The multiple sclerosis (EM) is a neurological disease that affects the brain and spinal cordthe central nervous system (CNS). Myelin, composed of proteins and fats, which facilitates the conduction of electrical impulses between nerve fibers and which surrounds the nerve fibers of the CNS, is lost in multiple areas, sometimes leaving scars or demyelination (sclerosis). Destruction or damage to myelin causes the nerves’ ability to conduct electrical impulses to and from the brain to be interrupted or slowed. It is when the symptoms manifest themselves, which usually occur between the ages of 20 and 30, causing disability. The prevalence is that it affects twice as many women as men.
Causes of multiple sclerosis
Unknown
It is unknown what causes multiple sclerosis. It is considered an autoimmune disease in which the immune system destroys myelin and even damages the nerve. It is also not clear why it manifests itself, although a combination of hereditary and environmental factors has been suggested.
Types of multiple sclerosis:
– Recurring-remitting (EMRR). It affects more than 80% of MS patients. Symptoms can take years to appear even though inflammatory lesions are already occurring in the central nervous system. Outbreaks are unpredictable and last days or weeks and then disappear. Between one recurrence and another, the disease may not progress.
– Secondary progressive (PFMS). It may appear after a relapsing-remitting phase, the disability persists and/or worsens after flares. Between 30% and 50% of patients suffer from it. It usually occurs between the ages of 35 and 45 and is characterized by continuous progression with or without occasional relapses, minor remissions and phases of stability.
– Primary progressive (EMPP). It is the least common since it affects only 10% of patients. It does not have defined outbreaks and begins very slowly with a constant worsening of symptoms without an intermediate period or remission. The stability phases are occasional and the improvements are minimal or barely perceptible.
– Progressive relapsing (EMPR). Atypical. It progresses from the beginning with clear acute outbreaks and with periods between outbreaks of continuous progression. Outbreaks may or may not have complete recovery.
Risk factors can be:
– At any age, but more frequently from 15 to 60 years old.
– The number of cases in women is double that of men.
– History of multiple sclerosis in first-degree relatives, parents and siblings.
– Certain infections such as infectious mononucleosis caused by Epstein-Barr.
– Certain autoimmune diseases such as thyroid diseases, diabetes
type 1 or inflammatory bowel disease.
– Smoking.
Symptoms of multiple sclerosis
Miscellaneous
Each case can present very specific symptoms both in the manifestation of the disease and in its development. The location of the nerve fibers can determine the type of symptoms which may be:
– Numbness or weakness in one or more extremities, usually on one side of the body.
– Partial or total loss of vision in one eye and pain when moving it.
– Maintained double vision.
-Tingling or pain in various parts of the body.
– Sensation of electric shocks with some movements of the neck, especially when tilting it forward (Lhermitte sign).
– Lack of coordination or unstable gait.
– Tremors.
– Babble.
– Fatigue.
– Dizziness.
– Intestinal and bladder function problems.
– Muscle rigidity.
– Muscle spasms.
– Paralysis, usually in the legs.
– Forgetfulness and mood swings.
– Depression.
– Epilepsy.
Diagnosis of multiple sclerosis
Differential diagnosis
There are no specific tests to determine the diagnosis of multiple sclerosis, so the first step, in addition to the physical examination, is the differential diagnosis to rule out other causes or diseases. The blood test is used to make this differential diagnosis, just like a lumbar puncture or MRI. The puncture can help detect abnormalities in the antibodies associated with the pathology and rules out infections or other diseases with similar symptoms. MRI can show areas damaged by multiple sclerosis in the brain and spinal cord.
A test can also be performed that records the electrical signals of the central nervous system to certain stimuli and the speed with which the information is transmitted through this system.
Multiple sclerosis treatment and medication
It has no specific treatment
Multiple sclerosis has no cure and, therefore, there is no specific treatment. Therapeutic options involve treating the symptoms and achieving a better and faster recovery after outbreaks and trying to slow the progression of the disease.
Treatment guidelines have to be specific for each patient. For relapsing-remitting multiple sclerosis they may include: beta interferons; ocrelizumab, humanized immunoglobulin antibody for intravenous hospital administration; glatiramer acetate to block autoimmune attacks on myelin; dimethyl fumarate and fingolimod to reduce relapses; teriflunomide to reduce the relapse rate and natalizumab to block the movement of potentially harmful immune cells. The latter is for intravenous hospital administration.
Some cases can be treated with alemtuzumab to attack a protein on immune cells, help reduce relapses and reduce white blood cells. It is administered intravenously in hospitals.
Mitoxantrone, an immunosuppressant, is administered intravenously in the hospital and is only used in cases of severe and advanced multiple sclerosis.
For primary progressive multiple sclerosis, the reference regimen is modifying therapies that have serious health risks, so each case must have a unique design plan.
Corticosteroids, plasmapheresis, muscle relaxants, compounds to reduce fatigue, antidepressants, medication for pain, sexual dysfunction, and bladder and bowel control problems may also be prescribed.
Prevention of multiple sclerosis
It can’t be prevented
Multiple sclerosis does not have prevention measures, but actions can be taken to stop its progression with physiotherapy and speech therapy.
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