Multiple sclerosis is an autoimmune disease, where our immune system starts considering our own cells of brain and spinal cord (neurons) as foreign cells and start attacking and eventually destroying them. In the term multiple sclerosis, the word ‘sclerosis’ refers to scars, plaques or lesions. Technically, the neurons (cells forming brain and spinal cord) are covered by a fatty myelin sheath around the axon area which are responsible for the conduction of electrical impulses in the brain and spinal cord. In multiple sclerosis our immune system starts attacking and destroying this myelin sheath thus the nerve impulses goes haywire causing wide range of neurological signs and symptoms which often progresses to the physical and cognitive disability.
Causes and risk factors
Even after an exhaustive research on the mechanisms involved in the process of multiple sclerosis, its exact cause is still unknown. Genetics is supposed to play a major role in the development of multiple sclerosis. Infection too could cause multiple sclerosis but these are still theories. There are various environmental risk factors that may be involved in the development of this disease. These may include agents like chemicals, toxins, pollution, etc. that can cause mutation in the genes and thus leading to this autoimmune disease. Those who live away from equator and are less exposed to sunlight are more prone to this disease. Gastroenteritis, stress, and pregnancy are considered to be the risk factors that trigger the relapse of multiple sclerosis. Spring and summer are seen to be the risk factor for triggering of the relapse of the disease commonly in all the patients.
Symptoms
Since this is a disease that affects the neurons, the cells of brain and spinal cord, the symptoms are mainly neurological. The signs and symptoms include loss of sensation, numbness, tingling sensation, weakness of muscles, mobility difficulties, the person feels it difficult to coordinate and balance. In many cases the person also feels difficulty in swallowing and speech. Other symptoms include fatigue, severe acute or chronic pain, and urinary bladder and bowel difficulties. The symptoms of multiple sclerosis are usually episodic in nature and appear acutely. These episodes are called flare ups, relapses or exacerbations. The relapse of this disease is often unpredictable and the patient may suffer a sudden exacerbation anytime without prior indication.
Diagnosis
This disease is difficult to diagnose as the symptoms vary and are familiar to the symptoms of other diseases. Medical fraternity had devised various diagnosis criteria for multiple sclerosis where Schumacher and Poser criteria were used which was then replaced by a more specific McDonald criteria that mainly focus on the combination of data available from clinical, laboratory, and radiological investigation. Many of the investigators believe that the only confirmation test for multiple sclerosis is autopsy or biopsy and by the use of histopathological techniques multiple sclerosis can be diagnosed. In the light of several episodes of relapses shown by the patient the clinical examination alone would be sufficient. Since most of the people seek medical attention only after an attack of MS, other techniques may ease and speed up the diagnosis process. The most commonly used radiological technique of neuroimaging like magnetic resonance imaging of the brain and the spinal cord that shows the indications of demyelination. At times as the process of confirmation the cerebrospinal fluid is also done that shows the markers of inflammation of the nervous system.
Treatment
It would be more appropriate to call this as the management of multiple sclerosis rather than treatment as there is no known cure for this disease. Several therapies are useful for the symptomatic treatment. The primary focus of the treatment is on restoring the functioning of the body after the attack, preventing further attacks and forthcoming disability. During an acute attack the use of intravenous corticosteroids such as methylprednisolone is the first line of therapy. But these injections are not used for long term treatment of MS.
Disease modifying treatments include the drug called fingolimod that is approved for MS b FDA in 2010. Other agents are interferon beta 1a and 1b. Immunomodulators like glatiramer acetate which is a non-interferon, non-steroidal drug is sometime administered to modify the disease. Mitoxantrone has shown encouraging results in the patients to prevent relapse. Disease modifying agents can only reduce the progression of the disease but cannot stop it. This is the reason why supportive therapy like neurorehabilitation have shown positive effects on the health of patients suffering from multiple sclerosis.
