Multiple Sclerosis – How the autoimmune disease turns life upside down
Repeatedly twisting an ankle, tingling or numbness in one arm or leg, great fatigue throughout the day or blurred vision can be symptoms of multiple sclerosis (MS).
Multiple sclerosis (Encephalomyelitis disseminata) is one of the most common neurological disorders. The typical age of onset is between 20 and 40 years old. An MS diagnosis raises many questions for patients as well as for their relatives. This article tries to provide some answers.
Causes of MS
MS is a chronic inflammatory autoimmune disease. The immune system attacks the body’s own cells in the patient’s brain and spinal cord.
Despite worldwide research, the causes of MS are not yet clear. Classical MS theory assumes that three factors cause the condition to manifest:
- Genetic predisposition: Approximately 15% of MS patients have immediate or extended family members who were also diagnosed with MS
- Environmental influences in childhood: Viral infections (e.g. Epstein-Barr virus) or vitamin D deficiency
- Trigger event in adulthood: It is not yet absolutely clear what such a trigger event might be. In most cases, emotional stress precedes the first acute episode of the disease.
There is a consensus in the scientific community that complex interactions of environmental, genetic, and epigenetic factors are the probable cause for onset of the disease.
What are the symptoms of MS?
The symptoms are varied and manifest differently in each patient. This is why MS is also called the “disease of a thousand faces”.
There are different types of MS. In most cases (85–90%), the disease is intermittent-relapsing.
Neurological symptoms appear relatively suddenly, subside over several weeks, and often regress completely.
MS is not always diagnosed immediately. A diagnosis may take years.
As the disease progresses, symptoms may not regress completely after an acute episode, leaving residual impairments. The condition can become chronic, and symptoms may gradually worsen over time.
In rare cases (10–15%), the disease progresses from onset. This form has no distinct acute episodes.
The symptoms vary depending on the areas of the brain and/or spinal cord affected by inflammatory lesions. Some possible symptoms include:
- Optic neuritis (inflammation of the optic nerve) – Common first symptom; deterioration of vision, usually in one eye; foggy or hazy vision; pain may occur.
- Paresthesia Common first symptom; sensory impairments such as tingling, tightness around joints, numbness; often described as a sock-like or glove-like sensation; difficulty sensing temperature.
- Ocular motility disorder – e.g. double vision; nystagmus (uncontrolled horizontal or vertical eye movements).
- Paresis (weakness) / plegia (paralysis) – Initial mild weakness, such as “tiredness” in an arm or leg; frequent ankle twisting or joint stiffness; paralysis is rare in early stages.
- Coordination Problems– Often develop during the disease course; e.g. vertigo, loss of balance, tremors.
- Vegetative dysfunction – Changes in bladder function, frequent urinary tract infections, sexual dysfunction, altered sweating.
- Psychophysical symptoms – Fatigue (abnormal fatigability), marked exhaustion that improves with rest.
- Psychological changes – Cognitive impairment, such as reduced attention or cognitive performance; depression.
MS has many faces:
- Appoximately1/3 of patients with MS experience no significant impairment throughout their life.
- Approximately 1/3 of patients with MS experience limitations that interfere with everyday activities. Living a normal life is mostly possible (e.g.: professional occupation, family planning).
- Approximately 1/3 of patients with MS experience significant impairments (e.g.: inability to work, loss of ability to walk).
How is MS diagnosed?
Preparing a detailed medical history and good patient documentation are critical for diagnosing MS.
If MS is suspected, the suspicion can be verified by taking a sample of cerebrospinal fluid from the spinal canal or with the help of an MRI.
Drug therapy for MS
During an acute episode, cortisone therapy can help to shorten the episode and reduce its consequences.
Options for long-term therapy depend on the form of MS. Various medications are used to influence the immune system. The immune system is either suppressed (immunosuppression) or influenced (immunomodulation). An effective immunotherapy can have a significant positive impact on the progression of the disease or the impairment caused by it.
Rehabilitation and conservative MS therapy
Rehabilitation for MS patients is designed to help preserve physical, social, and/or occupational skills. The treatment options are as varied as the symptoms of the condition itself. Physical and occupational therapy, speech therapy and psychotherapy can help patients to cope with everyday activities.
Rehabilitation goals:
- Preserving or improving functional capabilities
- Promoting independence and mobility
- Promoting and maintaining involvement in family life, social environment, and work
- Preventing and/or treating possible deficits caused by MS
- Alleviating psychological changes
- Reducing the amount of care required
An essential part of outpatient therapy is an active lifestyle – whenever possible. Studies show that physiotherapy increases patient mobility and muscle strength, reduces fatigue, and improves the quality of life.
Living with MS
Accepting the diagnosis and learning to develop strategies for new daily routines will help patients keep control and maximize independence.
Deliberate “disease-free” time spent with friends, outdoors, or engaging in a hobby can help individuals to see themselves as persons rather than patients. However, this may be easier said than done. Conversations with other patients (e.g. in self-help groups) or psychotherapy may be helpful.
Physical activity, in particular, is important for maintaining skills and physical awareness. Nevertheless, it is also important to accept one’s own limits. Too little, but also too much activity can have an adverse effect on the progression of the disease. Try to find enjoyable activities that are within your physical capabilities.
It is important that family and other people in the patient’s environment are open regarding MS. Relatives too are often overwhelmed by the diagnosis. Talking to each other about the uncertainties and the challenges can prevent misunderstandings.
Every patient develops his or her own strategies when living with MS.
Author: Saskia Wibner
Sources:
Wiendl, H., Korsukewitz, C. & Kieseier, B. (2021). Multiple Sklerose: Klinik, Diagnostik und Therapie. 2. Erweiterte Auflage. Kohlhammer Verlag
Hansen, S., Wettinger, L. & Keune, P. (2021). Multiple Sklerose. Hogrefe Verlag.
Epigenetic aspects of multiple sclerosis and future therapeutic options (2021)
Multiple Sclerosis Epidemiologic, Clinical, and Therapeutic Aspects (2017)
Differential diagnosis of multiple sclerosis and other inflammatory CNS diseases (2019)
Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews (2019)
