Multiple Sclerosis and its Symptoms
Multiple Sclerosis and its Symptoms
Multiple Sclerosis is a chronic autoimmune disease of the nervous system that can also affects the brain, as well as the spinal cord. This disease mostly affects young adults between the ages of 20 and 40 years, and women are affected twice as often. There are a number of theories about the development of multiple sclerosis, though none of them have shown to be definitive. Multiple sclerosis is an incurable disease, though with the help of appropriate medications, its progression can be slowed.
The brain and spinal cord are composed of nerve cells, called neurons, composed of a body and long projections (axons), which may be up to 1 meter long. This projection is intended to unite nerve cells with other nerve cells. Projections of nerve cells are covered by white matter known as a myelin sheath. This sheath does not surround the projection after a certain length, forming gaps. These are called nodes of Ranvier. Because a neuron is a cell that conducts electrical impulses, these gaps are very important as they increase the speed of conduction of the electrical impulses. Multiple sclerosis is a disease affecting the myelin sheath. The sheath on the neurons is damaged and thus electrical impulses are significantly slowed or even unable to travel along the cell.
The cause of Multiple Sclerosis
Multiple sclerosis is an autoimmune disease, which means that the immune system plays a large role in its development, as it begins to attack its own body. More specifically, the cells of the immune system aim directly for the myelin sheath that surrounds neurons in the central nervous system. Activated are primarily T-lymphocytes, which produce a chemical compound attracting other cells such a macrophages, into a specific area of the brain. These cells create inflammation and gradual destruction of the myelin sheath ensues. After an attack, affected areas heal with non-conductive tissue (known as glial scars), composed of cells that have a supportive function in the brain, but are no longer conductive. The brain and spinal cord cease to function as a complex communication network, leading to physical manifestations of the disease.
The Course of Multiple Sclerosis
Multiple sclerosis is a disease whose course can vary widely. Typically, this disease comprises of attacks and remissions, the alternation of periods of symptoms, followed by apparent recovery. The first attack can be manifested by certain symptoms that disappear after some time. Following it, is the period of remission, when the patient has no symptoms, though the illnesses is still progressing quietly. A patient can experience these kinds of attacks many times. Typically, clinical manifestations in patients accumulate over time and remissions are no longer completely symptomless. Gradually, clinical symptoms worsen, known as secondary progressive multiple sclerosis. In some cases, multiple sclerosis may be experienced in the primary stage, when symptoms of the first attack do not completely disappear and the patient's condition only worsens. Multiple sclerosis is an incurable disease and leads to progressive disability and immobilization of the affected individual.
Symptoms of Multiple Sclerosis
Clinical symptoms of multiple sclerosis vary, but arise from the repeated damage to the central nervous system. In the beginning, the disease typically appears as retrobulbar optic neuritis, i.e. inflammation of the optic nerve, manifested by unilateral vision problems. The patient may experience pain with eye movement. Vision usually returns to normal, but colour recognition may be affected. Other common manifestations include tingling in the upper and lower limbs and loss of sensation; patients often complain of weakness in one or more limbs. Typical symptoms are also spinal cord damage, manifested by sudden impairment of lower limb movement. The affected individual experiences weakness or clumsiness in his or her limbs, increased fatigue and uncertainty when walking. The patient may suffer from dizziness, double vision, tremors in the upper limbs during movement, as well as sphincter disorders. These include sudden urges to urinate, which must be performed immediately. This is later followed by urine incontinence. Patients with multiple sclerosis suffer from psychological symptoms as well, such as depression, occasional euphoria and fatigue. Intellect is usually not affected.
The Development of Multiple Sclerosis
After the first manifestation of multiple sclerosis, further development may vary greatly. There are benign forms, or mild, where patients experience only mild clinical symptoms and can still be mobile after 20 years. In more severe cases, or malignant forms, the patient's condition can worsen very quickly and the patient can be immobile and wheelchair dependant within the following few weeks. Usually patients experience gradual deterioration of motor activity over several years.
Diagnosing Multiple Sclerosis
Clinical manifestations and their course are important in order to diagnose multiple sclerosis. Criteria for this diagnosis are at least two attacks and proof of at least two different localizations in the brain, with the help of imaging methods. The most important is the use of magnetic resonance imaging, which can show the destroyed myelin sheath, known as plaque. It is also important to examine the cerebrospinal fluid, which apart from high protein levels and increased number of white blood cells, contains a higher amount of the antibody IgG. Cerebrospinal fluid is examined by electrophoresis, which are characterized by the oligoclonal bands, which are antibodies produced by white blood cells and characteristic of multiple sclerosis.
Treating Multiple Sclerosis
Multiple sclerosis is an incurable illness, as the factor that initiates the whole pathological process is unknown. It is, however, possible to dampen and slow the course of the illness. Treatment for multiple sclerosis can be divided according to treatment during an attack, preventing relapse, and treatment of symptoms. Lifestyle modifications are also necessary. Treatment for multiple sclerosis during an attack requires high doses of corticosteroids, administered intravenously. Methylprednisolone is used most often, typically for a period of 5 days. In the event that the effect is not sufficient, a single dose of cyclophosphamide can be administered.
Relapse prevention means the delaying of further attacks and is therefore supposed to stabilize the patient's condition. It requires the administration of interferon beta, which acts on the patient's immune system. Long term use of corticosteroids, however, comes with a number of side effects, such as peptic ulcers, high blood pressure, osteoporosis, weight gain, cataracts, glaucoma and muscle damage.
Symptomatic treatment is based mainly on the administration of muscle relaxants to decrease muscle tension. Medications to control tremors, tingling and the urge to urinate are also given. Rehabilitation is also necessary.
Lifestyle modifications in people with multiple sclerosis require the individual to avoid physical activity, mental stress, and because attacks can trigger infectious illnesses, it is important to protect oneself against the cold or flu.