Multiple sclerosis (MS) is a neurological disease that begins in early adulthood. At the time of onset, patients are usually between the age of 25 and 40. The course of the disease can vary greatly and there is no cure. It occurs when the immune system destroys the myelin, which envelops the nerve cells in the brain and the spinal cord.
Common early symptoms of MS include sensory disturbances, vertigo, impaired walking or trouble balancing, which results in unsteady gait. Early symptoms may also include unilateral optic neuritis. The eyes may be affected by a vision or ocular movement disorder. The person experiences double vision or involuntary eye movements (nystagmus).
MS symptoms vary greatly depending on where the inflammation occurs. Most patients suffer from several of these symptoms.
- Impaired vision: double vision, blurred vision, eye movement disorders
- Motor disorders: paresis, weakness, trouble walking
- Sensory disturbances: tingling, hearing loss or other sensory disturbances
- Speech abnormalities: slurred pronunciation, changes in speaking tempo
- Spasticity: increased muscle tension can cause muscle stiffness, which affects the person’s ability to walk.
- Coordination problems: trembling
- Pain: MS patients often also experience pain, e.g. in the face or muscles.
- Fatigue: general tiredness and low resilience
- Memory and other thought disorders, trouble concentrating and impaired judgment.
Progression of the disease
The progression of the disease cannot be predicted in each case. Normally, it starts out in its relapsing-remitting form, but can also be progressive with various phases of transition. An episode is defined as the occurrence of new clinical symptoms or a flare-up of ones that have already been diagnosed.
The progression of MS can manifest itself as:
- clinically isolated syndrome (CIS)
- episodic, “relapsing-remitting” MS (RPMS),
- primary progressive (PPMS) and
- secondary progressive (SPMS)
What will the doctor want to know?
The doctor will ask questions about the onset of symptoms. How have they evolved, how severe were they, and are there any changes? What has improved, what makes the symptoms worse? Do any other family members have MS?
MS is diagnosed based on the patient’s medical history, the neurological examination and radiological imaging. Are there signs of past neurological events of an episodic nature? Does the neurological examination uncover any indications of a disorder in the brain and spinal cord? Optical coherence tomography (OCT) is becoming a more common examination method. OCT is a technique that was developed over the last decade for the non-invasive examination and that uses a beam of long-wavelength light to essentially create a scan of the retina.
There have been and are several hypotheses about what causes MS, including a genetic predisposition. The infection hypothesis attributes the disease to a viral or bacterial infection and environmental factors. What is an established fact about MS is that cells are found in the brain and spinal cord that are not found in healthy individuals.
Treating patients with multiple sclerosis has greatly improved in recent years. A distinction is made between basic therapy, escalation therapy and episodic therapy. Overall, immunotherapeutics have shown the greatest benefit for MS patients, as they are able to effectively stem inflammatory reactions of the CNS.
New treatments with antibodies can reduce the frequency of episodes, preventing further lesions and nerve damage. Drugs are administered in the form of injections, infusions or orally. Some are taken daily, others weekly. Certain drugs are administered monthly or just once a year. Discussing the benefits and risks of the wide range of medications currently available is a major challenge.
Acute episodes are treated with a large dose of cortisone. Blood lavage (hemodialysis) has also proven highly effective during this stage. Unfortunately, these agents, which have to be injected, can sometimes be unpleasant for patients and have serious side effects, such as flu symptoms.
In addition to immunomodulation and immunosuppression, an important part of a comprehensive MS treatment regimen includes symptomatic therapy. The primary goal here is to improve the quality of life for the MS patient.