Multiple Sclerosis

The brain and spinal cord make up the central nervous system (CNS). It is responsible for coordinating all motor functions and internal organic processes, as well as the integration of all external and internal stimuli. It works according to the principle of a control centre that conducts electric impulses over nerve fibres. The nerve fibres are sheathed in an insulating layer.

This insulating layer is mainly composed of myelin, a white fatty substance. In people with multiple sclerosis, this is irreversibly damaged due to a defensive reaction of the immune system. This means that individual impulses are slowed down or cannot be transmitted at all anymore.

Around 200,000 people in Germany suffer from MS, which often does not occur until the age of 20 to 40. For reasons that remain to be explained, adult women account for the largest proportion of the 2,500 new cases in Germany each year.


Symptoms

MS can cause many different neurological symptoms. These include impaired vision (i.e. seeing double), impaired bladder function, spastic paralysis of the limbs, fatigue and disruptions of fine motor skills. These symptoms frequently occur in stages, which can be caused for example by physical or emotional stress or by infections, and which may vary in frequency and intensity.

MS is classified into various disorders:

Relapsing-remitting MS predominates initially (approx. 85 to 90 %): One or more neurological symptoms occur for a short time only, i.e. they are alleviated again (almost) entirely after just a few days.

Around 30 to 40 % of patients with an initially relapsing-remitting course of the disease develop increasingly severe impairments over a period of 10 to 15 years. In this case one speaks of a secondary chronic-progressive course of the disease.

In 10 to 15 % of the patients, the illness begins directly with the primary chronic-progressive form. With this course of the disease, the neurological symptoms which develop do not go away again. But this is relatively rare. Mixed forms of these basic versions of the disease occur as well.

Causes

The causes of MS have not been determined to date. However, it has been established that specific defence cells, which are normally used by the body's immune system to respond to invading pathogens, are incorrectly programmed with this illness. They combat the body's own structures instead of foreign ones (namely the myelin of the myelin sheath and myelin-based proteins).

Numerous theses on the origins of multiple sclerosis have been discussed and corresponding studies conducted on this basis. There appear to be links to a genetic predisposition and the role of the Epstein-Barr virus and the herpes virus HHV-6 has been examined intensively as well. At this point, it is reasonable to assume that the disease is caused by a whole host of factors.

Diagnosis

In order to determine whether a patient has developed MS, the attending neurologist has access to a broad range of diagnostic procedures. This however is preceded by thoroughly establishing the patient's individual history (anamnesis).

If the anamnesis confirms the suspicion of MS, clinical tests provide further information. They examine the patient's motor skills, coordination, reflexes, vision and strength in detail. This makes it possible to determine the extent to which neurological functions are damaged and what areas of the brain are affected. The conductivity of the nerve fibres can also be determined in electro-physiological tests (checking sensitivity in the limbs).

Magnetic resonance tomography (MRT) can be used to visualise the inflamed areas of the CNS. Lumbar puncture is another examination method; the patient's spinal canal is punctured between two lumbar vertebrae so that cerebrospinal fluid (liquor) can be extracted.

Therapy

Therapy to treat the causes of multiple sclerosis does not exist at this time. In contrast to previous assumptions, moderate participation in sports is recommended with nearly all versions. When MS patients suffer from spasticity, regular physical therapy (physiotherapy) and/or the use of medical devices such as orthoses is recommended. The treatment may also be supplemented by the administration of medications.

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