poor recovery to transition to progression. When progression of MS begins, patients are usually around 40 years old, regardless of whether they have a secondary (chronic) or primary progressive form of the disease. Obviously, at this age, the brain has difficulty repairing the myelin damage. The course can be favorably influenced by pharmacotherapy (drug treatment). The so-called cognitive reserve (= brain performance) can be strengthened and the course of the disease positively influenced by mental activities at work and in everyday life. In chronic progressive MS, rehabilitative treatment and sports should be given special attention due to the proven neuroplasticity of the brain. The life expectancy of an MS patient is on average 7 to 14 years lower than that of the healthy general population. Comorbidities (concomitant diseases): Multiple sclerosis is increasingly associated with irritable bowel syndrome, arthritis and chronic lung disease. Other comorbidities include depression and anxiety disorders.