Main points of the article:
- Multiple sclerosis is a chronic, autoimmune and inflammatory disease of the nervous system, in which the immune system attacks the nervous system.
- The common symptoms of multiple sclerosis are vision disorders, movement and balance disorders, tingling and numbness, muscle weakness and muscle stiffness, cognitive impairment, and more.
- It is difficult to diagnose multiple sclerosis and it is usually done by ruling out other symptoms, by auxiliary tests such as MRI, lumbar puncture and vision tests.
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Multiple sclerosis is a chronic, autoimmune and inflammatory disease of the nervous system, in which the immune system attacks the nervous system using white blood cells, the ones designed to fight diseases and infections in the body.
Every fiber in the central nervous system is surrounded by myelin, a kind of membrane that wraps the nerves in order to protect them and helps in the alert and efficient transmission of messages from the brain to the body. In multiple sclerosis, the immune system damages the myelin and this creates a disturbance in the ability to transmit messages in terms of efficiency and speed.
Contrary to what the name of the disease suggests, multiple sclerosis is not a common disease. The explosive characteristic of the disease is associated with inflammatory lesions common in different areas of the central nervous system.
Multiple sclerosis – symptoms
The central nervous system controls the actions of the body, including the brain, spinal cord and optic nerves. Therefore, multiple sclerosis can impair vision, movement, sensation, hearing, posture and balance.
The most common symptoms: blurred vision, movement and balance disorders, tingling and numbness, muscle weakness and muscle stiffness, cognitive disorder – ADHD, memory disorders, fatigue, lack of control over sphincters and emotional changes. Symptoms can appear at any age, but appear between the ages of 20 and 40. The risk of developing multiple sclerosis is twice as high for women as for men.
Most patients will experience some but not all of the symptoms. The symptoms can appear and worsen over time or appear and disappear cyclically, in attacks of at least 24 hours, after which there are also remissions. The attacks result from the severe damage to the myelin, while the remission periods are associated with the rebuilding of the myelin. Sometimes a short-term worsening of symptoms can be caused by other factors, such as heat due to weather or a shower, an infection in the body or even physical activity.
The body systems affected by multiple sclerosis. Image: Shutterstock
vision problems – A large percentage of patients, approximately 15% to 20%, will experience visual disturbances for the first time, in particular inflammation of the optic nerve whose function is to transmit visual information to the brain. The inflammation will usually affect one eye and manifest as pain behind the eye, loss or blurring of vision and even color blindness. About half of the patients will experience inflammation of the optic nerve during the illness. Other visual disturbances caused by multiple sclerosis are strabismus, double vision and difficulty concentrating in the case of damage to the brain stem.
Pain – A common symptom that appears in over 80% of MS cases is pain. Two main types of pain are neuropathic pain, which is caused by damage to the nerve fibers in the central nervous system, as a stabbing and burning pain that causes increased sensitivity to a gentle touch on the surface of the skin. The second type, musculoskeletal pain, which originates in the muscle and bone system, as a result of muscle or joint pressure resulting from muscle strain – another symptom of the disease.
muscle strain – About 50% to 80% of sclerosis patients will develop muscle stiffness, which will make it difficult to move and walk.
Movement disorders – The cerebellum is an area of the brain called the cerebellum and is involved in motor skills, stability and coordination of movements. This area is affected by multiple sclerosis and combined with muscle weakness and stiffness, this makes it difficult for multiple sclerosis patients to move, including difficulty in coordination and walking, and even tremors and dizziness in rare cases.
cognitive disorders – are mainly expressed in the impairment of the ability to think and learn. In the past, it was thought that only the white matter in the brain was involved in the disease, but today it is known that the gray matter is also involved from the beginning of the disease. This is mainly expressed in the speed of information processing, in the impairment of memory, learning and attention and concentration disorders.
Erectile Dysfunction – Multiple sclerosis can lead to an overactive or underactive bladder. A state of urgency in urinating will stimulate the patient to go to the bathroom frequently, to empty small amounts and even cause urinary incontinence. In addition, a decrease in bladder activity can also appear, with a disturbance in the flow of urine, a feeling of the lack of emptying and even retention of urine. In the digestive system, multiple sclerosis causes constipation and even loss of control over passing stool.
Multiple sclerosis – types
relapsing-remitting multiple sclerosis (Relapsing-Remitting) – The most common type of multiple sclerosis that occurs in 85% of patients and is characterized by attacks and remissions. The attacks last from days to weeks, and in a small number of patients even weeks. In each attack, new or familiar symptoms from the past may appear. After each attack, a full recovery is possible, or only an improvement in symptoms without full recovery.
Benign multiple sclerosis (Benign) – Characterized by a small number of attacks, after which there will be a full recovery. Sclerosis does not progress for 10-20 years.
Secondary progressive multiple sclerosis (Secondary Progressive) – This type is a continuation of multiple sclerosis that began as relapsing-remitting. Her symptoms get worse regularly, and do not necessarily appear in attacks. Most patients will develop progressive sclerosis about a decade or 15 years after the onset of the disease.
Primary progressive multiple sclerosis (Primary Progressive) – The rarest type of multiple sclerosis that occurs in about 10% to 15% of patients. Characterized by symptoms that get worse and worse from the moment the disease appears, when there is no pattern of attacks and remissions.
How to find out multiple sclerosis
It is difficult to diagnose multiple sclerosis due to diverse symptoms that appear scattered, alone, together and for limited periods. The guiding rule for diagnosing multiple sclerosis is the appearance of two seizures characteristic of the disease in characteristic areas of the brain.
A diagnosis can also be made based on one attack in combination with additional evidence, including medical history, other symptoms, physical examinations, imaging of the central nervous system, and even the results of a lumbar puncture, in addition to which there are a number of ancillary tests that make it possible to rule out other diseases that may cause the same symptoms and thus diagnose sclerosis Common through the negation:
lumbar puncture – A test during which a small sample of cerebrospinal fluid is taken from the spinal cord canal and sent to be tested in a laboratory. Abnormal levels of white blood cells or proteins can indicate multiple sclerosis. Through the test, viral infection or other diseases that cause neurological symptoms such as multiple sclerosis can also be ruled out.
The disease can be diagnosed using an MRI scan. Illustration: Shutterstock
check MRI – A test that makes it possible to create a detailed image of internal organs and thus discover damage to the brain and spinal cord. Using the test, it is possible to detect myelin loss caused by multiple sclerosis. The test takes place inside a tube-like machine that makes clicking sounds during the scan, which takes at least an hour and uses a high-intensity magnetic field.
On top of that, the subject is injected with a dye into the vein that makes it possible to more easily identify “active” lesions in real time, compared to “active” and old lesions. In this way, the doctor can determine if the subject is during an attack of multiple sclerosis even if he does not feel the symptoms and even the number of attacks he has had, thus effectively diagnosing the disease without having to wait for symptoms and another attack.
Nerve impulse test – The test measures the electrical signals that the brain sends in response to visual stimuli or through short electrical impulses in the legs or arms.
How to detect multiple sclerosis in an eye test? An eye exam will help diagnose optic nerves damaged by the disease. Examining the pupils, fundus and red color vision can demonstrate active or old damage to the optic nerve. OCT (Optical Coherence Tomography), is another test that makes it possible to indicate damage to the ends of the optic nerves that make up the retina.
Multiple sclerosis – treatment methods
There is no cure for multiple sclerosis, only treatments for attacks, symptoms and to slow down the progression of the disease. Studies show that early treatment will prevent cumulative disability and delay the development of progressive sclerosis.
steroids – Symptoms that are the result of an attack are usually treated in a series of 3-5 days using high-dose steroids. The steroids suppress the immune system. Since they have long-term side effects, it is not recommended to take them regularly for a long time.
plasma exchange – The antibodies in the bloodstream are actively removed. The treatment is performed once every two days for ten days in patients with a severe attack who need immediate relief of symptoms.
physiotherapy – In order to relieve pain, muscle deformity and spasticity, the muscles are stretched and strengthened in physical therapy. Muscle relaxants and anti-depressants can also be used.
Medicines – For fatigue, cognitive, mental and depression disorders, bladder and digestive system disorders, topical medications are given for the specific symptom.
Multiple sclerosis – innovative treatment forSlowing down the progression of the disease
As of 2022, approximately 15 secondary treatments that alleviate the severity of attacks are approved in Israel. Medicines that change the course of a disease reduce the damage and injury to myelin, and are given by subcutaneous injection, orally or intravenously. They are adapted to each patient according to the type of disease, rate of progression, severity and possible side effects. There are two main methods: a method in which a treatment that is considered weak is started and if there is a worsening of the symptoms, they switch to a stronger treatment. In the second method, with a very active disease, they start directly with strong treatment.
Multiple sclerosis – nutrition
- Obesity is a risk factor that adversely affects the disease, so patients are advised to lose weight through a dietician.
- It is recommended to prefer fresh food without added salt, sugar or high-calorie sauces.
- It is advisable to include in the diet whole grains, vegetable fat such as olive oil, walnuts and natural almonds
- It is recommended to consume at least 5 different types of vegetables and fruits per day, 2-3 servings of oily sea fish per week.
- It is recommended to minimize the consumption of meats and dairy products high in fat and sodium.
- Processed and industrialized foods containing trans fat, saturated fat and added sugar and food additives should be avoided.
- Intermittent fasting, combined with proper nutrition, may help reduce the body’s autoimmune response and slow down the aging process by self-repair.
- It is recommended to drink a large amount of water, minimize natural juices and avoid drinks sweetened with sugar and sugar substitutes.
- When receiving steroids, you must adhere to a low-salt diet, avoid purchased and processed food as much as possible, avoid foods rich in sugar and prefer foods rich in whole grains and dietary fiber. Special emphasis should be placed on a diet rich in calcium.
Medical cannabis and multiple sclerosis
In recent years, emphasis has been placed on the potential role of cannabinoids in protecting the brain in neurodegenerative disorders such as Parkinson’s disease and multiple sclerosis. Today in Israel, medical cannabis is used to alleviate chronic pain and muscle deformities due to multiple sclerosis, in situations of great muscle resistance (spasticity) that have not responded to conventional treatments.
Medical cannabis is used to relieve chronic pain and muscle deformities due to multiple sclerosis. Illustration: Shutterstock
In many countries in the world, such as Iceland, Great Britain, Denmark, Finland, Sweden and Norway, MS symptoms are treated using the medical preparation Sativex, which contains two active substances of the plant – THC and cannabidiol.
Multiple sclerosis – life expectancy
Multiple sclerosis is not a terminal disease but a chronic disease, where the life expectancy of the patients is shorter by 6-7 years compared to the general population. Age, sex, onset and severity of the disease are factors that affect life expectancy.
Questions and Answers
What is multiple sclerosis? Multiple sclerosis is a chronic, autoimmune and inflammatory disease of the nervous system, in which the immune system attacks the nervous system using white blood cells.
How is multiple sclerosis diagnosed? It is difficult to diagnose multiple sclerosis due to the varied symptoms that appear during attacks. The guiding rule for diagnosing multiple sclerosis is the appearance of two attacks typical of the disease in typical areas of the brain, which can be diagnosed according to auxiliary tests such as MRI, lumbar puncture and vision tests.
Multiple sclerosis – what is the interval between attacks? Between attacks of multiple sclerosis there is usually a gap of several months and sometimes even years.
What are the symptoms of multiple sclerosis?? The disease causes disturbances in visual function, disturbances in movement and balance, tingling and numbness, muscle weakness, muscle distortions and stiffness, cognitive and emotional disorders and more.