What is Multiple Sclerosis?
Multiple sclerosis is a disease of the central nervous system (brain and spinal cord) in which there is a destruction of the substance that covers the nerves (myelin) without which the nervous transmission is severely affected.
This destruction is due to inflammatory phenomena that leave areas of the nerve without the coating of myelin. They are called “plaques”, hence also called plaque sclerosis.
The affected areas can remyelinise and thus recover the nerve transmission or be permanently affected, causing a deficit in the functioning of the affected nervous tissue. The progression of the disease can sometimes lead to a state of severe physical disability and limit with the life of the patient. Life expectancy is 82.5% of the normal pattern.
It is more common in women than in men and the age of onset is usually between 20 and 45 years. It occurs more in temperate zones than in the tropics and subtropical areas. In Spain we find an incidence rate of about 3 cases per 100,000 inhabitants per year.
What are the causes of multiple sclerosis?
The cause of the disease is unknown, although the most accepted hypothesis is that it is the result of a genetic predisposition and an unknown external or environmental factor (it could be a virus) that causes an alteration in the immune system, so that our Own defensive system attacks the myelin sheath, causing its inflammation and destruction.
The Spanish health authorities have given the green light to the marketing in Spain of Sativex, a drug derived from cannabis for the treatment of spasticity (muscle spasms, stiffness …) in patients with multiple sclerosis. It will be marketed when final approval is obtained from the Ministry of Health, which is expected before the end of the year.
What are the symptoms of multiple sclerosis?
Multiple sclerosis attacks can develop for days or weeks, leaving the patient incapacitated. This first episode is followed by other attacks in an unpredictable time span, which may be a short or prolonged period of time. The symptoms vary in each patient, considering that it can attack the whole nervous system.
A common symptom of the onset of the disease is inflammation of the optic nerve, which results in decreased vision accompanied by pain behind the eye. In general, after several weeks the vision recovers partially or totally. The alteration occurs mainly in the central vision.
Other common symptoms are:
- Loss of strength (may lead to paralysis) and generalized fatigue
- Alterations in sensitivity
- Urinary problems (impaired urinary sphincter function, which causes urinary incontinence).
How does the doctor diagnose?
During the interview the patient may report several episodes with different symptoms, which have partially or totally improved. The clinical course is characterized by acute episodes, followed by relapses. The alterations in the physical examination allow the doctor to suspect a multiple sclerosis, the medical history and test results allow the physician to diagnose multiple sclerosis; here are the several necessary tests to confirm the diagnosis:
- Magnetic resonance imaging: findings and characteristic localization of the disease are seen in the MRI of the brain and spinal cord.
- Neurophysiological examinations: Neurophysiological examinations show a decrease in the conduction of the nerves.
- Cerebrospinal fluid (CSF) study: the presence of antibodies is detected in the study of cerebrospinal fluid (CSF).
Study of electrical events: Evoked potentials that study electrical events of the central nervous system (CNS) generated by peripheral sensorial stimulation, detect a CNS function alteration, not detected clinically.
- Treatment with steroids: can shorten the duration and in some cases the severity of each attack (called outbreak). They are used in tablets or in injections.
- Interferon therapy: promising to reduce the onset of new attacks and the extent of neurological involvement. In recent years, some groups of patients with multiple sclerosis have followed
- this treatment by intramuscular or subcutaneous injections. The main drawback of this treatment is its high cost and long life.
- Treatment with amitriptyline, fluoxetine or other antidepressants: this treatment will be done in case of depression.
How is multiple sclerosis treated?
Unfortunately, it is now an incurable disease. After each seizure, it is very important to perform a proper physiotherapeutic treatment quickly to recover the lost functions. The purpose of treatment is to:
- Reduce or modify symptoms and clinical signs.
- Shorten the duration or limit as much as possible the effects of a relapse.
- Prevent progression or decrease its clinical course.
- Provide help to the patient and the family.
Is it possible, at the beginning of the disease, to predict the progress of the disease?
It is not possible to predict the progress of multiple sclerosis. The progressive course of the disease is variable since there are different forms of disease. In fact, it is impossible to give a prognosis for a particular patient, at least until 5 to 10 years have elapsed since its evolution.