Multiple sclerosis

It is a disease that occurs with demyelination of the central nervous system (loss of myelin). This loss of myelin is distributed in plaques throughout the Central Nervous System, thus originating a symptomatology varied depending on the brain structures affected. The demyelination of the central nervous system causes a block in the conduction of the affected fibers within an affected area. In it, the myelin sheath that covers the nerves is replaced by a plate of hardened tissue (sclerosis).

How is it produced?

The cause of multiple sclerosis is unknown. However, even in a 15% of patients have an affected family member by the disease, data that would support the theory of the existence of genetic predisposition of the same.

However, the possibility seems to be defended, that on these genetically predisposed subjects a possible environmental factor, possibly a virus, during childhood, this possible virus remaining latent, developing a series of antibodies that would slowly and progressively affect the white matter of the central nervous system, thus defending the term autoimmune disease of multiple sclerosis.

Multiple sclerosis symptoms

The symptoms are very varied, since they correspond to the multifocal distribution of myelin loss. The most frequent symptoms are:

• Motor and sensitivity alterations: The loss of strength in the lower and upper extremities stands out, manifesting loss of strength in the hands, heaviness in the legs, clumsiness when walking with shuffling and even fatigue from small efforts.
• Sensitive symptoms: numbness, paresthesia (tingling) or dysesthesia in one or more limbs or trunk.
• Loss of visual acuity: up to 25% of patients present sudden loss of visual acuity secondary to an episode of optic neuritis.
• Cerebellum involvement: It can cause coordination disorders that manifest as language disorders, incoordination, or clumsiness of hand movements.
• Mental symptoms: they are more frequent, in the form of depression, memory disorders, inappropriate euphoria, and in more advanced cases episodes of disproportionate laughter or spasmodic crying.
• Other less common symptomsSphincter disorders, both bladder and rectal, diplopia (double vision), dizziness, trigeminal neuralgia and sexual dysfunction may occur less frequently.

Multiple sclerosis flare-ups

MS typically occurs in outbreaks, with any of the symptoms described above. These they can last days, weeks or months, with more or less complete subsequent remission.

Each time, the outbreaks remit less completely and little by little the patient adds more neurological deficit after each flare. The triggers for outbreaks are not known, although they occasionally appear after viral infections.

Types of Multiple Sclerosis

The different clinical forms of the disease, are:

• Benign MS: 20% of patients present with mild flare-ups and complete or almost complete remission. Very little or no disability.
• Relapsing or remitting MS: it occurs with unpredictable relapses, aggravating existing symptoms or adding new ones. Variable duration from days to months with partial or total remission. Between the shoots you can spend many years.
• Primary progressive MS: chronic and progressive course from the beginning, without well-defined outbreaks, accumulating the neurological deficit that may well stabilize or continue for months and years.
• Secondary progressive MS: Up to 40% of patients with remitting / recurrent forms develop a progressive form at 6-10 years of evolution with progressive disability.

Diagnosis

There are no specific diagnostic tests for multiple sclerosis but is based on the sum of symptoms and signs of the disease that appear in a patient.

A series of diagnostic criteria that define it as clinically definitive or clinically probable, based on:

• Number of shoots
• Clinical evidence
• Evidence by complementary tests (evoked potentials, CT or brain MRI)
• CSF study: presence of oligoclonal bands or increased igG

The evoked potentials allow the detection of lesions not evident by the symptoms. They measure the time it takes for the brain to interpret the messages that come to it through nerve conduction (which is slowed down in MS due to sclerosis). The most used are visual, auditory and somatosensitive (it is a painless test).

The Brain MRI is of choice to show demyelinating plaques as well as to rule out other diseases. However, it cannot be considered a conclusive proof of disease, because although it is the only test that allows these plaques to be objectified, it may not capture all of them and there are also other diseases with similar lesions.

CSF evaluation with the existence of oligoclonal bands or an increased IgG can support the diagnosis of MS.

Treatment for multiple sclerosis

The treatment of MS aims to slow the course of the disease and relieve symptoms and its complications. This is done even without having a definitive curative treatment.

The drugs used in order to modify the course of the disease, reducing the number of outbreaks and their sequelae, are interferon beta, copolymer 1 and oral myelin, among others.

For the acute outbreaks glucocorticoids are used at high doses and in short periods of time due to its anti-inflammatory and immunosuppressive capacity. The prolonged use of these drugs is not indicated nor do they alter the course of the disease.

• The spasticity improves with the use of diazepam and baclofen
• The urination disorders due to sphincter alterations improve with anticholinergics
• The pain is treated with carbamazepine, phenytoin, and amitriptyline
• The fatigue with amantadine
• The lability emotional with amitriptyline
• The depression with antidepressant medications.

Physical exercise is recommended during periods of remission or when the course is stationary in order to maintain mobility and avoid contractures, but not excessively so as not to worsen the fatigue that the disease itself presents.

Remember to protect your family with it to be protected before any disease such as Multiple Sclerosis appears that requires diagnosis, tests and treatment for life.

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