Multiple sclerosis

Multiple sclerosis is a chronic and progressive disease of the central nervous

system (CNS). Due to the breakdown of the myelin sheaths of nerve fibres (demyelination), nerves are unable to properly transmit CNS signals. The damage to the brain and spinal cord is multifocal (diffuse), making neurological symptoms and disease progression variable. The disease can occur at any age, but it mainly affects adults aged 20-40. Multiple sclerosis is the most common cause of non-injury-related disability among young adults

Symptoms

The onset of the disease is characterised by a single neurological symptom. Less commonly, two or more symptoms occur during the first stage of the disease. The first symptom occurring with multiple sclerosis may be:

• Extraocular optic neuritis – manifested by eyeball pain, worse or double vision, impaired colour perception and dizziness
• Motor coordination disorders
• Weakness of the legs after prolonged walking
• Sensory disturbance on the surface of the limbs, trunk or face
• Sometimes there are problems with urination and defecation

The aetiology of multiple sclerosis isn’t clear, but it may be related to abnormal functioning of the immune system, as well as neurodegenerative processes.

The pathomechanism of this disease is related to:

• Epstein-Barr virus infection – the risk of developing multiple sclerosis is twice as high in people with symptomatic infection (such as infectious mononucleosis)
• Genetic factors – the presence of the HLA-DRB1*15 genotype increases the chances of getting the disease threefold with a heterozygous system (in one allele) or sixfold in a homozygous system (in both alleles)
• Environmental factors, such as low vitamin D levels due to infrequent exposure to sunlight and smoking

Diagnosis and treatment

If any symptoms indicative of multiple sclerosis are observed, you should see a neurologist for proper diagnosis. In addition to the all-important history taken by the doctor, diagnostic tests in the form of MRIs and cerebrospinal fluid studies are used.

Due to the undetermined aetiology of the disease, multiple sclerosis cannot be cured. The main treatments focus on slowing the progression of multiple sclerosis and reducing the incidence of relapses.

The main therapeutic approaches are the use of β1a and β1b interferons together with glatiramer acetate. During the current flare-up of symptoms, glucocorticosteroids (usually methylprednisolone given intravenously or prednisone given orally) are used. Equally important are regular rehabilitation exercises to slow the rate of disability progression.