What is Multiple Sclerosis?

Multiple sclerosis is a chronic inflammatory diseases that affects the nervous system, including the brain and spinal cord . Many people abbreviate multiple sclerosis as MS . In technical jargon, the neurological disease is also called encephalomyelitis disseminata . Translated, this means something like "scattered brain and spinal cord inflammation". This is actually quite a good thing, because with MS, multiple foci of inflammation often form in different parts of the nervous system. Multiple sclerosis can spread to the entire brain and spinal cord.

Multiple sclerosis: definition

Doctors classify multiple sclerosis as an autoimmune disease by definition . The immune system acts against the body's own structures and destroys them. In the case of MS, it attacks the protective covering of the nerve fibers, the so-called myelin . They are crucial for smooth communication between nerve cells. If they are damaged, the neurons can no longer exchange and transmit signals. But the nerve fibers and cells themselves are not spared either. The MS therefore also shows itself through movement and coordination disorders as well as paralysis .

It is still unclear why the immune system gets out of hand and wrongly attacks its own organs and tissues. Incidentally, multiple sclerosis is not contagious , even if researchers suspect that infections play a role as risk factors.

Multiple sclerosis: incidence and age

More than two million peoples worldwide live with multiple sclerosis. In Germany, experts estimate the incidence at around 230,000 people . Every year around 10,000 people in this country are newly diagnosed with "MS". The nerve disease is not evenly distributed across the globe. Researchers have observed that the incidence of the disease increases with distance from the equator.

There are also clear difference between the sexes. Women are about two to three times as likely to develop multiple sclerosis (more precisely: relapsing MS) than men.

The age at which MS is diagnosed is young compared to many other diseases. Doctors diagnose the nerve disease most frequently between the ages of 20 and 40 . Sometimes even children or adolescents fall ill. By contrast, diagnoses of MS are extremely rare at ages 60 and up.

Multiple sclerosis: course of the disease

The course of multiple sclerosis can vary greatly from person to person. Doctors cannot accurately predict how the condition will develop from the time it is diagnosed. The severity of MS can also often not be estimated. Doctors usually do not know which bodily functions will be impaired in the future and to what extent. Many people associate multiple sclerosis with being in a wheelchair. However, this is only the case for a few. There are effective treatments available today that have a beneficial effect on the course of MS . In this way it can often be slowed down or improved again.

Doctors differentiate between different forms of MS:

• Relapsing -remitting MS or relapsing-remitting MS = RRMS : This is the form around 90 percent of those affected have when multiple sclerosis begins. An episode of inflammation in the nervous system is followed by an inflammation-free phase. Then the disease activity is low, the inflammation centers largely calm down and the symptoms decrease (or disappear completely). How much time will elapse between two attacks cannot be predicted. It can be weeks, months, or even years.
• Secondary progressive course (SPMS): After about ten to 15 years, relapsing MS progresses in up to 40 percent of patients. After more than 20 years, this type of MS can even be found in 90 percent.
• Primarily progressive course (creeping-progressive course = PPMS) : Doctors cannot identify a multiple sclerosis flare-up in around ten percent of patients. MS slowly but steadily worsens from the start.

There is also the so-called Clinically Isolated Syndrome (KIS, English CIS). The first symptoms that indicate MS can be detected here. However, doctors cannot yet make the diagnosis because further criteria for the disease are missing.

In some MS patients, the progression is favorable over their life. Others are impaired by slight disabilities, but can largely manage their life and everyday life independently. For some, however, the course of multiple sclerosis is difficult and they develop massive disabilities - in the worst case, up to death. However, there is no typical end stage in MS - in contrast to other diseases such as cancer.

Multiple Sclerosis: Life Expectancy

The prognosis for MS can not be generally predicted because the disease progresses very differently from person to person. It is also difficult to make general statement about life expectancy with multiple sclerosis. The prognosis for MS depends crucially on the form of the disease. About a third each:

• Shows a favorable course throughout its life
• Suffers from disabilities, but remains independent
• Develops severe disabilities - in the worst case, multiple sclerosis can be fatal.

Thanks to improved treatment options, the prognosis has steadily improved in recent years. In addition, doctors now usually start therapy early, which also has a positive effect on the MS prognosis. However, doctors have identified some factors that adversely affect the prognosis.

These include, for example:

• late onset of illness
• male gender
• numerous different symptoms to begin with
• Relapses that do not resolve completely
• progressive (progressive) course

Multiple sclerosis: causes

The causes of multiples sclerosis are not yet fully understood . Several factors are likely to have to interact for MS to develop. What these are and how they work together is still unclear. However, researchers suspect a combination of genetic and environmental factors .

It is known that the body's own immune system attacks and destroys the protective, insulating nerve sheaths - the myelin. The nerve fibers and nerve cells are not spared either. The myelin normally accelerates the transmission of signals between the nerve cells, so it plays an essential role in smooth communication. If the myelin is no longer intact, the transmission of impulses slows down. And this is noticeable through various neurological symptoms, such as sensory disturbances or symptoms of paralysis.

Multiple sclerosis cause: misdirected immune system

Doctor consider MS to be an autoimmune disease. Researchers do not know why the immune system is misdirected and directed against the body's own structures. However, they assume that the immune system classifies certain proteins on the myelin cells as "foreign" and dangerous and therefore fights them.

Most of the time, the entire nervous system is not affected, rather the immune system only attacks certain areas - they are often located in the brain. This creates isolated and scattered foci of inflammation, which are noticeable as a flare-up. The affected nerve tissue then becomes scarred and parts of the nervous system lose their function.

Even if the exact causes of multiple sclerosis are still largely in the dark, scientists have identified some risk factors that can promote MS. These include, for example:

• Hereditary factors (genes) : MS is more common in some families. Multiple sclerosis is not a classic hereditary disease. Parents can, however, pass on the tendency for the nerve disease to their children.
• Viral infections , for example with measles and herpes viruses or the Epstein-Barr virus
• Vitamin D deficiency - it is considered a risk factor for various diseases, including MS
• Smoking: MS affects smokers more often than non-smokers
• Overweight , obesity ( adiposity ) - adipose tissue produces inflammatory messenger substances

Multiple sclerosis: symptoms

The symptoms of multiple sclerosis can be extremely diverse. In addition, they are often very different from one individual to the next . So not every patient experiences the same symptoms to the same extent. It is also typical of MS that it usually runs in spurts . Then phases with few or no symptoms alternate with intervals in which the inflammation flares up and causes discomfort.

Multiple sclerosis: early symptoms

MS often shows up through early symptoms. “ Clinically isolated syndrome ”, abbreviated to KIS (or CIS), is what doctors call the onset of symptoms in multiple sclerosis . Usually there are the following first signs:

• Visual disturbances , e.g. blurred vision or cloudy vision like through a frosted glass or fog
• Sensory disturbances
• Tiredness, exhaustion

These harbingers set in within hours or days and can be traced back to individual foci of inflammation in the brain. They are visible in imaging procedures such as magnetic resonance imaging . However, such early symptoms are not enough to make a reliable diagnosis of "multiple sclerosis". The symptoms can also occur in the context of other diseases that doctors must first rule out. For the diagnosis of MS, the foci of inflammation must be spatially dispersed in the nervous system and occur at different times. However, doctors now recommend starting treatment immediately with a HIS.

An overview of important multiple sclerosis symptoms

MS destroys myelin as well as nerve fibers and nerve cells. The symptoms therefore affect the entire central nervous system with the spinal cord and brain - as well as all the functions that control them. The symptoms of MS are correspondingly diverse.

The following symptoms can occur:

• Visual disturbances when multiple sclerosis attacks the eyes and optic nerves: loss of visual acuity, disturbances in color vision, pain when moving the eyes, double vision, impaired vision up to temporary blindness
• Gait and balance disorders : those affected walk insecurely and sway. Outsiders often interpret this as being drunk.
• Movement and coordination disorders: For example, patients have difficulty tapping the tip of their nose with their fingers, grabbing a glass or brushing their teeth. Often times, people with MS experience tremors ( tremors )
• Sensory and sensory disorders , such as tingling ("pins and needles"), burning and numbness in the arms, legs or trunk
• Speech disorders : The language sounds slurred or choppy
• Cognitive disorders : thinking, memory, attention and concentration are impaired. A personality change in multiple sclerosis can be, for example, that a person who was previously very fixative suddenly becomes significantly slower in thinking.
• Muscle weakness and paralysis , for example in the extremities
• Pain , such as headache , facial pain (trigeminal neuralgia), muscle pain (stiff and cramped muscles), back pain
• Fatigue and rapid exhaustion, especially during physical exertion and fatigue (very severe exhaustion)
• Disorders of the bladder and bowel function : constant urge to urinate, urinary and fecal incontinence
• Disorders of libido and sexual function: decreased feeling of pleasure, erectile dysfunction
• Psychological changes : lack of drive, depressive moods up to and including depression. These symptoms are probably more the result of MS, given the multitude of profound symptoms and changes.

Multiple sclerosis: diagnosis

The diagnosis of "multiple sclerosis" is not easy to make because there are so many different symptoms. And these can also occur in the context of other neurological diseases. Doctors therefore carry out so-called exclusion diagnostics . They try to identify other diseases with similar symptoms as the cause. There is no multiple sclerosis test with which the nerve disease can be clearly identified. Doctors always rely on various examinations and their results.

MS diagnosis: ask for medical history

At the beginning there is always a conversation about the medical history between doctor and patient. The following questions, for example, are of interest for the diagnosis of MS:

• What are your symptoms exactly?
• When did you first notice this?
• Where would you locate the symptoms?
• How severe are the symptoms?
• Have the symptoms improved again after a while or have they worsened continuously?
• Are you aware of any illnesses or previous infections?
• Do you take any medicine?
• Have there been any cases of multiple sclerosis (or other neurological diseases) in your family?
• Are you a smoker or have you smoked before?

Doctors can draw initial conclusions about the cause of the symptoms from your answers. This is usually follow by a physical exam , during which the doctor palpates different areas of the body and listens to the heart and lungs. The determination of blood values ​​in suspected multiple sclerosis is usually also standard. As part of the blood test, doctors look for abnormalities, for example signs of inflammation.

Further research to diagnose multiple sclerosis

• Neurological examination : the doctor uses various tests to check the function of muscles and nerves. He examines fine motor skills, reflexes, coordination skills, muscle strength, muscle tension, sensitivity and the gait pattern. This also excludes other diseases that can cause similar symptoms. Examples are borreliosis , HIV infection or vascular and metabolic diseases.

• Evoked potentials : In this electrophysiological measurement, doctors stimulate selected nerves and determine their conductivity and speed. The condition of the optic nerves, the motor system or the sensory perception can be checked with this test.
• CSF examination : Doctors take small amounts of cerebrospinal fluid and spinal cord fluid with a fine needle (lumbar puncture). Laboratory doctors then analyze them for suspicious substances, such as certain proteins or cells (so-called oligoclonal bands) that occur in MS. The lumbar puncture can also rule out other diseases.
• Magnetic resonance tomography (MRT = nuclear spin tomography): The method works with strong magnetic fields. In most cases, if multiple sclerosis is suspected, a contrast agent is also used to distinguish fresh, active foci of inflammation from older, inactive inflammation (they do not absorb contrast agent). With MRI, radiologists map the body “slice by slice” and generate high-resolution, detailed cross-sectional images. Foci of inflammation in the brain can be seen well in an MRI.

MS diagnosis according to Mc-Donald criteria

Doctors diagnose MS according to the so-called McDonald criteria (2017). The number of relapses , evidence of focal points of inflammation and the spatial and temporal distribution of relapses and foci of inflammation play a role here.