The CNS encompasses the brain and spinal cord and both self-possessed gray matter and white matter. In the white matter are the nervous fibers which allow the communication between the body and the brain from which all commands leave; the nerve fibers are more or less long; the central axis (axon) where an electrical current (nerve impulses) circulates is surrounded by a sleeve called myelin.
At the exit of the spinal cord and the brain, the nerve fibers gather together and give the nerves
Multiple sclerosis is an Chronic neurological disease. It is due to an attack of myelin (the “sleeve” that allows a good propagation of the nerve flux). It is a demyelination of the white matter, demyelination plates can occur anywhere in the central nervous system; this explains the extreme diversity of clinical forms and the difficulty of making a safe diagnosis from the beginning of the disease.
When nerve fibers are demyelinated, the nervous impulse is slowed down or even stopped, so paralysis can set in, sensory disturbances can also appear.
To read this complete file on multiple sclerosis, symptoms … to the treatment, with the advice of a specialist doctor and the testimony of a patient who tells how she experienced the diagnosis of her disease.
Causes of Multiple sclerosis
Multiple sclerosis (MS) is a disease that evolves in more or less disabling surges. The causes are not always known, and the effects vary from person to person. In any case, this disease is relatively frequent, since it is estimated that every four hours a person aged between 20 and 40 is affected in our country.
Multiple sclerosis is an inflammatory disease of the central nervous system (brain, optic nerves and spinal cord). It begins, most often, in young adults. The disease attacks myelin, the tissue that surrounds the nerve fibers. It is called multiple sclerosis, because some areas are affected, by area, by plaque. The disease evolves in more or less disabling attacks and more or less spaced out.
In fact, it is an inflammation: the lymphocytes, abnormally activated, enter the brain and attack the myelin sheaths (the role of myelin is to protect the nerve fibers, but also to accelerate the transmission of nerve impulses). Inflammation is the cause of demyelination (electrical conduction is worse, information is no longer correct or not at all). It causes, subsequently, suffering of the axon and an attack of the neuron. That is what causes a handicap.
If it is possible to fight against demyelination, by fighting inflammation, on the other hand, it is difficult to fight against neuronal damage. Hence the importance of diagnosing the disease as soon as possible, to limit its effects for as long as possible.
A thrust corresponds to the constitution of a new zone of demyelination. The remission corresponds to a repair, a healing of the myelin. Over time, scarring is less successful and the lesions become permanent. The rhythm of the alternating pace-remissions, is very variable from one person to another.
For some, the disease remains silent for a long time, without any particular handicap, whereas some evolutionary forms cause relatively close flares.
It should be noted that vaccination against hepatitis B has never been scientifically proven to be a risk of multiple sclerosis.
Multiple sclerosis (MS) does not always show specific, specific symptoms. The disease evolves in flares; each crisis can present itself in multiple ways, each corresponding to the attainment of a different neurological focus.
Multiple sclerosis usually begins between 20 and 40 years of age (10% of cases are detected in adolescents and 20% after 40 years). The disease affects three women for a man.
The disease often begins with a “pyramidal syndrome” (the pyramidal tract is the set of axons that direct the crusade of the muscles, from the brain to the end of the spinal cord). Pyramid involvement leads to symptoms such as difficulty walking, fatigue, exaggerated leg reflexes, an extensional plantar reflex (Babinski’s sign), a disappearance of the skin reflexes in the abdomen.
Optical disorders are also very common in early illness. In one third of the cases, there are symptoms of neuritis. The sight of an eye begins to drop, his vision of the colors is cloudy, and pain is felt in the eye and orbit. During the acute phase, the fundus of the eye is normal: it is said that the patient sees nothing and the doctor either … It is only after a fortnight that the Optic nerve becomes visible.
Sensitivity is also affected: with tingling sensations, a sensation of electrical discharge along the spine during certain movements of the neck, pain in the face.
Other MS symptoms may be suggestive of the disease:
Dizziness, involuntary eye movements, poor coordination of voluntary movements (such as walking or standing). We walk as if we were drunk.
Sensation of vision split.
Sphincter disorders (related to spinal cord injury) that are manifested by an urge to urinate or constipation, or even, in men, impotence.
Facial paralysis, when the facial nerve nucleus is affected.
Great fatigue that is often the most disabling symptom.
Mood disorders, irritability, depression, even paranoid syndrome. All these disorders are generally regressive in the first crises.
Diagnosis and progression of the disease
There is still no diagnostic test to recognize the disease with certainty. It is the physicians who diagnose it, clinically, that is to say according to the clinical signs that they can identify. And it’s not always simple as the signs of the disease vary from person to person.
However, the diagnosis is sometimes long to establish with certainty. Indeed, these disorders can, initially, be resolved by themselves. Then evolve suddenly, towards a new aggravation or disturbances. Additional diagnosis will be required.
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MRI: magnetic resonance imaging. This is the first supplementary examination. MRI makes it possible to obtain very precise and very detailed “photos” of the brain and the spinal cord. Through MRI, doctors can therefore visualize the lesions caused by the disease. However, smaller lesions can escape MRI. On the other hand, other diseases than multiple sclerosis, can cause similar lesions. MRI is therefore not diagnostic. The test is used to confirm the diagnosis, but not to establish it.
Lumbar puncture: this involves taking a very small amount of cerebrospinal fluid (the fluid in which the brain and the spinal cord bathe). In this cerebrospinal fluid, there may be particular antibodies, indicating inflammation.
The definitive diagnosis of multiple sclerosis is affirmed when:
At least two outbreaks were detected in at least two different sites.
Two outbreaks were detected in one site and MRI showed disseminated lesions; when a single outbreak was detected in two different sites and a subsequent MRI showed the appearance of new lesions.
When the progression of the disease is insidious, it takes a year of progression to establish the diagnosis and then perform a lumbar puncture, a cerebral MRI and a medullary MRI.
The evolution of the disease
The evolution of multiple sclerosis is sometimes difficult to predict. The disease evolves in flares. It should be noted that the evolution of MS is not always catastrophic. Each patient has a different disease; it is difficult to predict the course of the disease. Sometimes there are 2 or 3 flare-ups and the symptoms disappear completely.
At the onset of the disease, disorders, sometimes fleeting, disappear completely after the crisis, there is no sequelae. A period of remission follows, often several years.
At other times, a second crisis occurs, very different from the first often, more or less regressive, and so on.
Sometimes, the seizures become more and closer, the disorders do not heal completely, and the sequelae can accumulate. The evolution towards a very disabling form is rare. However, a permanent handicap can unfortunately be established and the patient is severely affected.
The main treatments
Treatments for MS are mainly cortisone and interferon. These treatments have evolved considerably in recent years. Over the last fifteen years, treatments have been able to delay the effects of the disease.
Treatment of relapses: it is mainly based on cortisone (corticosteroids), in particular methylprednisolone intravenously. This treatment is reserved for severe flare-ups. It has side effects and its action is not sustainable over time.
Background treatments: their purpose is to reduce the activity of the immune system: immuno-modulators and immuno-suppressors.
The immunomodulatory: they act on inflammation by modulating innate immunity. There are two main types of drugs: interferon beta, and glatiramer acetate. Both act on the thrusts and the lesions. They do not have serious side effects.
The immunosuppressive: they act directly on lymphocytes. They are therefore indicated in highly inflammatory forms. One of these drugs, mitoxantrone, can be toxic to the heart, and has hematological risks (blood). Of course new drugs are developing, such as ocrelizumab which has shown interesting results to reduce flares, and the evolution of the disease hadicap. Further work is needed on this drug to demonstrate its effectiveness (and evaluate exactly its side effects).
In hospital, a monoclonal antibody, natalizumab, is used, which is very effective, but which can lead to the appearance of allergic reactions or infectious diseases (it blocks the action of the immune system).
Several treatments exist to limit the symptoms of the disease.
Including fatigue, spasticity (stiffness of the legs), pain or sexual dysfunction:
The attack of the nervous pathways of sensibility causes pain. To combat these pain, an anticonvulsant and an antidepressant may be prescribed.
Against spasticity and painful discomfort in the legs, muscle relaxants are effective.
Against mood disorders (depressive symptoms, for example), we can resort to antidepressants associated with psychotherapy.
Unlike conventional treatments, they have generally not been scientifically proven effective. They may nevertheless serve some patients, but their use should not lead to the cessation of medicines with a proven effect.
The magnetic therapy: it is to “bombard” parts of the electron body and this, using small devices applied to the skin. Its purpose is to relieve pain.
The diet of Swank: it is a diet low in saturated fat. Red meat is banned during the first year of treatment, as well as biscuits, pastries, or anything that can contain too much fat.
The linoleic acid (an essential fatty acid of the omega 6 family) could reduce the severity of attacks.
The Reflexology (pressure on reflex points on the feet, hands and ears) Acupuncture, apitherapy (based on bee venom), massage therapy or relaxation techniques are also possible remedies.
Adapting your lifestyle
When a patient suffers from multiple sclerosis, he may be led to adapt his lifestyle to his disease.
The tiredness is one of the most common symptoms. It is therefore important to conserve energy, by granting long periods of rest or relaxation.
Physical activity is important for improving muscle strength and coordination. It’s good for morale.
Avoid stress, as long as you can. In this, support groups, psychotherapy or relaxation techniques can help.
Avoid infections. To do this, think about washing your hands thoroughly. Some infections can lead to relapses.
Avoid the cigarette that aggravates the disease, and alcohol.
The pain, disability, fatigue inherent in the disease, psychologically fragile. It is therefore important to get help. Associations have their usefulness at this level.
The NAFSEP (French New Sclerosis Association) and the French Multiple Sclerosis League (LFSEP) provide a telephone hotline (0 810 808 953) for the sick, where practical advice can be provided.
Do not hesitate to call on a psychotherapist. The effects of the disease on a daily basis are painful for the patient and his entourage. It is of course difficult to find a pleasant rhythm of life when one is disabled by fatigue.