Multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, the cause of which has not yet been clarified despite great research efforts. Along with epilepsy, it is one of the most common neurological diseases in young adults and of considerable socio-medical importance.

Multiple sclerosis, an inflammatory disease of the nervous system in which visual disturbances, paralysis, balance disorders, etc. can occur, cannot be cured. However, progression and effects can be limited if therapy is started early and cognitive deficits such as attention deficits, unusually fast fatigue, spasticity, and concomitant psychiatric diseases are also treated. Due to the high proportion of MS patients – around 20 percent of patients at Kliniken Schmieder Konstanz each year – doctors, therapists, and nursing staff have developed a great deal of expertise in meeting the needs of patients. In order to expand and improve this competence, we hold regular specialist events and staff training courses.

Contrary to popular belief, multiple sclerosis does not necessarily lead to severe disabilities. Even many years after the onset of the disease, the majority of patients are still able to walk. However, the course of the disease varies greatly. Some of those affected only develop symptoms temporarily and can go about their daily lives for many years. In other patients, however, the course of the disease is faster and the disabilities increase. It is also not possible to make a reliable prediction about the further course of the disease.

There are about 200,000 people affected in Germany and an estimated 2.3 million worldwide. The disease of the central nervous system, which leads to inflammation and tissue damage, can manifest itself in a variety of symptoms. Medication and non-drug measures are used to try to alleviate symptoms, prevent complications, and reduce the frequency of relapses.

The name “multiple sclerosis” is explained as follows: In MS, multiple inflammatory demyelinating lesions occur in the white matter of the brain and spinal cord, which are probably caused by the body’s own defense cells attacking the myelin sheaths of the nerve cell processes. This results in hardened areas of scarring (sclerosis).

The cause of the disease has not yet been clarified.

Disease

Because the demyelinating lesions in multiple sclerosis can occur throughout the central nervous system, multiple sclerosis can cause almost any neurological symptom. Most patients are between 20 and 40 years old when the symptoms first appear.

In more than a third of patients, MS starts with sensory disturbances: Arms or legs feel numb or the skin tingles. Many patients feel more tired than usual and are quickly exhausted, have bladder problems, or feel unsteady when walking or standing. Visual disturbances with a reduction in visual acuity and disturbances in eye movement (internuclear ophthalmoplegia) are also typical, but not specific to multiple sclerosis. Some patients suffer from weakness in the arms or legs or have pain. The symptoms described can occur individually, but also simultaneously.

MS flare-up
If inflammatory foci in MS patients manifest themselves with symptoms that increase sharply in phases, doctors refer to this as a relapse. After an initial attack, the symptoms may disappear and then return after a while. Sometimes other symptoms come along, which can also go away again.

The course of multiple sclerosis varies greatly from person to person. For some people with MS, the symptoms go away completely after a relapse, for some only partially. For some people, the disease becomes steadily stronger after a few relapses, after which the symptoms always go away. Sometimes the symptoms increase steadily from the beginning and relapses are not recognisable – in this case it is called a progressive course.

Common symptoms

• Paralysis
• Sensory disturbances
• Visual disturbances
• Balance disorders
• Bladder and bowel disorders
• Swallowing disorders
• Speech disorders
• Eye disorders

Causes

The causes of multiple sclerosis are not known. However, it is possible to determine risk factors that are associated with the disease. If they are present, the likelihood of developing MS increases.

Genetics

Genetic changes can play a role in MS and be a contributing factor. For example, the disease can occur more frequently in a family. In the meantime, scientists have been able to localise a gene locus on chromosome 6 that is relevant for immunological processes and where changes in MS have been found.

Environment

Geographical influences are also relevant. It has been shown that people living on the equator suffer less from MS than people living in North America and Northern Europe. Exposure to sunlight also plays an important role in the early phase of the immunological imprinting of humans. In this context, the formation of vitamin D in the body is also important and has an influence on the immune system.

Viruses

Viruses are repeatedly discussed as the causative agent of MS. However, this has not been scientifically proven. However, viruses can have an influence on the immune system, leading it to self-aggressive behaviour (Epstein-Barr virus).

Therapy

Multiple sclerosis is not curable. The aim of all therapeutic measures is to maintain the patient’s independence in every-day life and to ensure the best achievable quality of life. The existing therapeutic options can be divided into relapse therapy, long-term immunomodulating therapy and the treatment of symptomatic complaints. Achieving the therapeutic goals requires good cooperation between the patient and the treatment team. The selection of therapeutic measures always takes into account the patient’s individual case and personal goals.

The choice of therapy forms also differs in many respects according to whether the disease is relapsing or primarily progressive.

The following therapies are possible:

• Therapy of the relapses
• Immunomodulation and immunosuppression
• Symptomatic therapy
• Treatment of spasticity
• Pain therapy
• Treatment of bladder function
• Treatment of speech and swallowing disorders
• Treatment of fatigue and depressive disorders
• Nutrition