What is MS

What is Multiple Sclerosis?

- Chronic disease

- Inflammatory and demyelinating disease affecting the Myelin sheath (the protective covering that surrounds nerve cells) in the central nervous system (brain and spinal cord). It impedes the transmission of nerve signals between the nervous system and the rest of the body.

- Autoimmune disease. The immune system supposed to protect body cells starts to attack them.

- Relatively frequent disease: The number of persons affected by MS is estimated at about 2800 in Lebanon.

- In general, MS symptoms begin between the ages of 20 and 40 years old.

- The female-to-male incidence ratio is 3:1.

MS treatment

Currently MS is treated through:

Relapse treatment:

Relapses are usually treated with a high-dose course of powerful corticosteroids (a type of steroid) over a period of 3 to 5 days. These are given by intravenous infusion, providing the drug directly into the bloodstream for a quicker response.

Symptomatic treatment:

This treatment is intended to relieve the symptoms, such as: muscle spasms pains, bladder disorders, sensory problems, depression, weakness, less of balance, sexual problems.

Intensive treatment:

This treatment aims to slow disease progression; it includes two types of medicines: Immunomodolators and immunosuppressant.

It is noteworthy that medicines have emerged in recent years and other medicines are expected to arrive the next few years to Lebanon.

MS causes

The origin of MS is unknown.

It is probably caused by internal factors (ex: heredity) and external factors related to the environment.

The lesions are the consequence of an inflammatory reaction that destroys the myelin sheath and later causes nerve damage in the central nervous system.

What is a flare-up or an attack?

An attack in MS is the appearance of a new lesion\s in the central nervous system. Clinically, new symptoms can appear or old symptoms can get worse. This stage is followed by periods of stability (partial or complete recovery).

The attack is accompanied by inflammation that affects the myelin.

The relapse lasts usually several weeks.

The symptoms should last at least 24 hours apart from any fever. The interval between attacks varies from a few months to several years.

What are the symptoms of MS?

MS symptoms are variable; two people may not have exactly the same symptoms, and each person’s symptoms can change or fluctuate over time:

-  Sensory problems: Numbness, tingling, electrical sensation, or buzzing feeling, that goes down the back to the arms or legs when the head is bent forward.

-  Visual problems: blurred vision, poor contrast or color vision, double vision (diplopia) and pain during eye movement.

-  Movement disorder: Muscle spasm, muscle weakness that affects one or more parts of the body.

-  Bladder and bowel disorder: urinary incontinence, frequent urge to urinate, difficulty to urinate, constipation and diarrhea.

-  Sexual problems

-  Emotional Change: mood swings, depression

-  Balance problems: loss of coordination during walking, dizziness.

-  Weakness

-  Cognitive problems:  (advanced stage), affect concentration, attention and the ability to process incoming information, learn and remember new information.

How MS evolves

The evolution of MS varies over time and from one patient to another.

There are several forms:

-  Remitting Relapsing Multiple Sclerosis: The most common disease course (90% are initially diagnosed with RRMS) – is characterized by new attacks or the worsening of old symptoms. These attacks are followed by periods of partial or complete recovery (remissions). Most people who are diagnosed with RRMS will eventually turn into the secondary progressive course (SPMS) in which there is a progressive worsening of neurologic function (accumulation of disability) over time.

Primary progressive MS (PPMS): PPMS is diagnosed in about 10 percent of MS patients. This type is characterized by a slow and continuous aggravation of the symptoms without real relapses or remissions.

Diagnosis

The neurologist establishes the diagnosis according to the patient’s symptoms and their occurrence over time and relies on complementary tests.

Magnetic Resonance Imaging (MRI) of the Spine and Brain: MRI is the most sensitive method for revealing asymptomatic dissemination of lesions in space and time.

Lumbar puncture: this test allows the doctor to look for signs of inflammation in the cerebrospinal fluid (clear and colorless body fluid found in the brain and spinal cord). It helps to eliminate other inflammatory or infectious diseases.

Blood tests: Allow to eliminate some general inflammatory or infectious diseases.

Evoked potential test: this test measures the time it takes for nerves to respond to stimulation (visual, sensory, auditory and motor nerves).

Follow-up of MS patient

The neurologist usually sees the patient once or twice a year, but in case of new attack, the patient needs to repeat the “complementary tests” and he will be eventually hospitalized.

The perspective therapeutic

Long-term goal is to repair and prevent the myelin lesions and axons.

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