Multiple sclerosis (MS)

These early signs recede at the beginning. Over time, it can lead to increasing limitations and disabilities, and the relapsing course often turns into a so-called secondary progression after 10 – 15 years, during which neurological deficits can steadily worsen and the relapses disappear. Nevertheless, many sufferers are still able to work even after a long period of illness and can continue their lives without major restrictions. There is currently no cure for the disease. However, a whole range of treatments are available today, some of which are highly effective, which can slow down the progression, prevent acute symptoms and signs of the disease and shorten relapses. Even as an affected person, you can do a lot to maintain your quality of life.

Definition of multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). The central nervous system includes the brain and spinal cord. In multiple sclerosis, inflammatory cells, so-called T and B lymphocytes in the brain and spinal cord destroy the sheathing of the nerve fibers, the so-called myelin, and also the nerve cells and their projections. As the attack is directed against the body’s own tissue, multiple sclerosis is an autoimmune disease.

The term multiple sclerosis is derived from the Latin word „multiple“ = „many“ and the Greek word „skleros“ = „hard“. Doctors also refer to the disease as encephalomyelitis disseminata (ED). This translates as „an inflammation scattered throughout the brain and spinal cord“.

The protective layer of the nerve fibers, the so-called myelin sheaths, ensure that stimuli sent by the brain cells to the various regions of the body are transmitted very quickly. The inflammation damages the myelin at the sites of inflammation, which can temporarily interrupt or slow down nerve conduction. This can manifest itself in the symptoms mentioned. As a result, scar tissue forms in these areas. This pathological hardening of the tissue is called sclerosis.

The affected areas, known as plaques, occur particularly frequently on the optic nerves, in the brain stem, in the cerebellum and on the posterior cords of the spinal cord. The transmission of excitation is disturbed at these points. The nerve fibers themselves are also damaged to a greater or lesser extent. As a result, electrical impulses from the nerve cells only reach the body cells (e.g. muscle cells) and back to a limited extent. As a result, body movements (motor function) and body sensations (sensory function) may be impaired. This is noticeable, among other things, through symptoms of numbness or paralysis.

Multiple sclerosis: causes and risk factors

Although the causes of multiple sclerosis are not yet known in detail, there is a genetic component with a large number of immunologically relevant genes as well as environmental factors such as smoking, low vitamin D3, infection with the Epstein Barr virus and obesity in adolescence and early adulthood. These factors contribute to the triggering of the disease and its individually varying course. With regard to the mechanisms of the disease, it is now clearly established that it is an autoimmune disease. In an autoimmune disease, the body’s immune system mistakenly targets the body’s own tissue. This may be caused by an incorrect reaction to infections with pathogens that resemble the body’s own structures. As a result, the body produces immune cells, primarily certain T lymphocytes, as well as antibodies against the body’s own myelin and nerve cells.

The so-called complex genetic background means that first-degree relatives of a person affected by MS have a 20 to 40-fold increased risk of developing MS. With an incidence of around one in 1,000 people, this means a risk of two to four percent. The environmental factors also found, especially vitamin D3, which is formed in the skin through sunlight, together with the genes occurring in certain population groups, mean that MS is found with increasing frequency in both hemispheres of the earth north and south of the equator.

Infections with certain viruses, in particular the Epstein Barr virus (EBV), which causes Pfeiffer’s glandular fever, as well as specific intestinal bacteria can contribute to the triggering and progression of MS according to current knowledge. There are indications of other possible triggers such as stress situations, hormonal fluctuations, certain vaccinations and individual medications, but these are not considered sufficiently certain. With regard to vaccinations, it should be noted that natural infections, for example with the flu virus, pose a higher risk than vaccination.

Multiple sclerosis: frequency and age

Multiple sclerosis is the most common chronic disease of the central nervous system. It is the second most common neurological disease after epilepsy. Around 18,000 people with multiple sclerosis live in Switzerland.

Multiple sclerosis usually makes itself felt between the ages of 20 and 40. This makes MS the most common nerve disease in young adults. However, children and adolescents can also contract the disease. Women are affected about three times more often than men.

Multiple sclerosis symptoms

The symptoms of multiple sclerosis can manifest themselves in different ways. There are no specific signs of the disease that prove its presence. However, the occurrence of certain symptoms and the relapsing course in a young adult indicate MS.

Early symptoms and signs of the disease that occur particularly frequently in MS are:

• Sensory disturbances: The sensory disturbances often begin in the fingertips or feet and spread to the arms or legs. Typical symptoms are a feeling of numbness or tingling (formication), tightness around the joint and hip, pain and reduced sensitivity, for example to temperature. The so-called neck flexion sign is also widespread. Those affected experience an electrifying, sudden shooting sensation along the spine when they bend their head forward.
• Visual disturbances: Three out of four people affected suffer from visual impairment – usually due to a temporarily inflamed optic nerve (optic neuritis). Acute inflammation often leads to eye pain, which intensifies when the eyeballs are moved. Blurred vision as if through a veil, impaired color vision or when reading small print, double vision, flashes of light or loss of visual field are other possible symptoms.
• Muscle paralysis: Multiple sclerosis is also characterized by reduced muscle strength and even paralysis, which can be accompanied by rapid fatigue when walking, tension and stiffness.

Multiple sclerosis can also cause numerous other symptoms, which can occur individually or in combination:

• If cranial nerves are affected, for example, facial paralysis(facial nerve palsy), pain (trigeminal neuralgia) and eye movement disorders (double vision) can occur, as can taste disorders and balance problems.
• Damage to the cerebellum usually results in speech disorders, unsteady gait, trembling hands and coordination disorders.
• Two out of three people affected develop bladder dysfunction. While at the beginning there is often a strong urge to urinate with involuntary loss of urine (incontinence), later there is usually involuntary urinary retention.
• MS can also cause impaired defecation (usually constipation), impaired sexual function and impaired perspiration.
• Many sufferers also experience mood swings and depressive symptoms such as sadness, insomnia and listlessness.

The frequency of relapses, the respective symptoms and the progression of the disease vary greatly from person to person. Around five percent of those affected show a (very) mild course and never acquire any significant disabilities, while in around five to ten percent the disease progresses aggressively and clear signs of disability, such as walking restrictions, appear within a few years. Before the introduction of effective treatments, a high percentage of those affected lost their ability to walk after 20-25 years, which is why it is still often assumed that the disease leads to wheelchair use, which can now be prevented in most cases.

Diagnosis of multiple sclerosis

If multiple sclerosis is suspected, we will first ask you about your symptoms, when they first appeared and how they manifest themselves.

Taking a medical history alone is not sufficient for a reliable diagnosis. We therefore carry out a neurological examination next. For example, we check the function of the cranial nerves and test sensation, reflexes and muscle strength. This allows us to assess the extent of the restrictions.

An important part of the diagnosis is an examination of the so-called cerebrospinal fluid (CSF). Certain immune cells and antibodies are elevated in inflammatory changes in the brain and spinal cord. This can be proven on the basis of the sample obtained.

As this is also the case with other inflammatory diseases of the nervous system such as meningitis, other procedures are usually also used. Magnetic resonance imaging (MRI ) allows us to detect the inflammatory foci characteristic of the disease at an early stage. Sometimes these foci are found by chance during an MRI scan for migraines or after a concussion, before the first symptoms appear. Additional examinations such as visual evoked potentials (VEP) and optical coherence tomography (OCT) measure the conduction velocity of the optic nerve and the damage to the retina of the eye in MS. CT examinations are also carried out for clarification.

We can also use certain criteria to find out whether an MS relapse is present and determine the right treatment. This is the case when symptoms

• last for at least 24 hours,
• occurred at least 30 days after the start of the last episode and
• cannot be explained by fever (increased body temperature) or infection.

Multiple sclerosis: Important measures for those affected

It is not yet possible to prevent multiple sclerosis (MS). As a sufferer, however, you can have a positive influence on the course of the disease by having it treated early and consistently and by taking certain measures yourself.

Nutrition

A healthy and balanced diet can help to promote well-being and strengthen the immune system.

• Mediterranean diet: This diet is rich in fruit, vegetables, wholegrain products, fish and healthy fats such as olive oil. The consumption of red meat should be reduced.
• Vitamin D: Adequate vitamin D levels are important. Discuss with your doctor whether supplementation is necessary.
• Omega-3 fatty acids: These are found in fish oil and linseed and can have an anti-inflammatory effect.
• Drink: Drink plenty of water to ensure good hydration and prevent constipation.

Progression and prognosis of multiple sclerosis

Multiple sclerosis (MS) is a chronic disease, which means that it is usually permanent. However, early diagnosis and consistent treatment as well as the above-mentioned measures have a favorable effect on the disease, and it is now possible to prevent severe disabilities in most cases. To this end, it is important, especially at the beginning, to consistently monitor the progress and select and adapt the treatment accordingly.

There are three main forms of multiple sclerosis:

• In relapsing-remitting multiple sclerosis, symptoms suddenly appear within a few days. These last for several days to weeks and usually disappear completely. The average interval between relapses is six months to three years.
• In the case of primary chronic progressive multiple sclerosis, the symptoms develop gradually but progress steadily. There are no acute relapses with this form of the disease.
• Secondary chronic progressive multiple sclerosis is characterized by the fact that the relapses that occur become less frequent as the disease progresses and eventually cease altogether. However, the disabilities caused by multiple sclerosis are steadily increasing.

As the course of multiple sclerosis varies greatly, a general prognosis is difficult. Some sufferers notice no deterioration or hardly any impairment for years between attacks and can lead a normal life. In rare cases, the disease can also lead to severe disabilities or even death within a few years. However, using imaging techniques such as CT or MRI, we can now assess at an early stage whether the disease is more or less active and destructive, and design the treatment accordingly.

It is important for you to know that the prognosis is often much better than expected. After an average illness duration of 18 years, a third of those affected are still fully employed or can run their household without significant restrictions.

The exchange with people who are affected by the same disease can be a great support in coping with the disease. For advice on finding a suitable self-help group, please contact Self-help Zurich. Selbsthilfe Zürich and the University Hospital Zurich are cooperation partners in the national project „Health literacy thanks to self-help-friendly hospitals“.

Multiple sclerosis: Effective treatment

There is currently no cure for multiple sclerosis. However, there are several treatment options available to us. The aim is to reduce the extent of the inflammatory reactions, slow down the progression of the disease and alleviate the accompanying symptoms. It is important that the therapy is individually tailored to your case and the course of your illness. To do this, you should seek treatment at a center specializing in multiple sclerosis.