Multiple Sclerosis: All you need to know about the disease

This chronic disease appears in early stages of life and its clinical course is different from person to person. During outbreaks (crisis) there is an inflammation / axon myelin demyelination that causes several symptoms, from which a person may totally or partially recover.

SUBTYPES

• Clinically Isolated Syndrome (CIS): a single episode with neurological symptoms.

• Relapsing-Remitting MS: Symptoms develop over a few days or weeks, followed by remitting periods. Partial or total recovery from crisis. The most common pattern of the disease.

• Secondary-Progressive MS: Progression of symptoms without remitting periods. Generally occurs after 20 years of the disease but varies from person to person.

• Primary Progressive MS: Disability progression without crisis.

SYMPTOMS

In general, this disease reveals itself in crisis, defined as new neurological symptoms or signs, with a minimum duration of 24h, in the absence of fever or infection and 30 days breaks in between.

Most frequent symptoms and signs are:

• Cranial nerves: optic neuritis, ophthalmoparesis

• Motor functions: monoparesis, hemiparesis, paraparesis

• Sensory functions: paresthesia,dysesthesia

• Cognitive functions: slowed information processing, memory problems

• Cerebellar functions: ataxia, tremor

After a crisis, patients may recover totally or partially. Within some years, about half of the patients develop a progressive type of the disease that causes an increasing degree of inability.

DIAGNOSIS

Because symptoms may bebarely perceptible, it is common not to immediately consider medical assistance. There are other Central Nervous System diseases with symptoms similar to those of Multiple Sclerosis. Diagnosis is complex and despite complimentary exams, it rarely is immediate.

Diagnosing MS is the responsability of a neurologist, based on a suggestive history where symptoms appear disseminated in time and space (different locations of the NCS) and backed-up by a detailed neurological exam and all necessary complimentary exams (MRI, Cerebrospinal fluid study, Evoked potentials).

TREATMENT

Over the past years, there have been major therapeutic advances, especially due to disease-modifying treatments (immunomodulators). Despite not being a cure for the disease, these drugs manage to reduce inflammatory activity and long-term crisis, since they balance the immune system, blocking the attack on myelin. The progression of the disease is clearly delayed and accumulated disability over the years is reduced.

Drugs used for treating MS should be prescribed by a neurologist, since they are different according to each person and to the stage of the disease.

Both neurohabilitation and symptomatic treatment are important to reduce disease-related symptoms (depression, anxiety, spasticity, incontinence, amongst others).

High doses of intravenous corticoid (such as methylprednisolone for 3 to 5 days) are used for acute relapses.

As for immunomodulators therapy, the table below shows the most common first and second line drugs.

PROGNOSIS

It’s not possible to predict the evolution of Multiple Sclerosis for each individual case but the inability degree after 5 to 10 years of the disease allows a reliable forecast on the progression. However, there are many variables to consider (age at the time of onset, sex, form of presentation, amongst others) that will also influence this prediction.

Let’s bear in mind that MS treatment has known great advances over the last few years, mainly due to disease-modifying drugs. MS research is constant and abundant. There are a lot of on-going clinical trials, giving hope for the discovery of new and more efficient therapies in a nearby future.

Living with this disease is very demanding for patients, family and friends. Learn more here.

Joaquim Chaves Saúde has a team of Neurology specialists at your service.

SOURCES

McAlpine's Multiple Sclerosis, Fourth Edition

http://www.spem.pt/: Site da Sociedade Portuguesa de Esclerose Múltipla

http://www.anem.org.pt/Site da Associação nacional De esclerose Múltipla