What is it about ?
Multiple sclerosis (MS) is a chronic disease of the central nervous system. The central nervous system is made up of the brain and the spinal cord.
Nerve cells are surrounded by an insulating membrane, myelin. This myelin membrane is important for the proper functioning of the nerve cell. Repeated and long-lasting inflammation can damage this myelin membrane in various places. These inflammations lead to the formation of scar tissue, called sclerotic tissue, in the various affected areas, hence the name ‘multiple sclerosis’.
Multiple sclerosis (MS) is an autoimmune disease where your own immune system attacks the myelin in certain places, which triggers inflammation.
The functioning of neurons in the affected areas is therefore disrupted. This is how the functioning of your nervous system may be reduced or fail (this is called a neurological deficit). You then have neurological symptoms (see ‘How to recognize multiple sclerosis?). These symptoms depend on the areas affected and the extent of the inflammation. They are therefore different from one person to another. The progression of symptoms and possible recovery also varies from person to person.
Cause
The precise cause of the disease is not known. Several factors probably play a role:
- environmental factors;
- hereditary factors;
- the lifestyle.
These different factors can interact with each other and lead to MS. Scientists have found that the following factors, among others, may play a role in the onset of the disease:
- a hundred genes;
- infections;
- to smoke.
Evolution of the disease
It is impossible to say how MS will evolve.
The new inflammatory lesions cause what are called flare-ups. You don’t die of MS. However, inflammatory reactions can sometimes damage nerve cells permanently. This then causes a permanent handicap.
Depending on the course of the disease, there are three types of MS:
- relapsing-remitting MS;
- primary progressive MS;
- progressive secondary MS.
Relapsing-remitting MS
It is the most common form of MS.
It is characterized by periods of relapses (flare-ups) and partial or total remission. The chances of recovery between relapses are good, especially at the onset of the disease.
Primary progressive MS
It is characterized by a gradual increase in symptoms from the start, without flare-ups.
Secondary progressive MS
Out of 10 people with a relapsing-remitting form, 8 will develop a secondary progressive form after 20 years.
After a first phase of relapses and recoveries, the disease progresses gradually, independently of the relapses.
MS progresses very differently from person to person. It is therefore difficult to give a prognosis on the severity of the limitations.
Where and how often?
Multiple sclerosis is the most common chronic disease of the nervous system in young adults. In Belgium, around 90 out of 100,000 people suffer from MS. Each year, about 450 people are diagnosed with MS.
The diagnosis is usually made between the ages of 20 and 40. Before puberty, the disease is very rare.
Multiple sclerosis is twice as common in women than in men. Siblings or children of someone with MS have a higher risk of developing the disease.
In areas further from the equator, such as Scandinavia, North America, Canada and South Australia, the risk of MS is higher.
How to recognize multiple sclerosis?
The disease can manifest itself in different ways, depending on:
- places affected by inflammation;
- the severity of the inflammation;
- the type of evolution (relapses and remission, or progressive evolution).
In a (first) outbreak of MS, symptoms last at least 24 hours. They usually go away, in part or completely, within a few days or weeks.
In most people, symptoms appear fairly quickly, within a week. Above all, they attract the attention of the patient and those around him. But symptoms can also appear gradually, in varying ways.
Symptoms of an MS flare may include the following:
- eye symptoms (this happens in 1 in 5 new cases of MS):
- decreased eyesight (visual deficit),
- see double (double vision or diplopia),
- eye movement disturbances.
- loss of strength in the limbs or even paralysis, which can cause difficulty in walking;
- sensory disturbances, for example:
- deafness
- decreased sensitivity in a certain part of the body.
- bladder and bowel problems; then it is difficult to go to the toilet.
Several factors that stimulate the immune system can make MS worse:
- an infection ;
- vaccination;
- a delivery ;
- trauma (eg a fall);
- the stress.
How is multiple sclerosis (MS) diagnosed?
There is no test to confirm or rule out MS with certainty. Diagnosis is only possible after evaluation by a neurologist.
Discussion and neurological assessment
Your doctor will listen to your story and perform a neurological exam . This allows him or her to think of MS as a possible cause of your symptoms or not.
For example, your doctor will look for:
- symptoms that indicate a problem with your spinal cord, such as:
- loss of strength,
- modified sensitivity,
- abnormal reflexes,
- urinary or erectile dysfunction.
- eye problems, such as:
- a loss of vision in one or both eyes,
- pain when you move your eyes.
- symptoms that indicate a problem with the cerebellum or brainstem, such as:
- coordination or balance problems,
- dizziness,
- problems swallowing (swallowing disorders),
- problems speaking.
- cognitive symptoms, such as:
- concentration problems,
- memory problems.
Special exams
The following tests can help make a diagnosis:
- Magnetic Resonance Imaging (MRI): this test allows you to visualize the brain and the spinal cord;
- lumbar puncture : this test takes a small amount of cerebrospinal fluid. This liquid is then analyzed for anomalies;
- evoked potentials: this test makes it possible to know whether the signals are indeed transmitted by the nerve cells;
- blood test: the main purpose of this test is to rule out other causes. It is not possible to make a diagnosis of MS with a blood test.
What can you do ?
Until recently, people with MS were advised not to exercise. It was thought that it could lead to excessive fatigue or an increase in symptoms. In recent years, however, scientific studies have demonstrated the beneficial effects of moderate physical activity (walking, cycling, swimming, yoga, etc.). Physical exertion reduces symptoms of fatigue and improves muscle strength, endurance and performance (eg longer walking distance). Be sure to maintain a balanced diet and sufficient intake of vitamin D. Avoid smoking, because it increases the risk of developing and worsening MS.
MS is an autoimmune disease, the cause of which is not yet clear. Nevertheless, a healthy lifestyle is always advised.
- Eat in a balanced way, with enough vitamin D;
- If you smoke, try to quit . Indeed, smoking increases the risk of MS and can negatively influence the course of the disease;
- Get enough exercise. Indeed, scientific studies have clearly shown that moderate physical activity (eg walking, cycling, swimming, yoga) is important, also for people with MS. It helps reduce fatigue, strengthen muscles and improve general endurance. Do you need advice ? Ask your physiotherapist.
- Get regular rest. Take regular breaks.
Do you need support at work? Talk to your occupational physician. With you, he will assess the necessary adaptations.
Take care of yourself. With chronic illness, it’s important that you can rely on the people around you.
What can your doctor do?
It is not (yet) possible to cure MS. Fortunately, means exist to favorably influence the course of the disease. The treatment is always personalized. It is a combination of drug treatment, a rehabilitation program and an adapted lifestyle.
Medications
Maintenance therapy
For MS with relapses and remissions (relapsing remitting MS), there are medications available to slow the progression of the disease. These drugs slow down attacks by immune cells.
The first choice is beta interferon or glatiramer acetate, by injection. There are other medicines, by injection, in pill form or by infusion.
Treatment of symptoms
There are specific treatments for certain problems such as bladder problems, muscle cramps, constipation or pain.
Pain in MS is often caused by damage to the nervous system. If this is the case for you, the following medicines may help:
- an antidepressant (amitriptyline and duloxetine);
- an antiepileptic (carbamazepine, gabapentin and pregabalin).
Treatment of relapses
Cortisone may shorten the duration of relapses. It cannot be used if the flare is caused by a viral or bacterial infection.
Revalidation
When MS is active and manifests itself in flare-ups, neurological problems develop. After an outbreak, professional support is often necessary. Your GP and your neurologist will direct you to the therapist (s) you need.
Physiotherapy
Your doctor will recommend physiotherapy if you have
- movement disorders;
- muscle cramps;
- loss of strength.
Speech therapy
Do you have difficulty swallowing (swallowing disorders) or speaking (speech disorders)? Speech therapy can help.
Occupational therapy
Do you have difficulty carrying out your daily activities? Occupational therapy may then be appropriate.