Multiple sclerosis: insights into a complex neurological disease

Inflammatory diseases of the nervous system can be triggered by pathogens or occur as a result of an autoimmune disease of the nervous system. They are referred to as infectious-inflammatory or autoimmune-inflammatory diseases of the nervous system. Multiple sclerosis is an autoimmune inflammatory disease of the nervous system.

Autoimmune means that the immune system mistakenly targets the body's own healthy cells. In multiple sclerosis, the immune system targets the body's own structures of the nervous system and damages nerve structures in the event of persistent inflammatory activity.

More precisely, demyelination of nerves occurs: imagine that your nerves are an electric cable consisting of conductive wires and a protective, insulating sheath. In the case of most nerves, this sheathing consists of myelin. Put simply, the myelin ensures that the current can flow quickly or that impulses are transmitted quickly via the nerve tracts. In multiple sclerosis, the myelin sheath is damaged, resulting in demyelination of the nerves. Underlying nerve fibres can also be damaged piece by piece.The nervous system consists of the central and peripheral nervous system.

• Central nervous system: Nerves in the brain and spinal cord
• Peripheral nervous system: All other nerve pathways in the body.

Multiple sclerosis is a disease of the central nervous system, which means that nerve structures in the brain and spinal column are primarily affected. Neurological symptoms are the result.

‍

‍

First signs and common symptoms of multiple sclerosis

Multiple sclerosis is a chronic inflammatory disease of the central nervous system. Foci of inflammation can occur at various locations in the brain and spinal cord. Symptoms can be correspondingly diverse.

Early signs, also known medically as prodromal symptoms, can occur years before the diagnosis of multiple sclerosis. They include

• Bladder and bowel disorders
• pain
• Sleep disorders
• Fatigue (physical and cognitive exhaustion)
• gait disorders and
• Skin discomfort (tingling, burning)
• Visual disturbances, pain of the eye nerve

According to studies, MS patients visited their doctor almost 90% more often in the year prior to diagnosis than patients who were not diagnosed with MS. In around 20% of those affected, optic neuritis leads to the initial diagnosis of MS.

These symptoms can also occur after the diagnosis, but can also continue to change. As the disease progresses, the following symptoms, among others, are reported:

• Weakness, stiffness, paralysis of the limbs
• Sensory impairment and discomfort of the skin on the face and trunk
• Balance and coordination problems

The symptoms of multiple sclerosis depend on the localisation of the foci of inflammation. Early signs often manifest themselves in sensory dysfunctions such as tingling or numbness in the arms and legs. The symptoms described may or may not occur. The severity of symptoms is also very individual and differs from patient to patient.

It is therefore difficult to make predictions about the individual course of the disease due to its complexity.

Nevertheless, statistical progression patterns have been described:

‍

‍

Progress forms of MS

There are different types of multiple sclerosis progression forms.

‍

Relapsing-remitting MS

The most common form of MS is relapsing-remitting MS (RRMS). This occurs in 85% of people with MS. The relapses regress completely or incompletely with interruptions.

‍

Secondary progressive MS

50% of patients with RRMS progress to secondary progressive MS (SPMS) within 10 years. Progressive means advancing. In this form of multiple sclerosis, there is a progressive increase in disability without regression.

‍

Primary progressive MS

15% of patients suffer from primary progressive MS (PPMS). This describes an increasing deterioration from the onset of MS without regression of the relapses and is not based on a previous relapsing course. There are only rare phases of slight improvement.

‍

It is difficult to predict the course of the disease. Even after a long-term favourable course, symptoms of MS can change and become more severe.

Conversely, initially unfavourable courses can also become less severe over time.Signs of a more favourable course include the onset of the disease at a young age, visual disturbances and sensory disturbances as initial symptoms that disappear completely and a long interval between relapses. Signs of a more unfavourable course include signs of paralysis in the early stages of the disease, symptoms that only regress slightly or not at all and short intervals between relapses.

‍

‍

Treatment of multiple sclerosis

Multiple sclerosis is a chronic inflammatory disease of the central nervous system that is not yet curable but can be treated very well. It is always important to act quickly when symptoms occur. Once a diagnosis has been made, it is advisable to adapt your lifestyle and behaviour in order to live proactively with the disease. This is because symptoms can now be treated well. Multiple sclerosis also does not stand in the way of having children.Medical treatment approaches for multiple sclerosis can be divided into three categories:

‍

Treatment of an acute flare-up

The aim of this therapy is to combat the acute flare-up. Patients are injected with high doses of corticosteroids as inpatients. In normal parlance, this is referred to as a cortisone injection. However, cortisone is produced by the body itself; corticoids are produced synthetically.‍

‍

Course-modifying therapy

The aim of course-modifying therapy is to reduce the frequency of relapses and disease activity, as well as to delay the progression of the disease. So-called immunomodulators and immunosuppressants are used here. The immune system is reduced so that it can do less damage to its own body. This approach is implemented because the disease is an autoimmune disease.‍

‍

Symptomatic therapy for MS

The aim of symptomatic therapy is to combat the respective symptom. Depending on the symptom, physiotherapy and occupational therapy, speech therapy, psychotherapy and the provision of aids can be used. Drug therapies are also used to treat pain, spasticity or bladder disorders, for example.