Multiple sclerosis

What is MS?

Multiple sclerosis (MS) is a chronic disease of the central nervous system|(brain and spinal cord). The name 'multiple sclerosis' refers to the various inflammatory lesions in the central nervous system. Inflammation is located in the myelin. Myeline is a type of insulating layer around the nerve cells that ensures good conduction of the nerve signals.

Multiple sclerosis is an auto-immune disease: there is inflammation in the myelin due as your own immune systems work abnormally. New inflammatory lesions can cause resurgences (also called flare-ups).

Initially, the nervous system can recover fairly well from these flare-ups; after a certain period of time, permanent damage can occur.

Our team tries to provide as much help and support as possible to our patients with multiple sclerosis.

Causes

The precise cause of multiple sclerosis is not known. Multiple factors most likely play a role in the development of multiple sclerosis.

• Heredity is a factor. In the general population, the risk of multiple sclerosis is 1 in 1,000 people (10 to 15,000 people in Belgium). If multiple sclerosis occurs in the immediate family (e.g. first degree), the chance of developing the disease yourself is about 2%.
• Certain viruses, vitamin D deficiency and smoking also appear to play a role in the onset of multiple sclerosis.
• In addition, it appears that women are more frequently affected than men.

The exact mechanism why one person gets multiple sclerosis and another does not is not known exactly. Nor is it known why one person may have a much milder progression of the disease when compared to another.

The disease is usually detected in young adults between the ages of 20 and 40. Multiple sclerosis also occurs in childhood and can also cause problems for the first time after the age of 50.

Symptoms

The symptoms that first indicate multiple sclerosis are related to the place of inflammatory reaction in the nervous system.

Common:

• Loss of strength
• tingling
• Less fluid movements
• Blurred or double vision

As the disease progresses:

• Depression
• Double vision
• Concentration and memory issues
• Pain
• Sexual problems
• Fatigue
• ...

Process

In the early stages of the disease, multiple sclerosis is generally characterised by resurgences (flare-ups). The damage in the nervous system is still being repaired at that time and the symptom disappears after a few weeks. We refer to 'relapsing-remitting multiple sclerosis'.

Gradually, the damage caused by the inflammation becomes more difficult to repair. Permanent deterioration, and even a gradual decline of the clinical condition, occurs. This last phase is often called ‘secondary progressive multiple sclerosis’. When this phase starts differs from person to person.

In a small group of people, the disease is accompanied by gradual, continuous deterioration without clear attacks and eventual recovery from the onset. In that case, we refer to it as ‘primary progressive multiple sclerosis’.

In recent years, there has been a significant increase in medications that greatly decrease the chance of new flare-ups of multiple sclerosis. These products may also reduce the period of permanent handicap.

Diagnosis

If the clinical picture and a physical examination suggest MS, an NMR (nuclear magnetic resonance) scan of the brain and spinal cord is always performed. The central nervous system can then be imaged in detail. This will also reveal any inflammations.

Generally, a lumbar puncture is also performed. This involves collecting a small amount of fluid circulating around the brain and spinal cord through a thin needle at the base of the back. That fluid is then examined for signs of inflammation. These may indicate multiple sclerosis. There is often blood tests as well in order to rule out other diseases. Generated potentials can also be useful in the diagnosis and follow-up of multiple sclerosis. This involves measuring how the central nervous system responds to various sensory stimuli.

Treatment

• When a recurrence (flare-up) occurs, a high dose of cortisone is often given. The objective is to accelerate the disappearance of clinical symptoms
• Medication can be divided into so-called first-line and second-line medication.
  • First-line medication is usually given first. If this medication does not work adequately or if it concerns an aggressive forms of multiple sclerosis, it is possible to switch to second-line treatment.
  • There are oral forms as well as subcutaneous, intravenous or intramuscular forms of the medication.
• Regular follow-up (clinical examination, NMR, lab) is necessary to observe the evolution of the disease and to detect any side effects of the medication quickly.
• In addition to this medication that can improve the course of the disease, symptoms can be managed with additional support:
  • occupational therapy and psychological support
  • physical therapy, speech therapy
  • medication of symptoms
• Other care and support providers:
  • A social worker may also be helpful.
  • Other physicians (urologist, physical therapist, gynaecologist, dermatologist, etc.) are consult in a multidisciplinary approach.
  • A MS nurse also works in our department. She is the intermediary between the patient and the neurologist. It is easy to contact the nurse to discuss all kinds of problems. She will try to work with the neurologist and others to find a solution

Interesting link:

• Flemish MS League

Latest publication date: 02/08/2024
Supervising author: Dr Aers Isabelle