Multiple sclerosis: types, symptoms, and possible causes.

A chronic disease that is the result of a disorder in the nervous system.

Our nervous system transmits large amounts of information throughout our body, allowing us to think and have physical, cognitive and emotional abilities and capacities.It allows us to think and have physical, cognitive and emotional abilities and capacities. It also directs and keeps the different organs and systems of our body functioning.

For all this, the neurons that are part of the nervous system are connected to each other forming structures, tracts and nerves, which are projected to the rest of the body. But the information they carry needs to reach its target as quickly as possible, given the need to coordinate actions or react in time to environmental stimuli. Achieving such speed is possible thanks to a substance called myelin, a substance that allows the acceleration of the nerve impulse.

This transmission of information also allows us. However, there are some problems and diseases that cause the myelin not to act correctly or to be destroyed, causing a slowing down of the transmission of impulses that can cause serious problems in the vital functioning of the person. One of the most frequent disorders of this type is multiple sclerosis..

What is multiple sclerosis?

Multiple sclerosis is a chronic, progressive and currently incurable disease in which there is a demyelination of the brain. in which a progressive demyelination of the nervous system occurs. This demyelination is caused by the action of the immune system, which attacks the myelin present in the neurons and causes their destruction.

Small scars are also generated in the form of a hardened plaque that hinders the passage of nerve stimuli. The loss of myelin, together with the presence of these cicatricial plaques, causes that at neuronal level the information transported by the nerve fibers takes longer to reach its destination, causing great difficulties to those who suffer from it.

Symptoms of the disease

The symptoms of this disorder will depend on the areas that are demyelinated, but in general terms it is common for sufferers to experience fatigue, muscle weakness, incoordination, vision problems, pain and/or muscle tension.

Although it was initially thought to be a disease that only caused physical symptoms, it has been detected that during the course of the disease there is also intellectual impairment, with frequent deterioration of the frontal area and therefore of executive and cognitive functions.

Multiple sclerosis is a disorder that occurs in the form of outbreaks.The disease is usually partially recovered once the flare-up subsides. This is because although the myelin is destroyed by the immune system and the oligodendrocytes that produce it are unable to regenerate it, the organism sends stem cells to the damaged areas that with the passage of time transform into new oligodendrocytes and generate new myelin.

This new myelin is not as effective and resistant as the original one due to the presence of damage in the axon, so that subsequent attacks by the immune system will weaken the connections and subsequent recovery will be less, leading to progressive degeneration in the long run.

Causes

As mentioned above, multiple sclerosis is an autoimmune disease.It attacks and eliminates the myelin of neuronal axons, causing a series of effects derived from the poor transmission of nerve impulses. Thus, the mechanisms through which it acts are already in our body. However, the causes of this attack are still unknown to this day, and there is no clear reason to explain this affectation.

Some of the most accepted theories indicate that those who suffer from multiple sclerosis have a genetic vulnerability that upon the arrival of some type of stimulus from the environment such as an infection causes the immune system to react in the wall of the Blood vessels that irrigate the brain, crossing the blood-brain barrier and attacking the myelin of the neurons.

Types of multiple sclerosis

As indicated above, multiple sclerosis is a disease that presents itself in the form of outbreaks. But these outbreaks do not always occur in the same way or with the same intensity, and there may be different courses of the disorder. Based on the course it takes, different subtypes of this disease can be considered to exist.

1. Relapsing-remitting multiple sclerosis

The most frequent subtype and courseIn this type of multiple sclerosis, unexpected and unpredictable symptomatological outbreaks appear, which eventually disappear with the passage of time, with both remission and symptomatological recovery. This recovery between outbreaks may be partial or even complete. Symptoms do not worsen during the intermediate periods.

2. Primary progressive multiple sclerosis

One of the less frequent types, in this subtype of sclerosis no specific outbreaks can be identified, but in a progressive way, symptoms progressively worsen during the intermediate periods.but progressively worsening symptoms are seen. In this case there are no periods of remission or recovery (or at least not of great importance). However, on some occasions it can become stationary.

3. Secondary progressive multiple sclerosis

As in the relapsing-remitting form, in this type of multiple sclerosis different unexpected and unpredictable outbreaks are observed. unpredictable outbreaks. However, in the periods when the flare-up has ceased, the degree of disability of the patient does not improve but in fact a worsening can be observed, which is progressive.

4. Progressive relapsing or recurrent multiple sclerosis

As with the primary progressive form, in this rare subtype there is a progressive worsening without periods of remission. and without periods of remission, with the difference that in this case specific outbreaks are recognizable.

5. Benign multiple sclerosis

Sometimes identified with relapsing-remitting sclerosis, this type of multiple sclerosis is so named because, despite the presence of outbreaks, the patient's recovery from them is complete, having milder symptoms and havingIt is called relapsing-remitting multiple sclerosis because, despite the presence of outbreaks, the patient's recovery from them is complete, having milder symptoms and apparently does not worsen with time. The disability it causes is very small.

In search of a treatment

Although there is currently no cure for multiple sclerosis, there are a large number of pharmacological treatments that can be used to alleviate and delay the progression of the disease.. They can control symptoms, reduce the severity of symptoms and help patients maintain their quality of life.

Some of the medications used include corticosteroids to reduce the severity of flare-ups, analgesics in cases of pain or immunosuppressants to alter the course of the disease and reduce the level of deterioration.

Drugs

While these treatments do not cure the disease, research continues and progress is being made in the search for a cure for multiple sclerosis. Some of the latest research has gone so far as to test and conduct trials with a drug called Ocrelizumab, which has been shown to delay the progression of symptoms in the early stages of the disorder.

Although the problem itself is neurological and is therefore treated medically, the difficulties caused by multiple sclerosis often cause difficulties and problems that affect the psyche of those who suffer from it. It is common that upon detection of the disease, patients undergo mourning processes due to the progressive loss of faculties, and even suffer from depressive episodes.

Therefore, it can also be useful to work from a psychological point of view, increasing the level of emotional expression of the patient with respect to his situation and working on it, as well as to make him see the situation in a realistic way and avoid behavioral avoidance, isolation or self-destructive behaviors.

Occupational therapy

Specifically, the use of occupational therapy has been shown to be of some use in increasing the patient's autonomy and activity level of the patient and participation in support groups as a method of expressing and sharing feelings and views about the disease, its consequences and ways of coping with other people with multiple sclerosis. It is one of the most effective therapies in mitigating the psychological impact of symptoms.

Family and social support is essential in cases of multiple sclerosis, since it allows the patient to cope with day-to-day life and makes him/her see that he/she is not alone or helpless. The use of devices such as wheelchairs and bars can also help the patient to maintain a certain degree of autonomy for a longer period of time, as well as helping to reduce the level of disability caused by the disease.

Bibliographic references:

• Bermejo, P.E.; Blasco, M.R.; Sánchez, A.J. and García, A. (2011). Clinical manifestations, natural history, prognosis and complications of multiple sclerosis. Medicine; 10 (75) : 5079-86.

• Compston, A.; Coles, A. (2008). Multiple sclerosis. The Lancet, 372 (9648): pp. 1502-1517.

• World Health Organization (2006) Neurological disorders. Challenges for public health. WHO. 45-188.

• Rubin, S.M. (2013). Management of multiple sclerosis: an overview. Dis Mon.;59(7):253-260.

• Widener, G.L. (2013). Multiple sclerosis. In: Umphred DA, Burton GU, Lazaro RT, Roller ML, eds. Umphred's Neurological Rehabilitation. 6th ed. Philadelphia, PA: Elsevier Mosby: chap 19.