Multiple sclerosis – abbreviated MS – is a chronic inflammatory disease of the brain and spinal cord, which is to demyelination (demyelination) is certain nerve fibers.The Mark is a fatty layer around these nerve fibers. It is equipped with 30 to 80 diseases to 100,000 people a fairly common disease of the central nervous system, which is usually in early adulthood – begins – approximately between 20 and 40 years.
Among the various progressive forms of multiple sclerosis, there are very mild cases that are barely noticeable in daily life. More rarely occur serious gradients, which deprive the patients within a short time of their independence.
In Germany live about 120,000 victims, with women more likely than men with 61 percent become ill. Globally prevails in the distribution of MS, a north-south gradient ago: In colder zones, the disease is more common than near the equator.There are also ethnic differences. People with European-Caucasians suffer most, Japanese the least likely. Why these differences, just like the cause of MS is still unknown, despite many theories.
What is the cause of multiple sclerosis?
Most experts agree that an incorrect response of the body’s defense system (autoimmune disease) to the gradual destruction of the nerve sheaths (myelin sheaths) leads. This impairs the transmission of nerve impulses and thus leads to paralysis, sensory irritation symptoms of the body, vision problems often first on one eye and many other symptoms.
A key role in the pathogenesis of MS play the T cells of the immune defense.Normally they can clearly distinguish between the body’s own tissue and invaders such as bacteria or viruses, and usually do not reach the nervous system. However, the T-cells can be activated in the context of a still unclear mechanism. Poke now. On a permeable through inflammatory mechanisms blood-brain barrier, then you can find the cells of the so-called white matter in the brain an appropriate antigen This leads to increased destruction of the white matter. In the brain the T cells, so-called scavenger cells (macrophages) to encourage, to participate in the work of destruction. A portion of the nerve sheaths can be “nibbled”; You can then their actual function, transmit signals, less well no longer meet up sometimes (temporarily).
In families in which one member is already ill, the others are at increased risk of developing MS. This suggests that genetic predisposition also plays a role.
What symptoms have multiple sclerosis?
Mostly it is for the person concerned, or even the family doctor is not sure classify disturbances in the sense of an episode, the first leads the patients in the practice. A neurologist (neurologist) tries to reconstruct the course of the disease on the basis of medical history (anamnesis). Following symptoms in the early stages of MS Frequent:
Sudden vision problems
Paralysis of various limbs areas
Sensible irritation symptoms, often described by patients with the phrase “It tingles so funny”. There may be other abnormal sensations like a furry feeling occur. This may under certain circumstances, even lead to a complete loss of feeling, so to numbness of a body region.
Bladder weakness, constipation and other disorders of the urinary tract and digestive organs
Inefficiency at elevated body or outside temperature (Uhthoff’s phenomenon)
All of these features can also occur in other diseases. The individually very different course of MS diagnosis difficult, at least at the initial stage. In order to confirm the suspicion of MS, at least two different parts of the body to at least two different times in the course of life should not be too different to explanatory complaints occurred.Hence the name Multiple (multiple) sclerosis (this refers to the often residual scarring in the brain).
Since the diagnosis of multiple sclerosis may not always be clear from the medical history and the clinical picture enough, a number of studies are often necessary.
What course the disease takes?
The repeatedly recurrence abovementioned symptoms in most cases re-new expression is called the thrust of MS.
The further course varies greatly from patient to patient. The thrust is treated by a doctor. In most cases, the symptoms disappear after some time – until, perhaps, the next push. Depending on how often recur relapses, and how the patient’s condition changes between relapses, doctors distinguish four different types of MS:
Relapsing-remitting is the most common form and is experienced by about 70 per cent of all patients under 40 years. Between the bouts of sudden the patients recover completely or partially.
Secondary progressive (progressive): In about half of patients with relapsing-remitting MS developed this form of the disease within ten years. The physical condition is always worse and the regression of disability between relapses always incomplete.
Benign: People with this form of the disease typically suffer two or more relapses, which subside without permanent damage. Accordingly, the daily life is hardly affected. Up to 20 percent of all diseases fall into this category, however, the benign form may also be transferred in a progressive form. Which people this is going to happen, doctors can not predict so far. Meanwhile, it is assumed that there is one more number of patients with a for them not to bemerkenden MS, a so-called clinically silent form. These patients suffer from the damage in the nervous system so no failures. Multiple sclerosis is found here only as an incidental diagnosis in otherwise cause lasster diagnosis.
Primary progressive is the rarest but most serious form of MS. It meets about five to ten percent of all patients, usually there are those with late onset. Here occur no relapses and the physical condition deteriorates continuously.
The distinction of the different forms of MS is particularly difficult to onset, because the transitions are fluid. Scientists are currently looking for features that enable them to classify patients better. Meanwhile, theories have been raised that it could be various diseases with the same picture is quite. To gain more clarity here would be a great step forward for the treatment or the development of new therapeutics.Because then you could better align the use of currently available drugs to individual needs.
What tests are needed?
Measurement of visual evoked potentials (VEP): At the top electrode are attached, with which the time can be measured, the brain needs to receive and process information of a screen over the eyes.
Somatosensory evoked potentials measurement (SEP) and motor evoked potentials (MEP): Certain nerves electrically (SEP) or specific regions of the brain magnetic (MEP) are irritated. These studies provide an indication of the conductivity of the nerves of the central nervous system. If disturbances of nerve conductivity simultaneously on different sections of the central nervous system, so that speaks for the presence of multiple sclerosis. The examination results can also be good compared to subsequent tests to detect the progression of multiple sclerosis.
The magnetic resonance imaging (magnetic resonance imaging) provides detailed images (scans) from inside the brain. A case on suspicion of MS like Flocked paramagnetic contrast agent helps Details to be able to distinguish acute from old injuries primarily. Characteristic of the MS are more round, bright spots (lesions).New lesions can disappear or become smaller, which is probably the consequence of repair processes in the brain even after some time. Nuclear magnetic resonance tomography images, which have been obtained at longer intervals, help to assess the success or failure of therapy.
CSF analysis: The multiple sclerosis, as well as other diseases such as meningitis, betrayed by the fact that certain antibodies and proteins are increasingly being formed or the number and type of blood cell is changed.
How is treated the multiple sclerosis?
There are essentially three strategies of disease control.
Acute flare-ups can be mitigated and abbreviate administration of anti-inflammatory cortisone by and his descendants. Depending on which disorders or disabilities have occurred, the doctor will also prescribe medications that fight individual symptoms specifically. These include muscle-relaxing medications, antidepressants in depression and anxiety, antiepileptic drugs for epilepsy and pain relievers. There are also remedies for bladder problems.
Physiotherapy, exercises and a healthy diet will help in dealing with the disease.Demanding, but not overwhelm, is the motto. Therefore, experts advise to regular physical activity (swimming, gymnastics, treadmill) – even in patients with advanced MS. With increasing disability emotional support becomes more important by family, friends and carers. It is not uncommon to serious depression that must be treated with medication and / or psychotherapy.
The symptoms of multiple sclerosis can often be alleviated, cured multiple sclerosis, however, is not so far. However, there are several medications that can affect the immune system altered low and thus can slow the disease progression in relapsing-remitting or secondary progressive form of MS. In numerous studies of thousands of patients has been demonstrated that the following drugs reduce the frequency and severity of relapses:
Beta interferons. Several vendors manufacture these medicines by means of genetic engineering. According to a panel of experts, which has recently made recommendations for Germany, Switzerland and Austria, there are no fundamental quality differences between the products. However, they are dosed differently and have different times, be best if, injected by the patient under the skin or into the muscle. If one of these drugs poorly tolerated or it shows no effect, you should use an alternative product under certain circumstances.
Glatiramer, azathioprine and immunoglobulins are recommended as an alternative.However, to date only Glatiramer is specifically approved for MS treatment in Germany.
Professional societies advise patients to an earliest possible use of such a thrust of preventive measures, if the diagnosis is clear and there have been at least two functionally relevant relapses in the past two years or a serious illness episode with poor prognosis. The treatment costs are annually about 15,000 €, but are reimbursed by health insurers if the conditions are met.