Multiple Sclerosis: Definition, Symptoms, Causes, Diagnosis, and Treatment

By Cristiano Antonino Last updated Jun 16, 2023

Multiple sclerosis is a neurodegenerative disease that affects the central nervous system and can cause disruption of signals between the brain, spinal cord and optic nerves, leading to a wide range of symptoms

Multiple sclerosis is a chronic disease, which can be quite disabling, but which is neither contagious nor fatal

It is characterized by an abnormal reaction of the immune defenses that attack some components of the central nervous system.

This occurs because the central nervous system mistakes myelin for a foreign agent.

For this reason, multiple sclerosis is considered by many experts to be an autoimmune disease.

Attack on myelin

Specifically, multiple sclerosis attacks and damages myelin first.

It is the fatty substance that coats and protects nerve fibers in the central nervous system.

Myelin is involved in the correct transmission of nerve signals along the various elements of the central nervous system.

This aggression causes an increase in inflammation and consequently damage.

The different forms of multiple sclerosis

There are different forms of multiple sclerosis and the course and the appearance of relapses are not always predictable.

The most common forms are that with relapses and remissions and the primary progressive one, respectively in 85 and 15% of cases.

Sometimes, even in the absence of manifest symptoms, disease activity and damage to the central nervous system can continue and evolve.

Multiple sclerosis can occur at any age, but is most commonly diagnosed between the ages of 20 and 40.

The diagnosis comes through a neurological examination.

Around 2.8 million people are affected by this disease worldwide, of which 1.2 million in Europe and around 130,000 in Italy.

As for gender, the number of women with multiple sclerosis is almost three times that of men.

Symptoms of multiple sclerosis

Multiple sclerosis manifests itself through a wide range of symptoms which include:

motor difficulties
vision disorders
tiredness (even in carrying out the usual daily activities)
muscle aches
tingling and numbness in the face, body and/or limbs
sensitivity disorders (such as impaired touch, decreased sensitivity to heat, cold and pain)
speech disorders
bladder problems (such as urgency to urinate, urinary incontinence and difficulty emptying the bladder completely)
intestinal disorders
sexual dysfunctions
spasticity (typically muscle stiffness and involuntary spasms that make movement difficult)
mood problems.

The intensity of the disturbances is related to the extent of the area of myelin loss and the severity of the damage to the axons (fundamental structures of nerve impulse conduction), while the type depends on the site.

The duration of symptoms depends on how long it takes for the central nervous system to clear inflammation (days) and replenish myelin (weeks to months), and how well the nervous system can restore itself.

Symptoms can vary from person to person, be different over time and in impact.

The disturbances induced by the disease can sometimes prove disabling to the point of significantly affecting daily life.

Theoretically easy actions such as walking, reading, talking, or maneuvering an object may become difficult due to the disease.

The pathology involves physical complications which in 80% of cases also lead to serious forms of disability, capable of greatly affecting the life and daily life of people affected by multiple sclerosis.

One in two people say their symptoms prevent them from doing the job they are qualified to do or would like to do.

One in three patients leave work due to illness and one in five people experience difficulties in integrating and living in the social fabric.

Causes, a multifactorial approach

The correlation between the EBV virus and the probable development of this pathology has been demonstrated.

The causes of this anomaly in the functioning of the immune system are not known with certainty to date and are still being studied.

It is believed that a combination of multiple factors may be responsible for the onset of multiple sclerosis.

That is why investigations are underway in the field of immunology, but also epidemiological and genetic studies.

We can therefore correctly speak of a multifactorial matrix, which includes elements such as:

immunological causes; the exact antigen or target that causes immune cells to respond with an attack on myelin remains, to date, unknown. However, recently researchers have been able to identify: which immune cell prepares the attack, some of the factors that induce cells to attack myelin and some receptors that seem to be attracted to myelin to initiate the process of destroying it. However, this is still an ongoing investigation
the environment (temperate climate, latitude, Caucasian origin, toxic agents, low levels of vitamin D); multiple sclerosis is known to occur more frequently in areas far from the equator. Many factors were analyzed, including geographic, demographic (age, gender and ethnicity) variations, to try to understand the reason for this evidence. It would seem that exposure to some environmental factors before puberty would predispose the person to later develop the disease. Some scholars argue that this may be connected with the vitamin D normally produced by the body during exposure of the skin to the sun. People who live much closer to the equator are exposed to a great deal of sunlight throughout the year; as a result, they tend to have higher levels of naturally produced vitamin D. Vitamin D is thought to have a beneficial impact on immune function and may help protect against autoimmune diseases such as multiple sclerosis
exposure to infectious agents (viruses, bacteria) especially in the first years of life; Because viruses are known to cause demyelination, it is possible that a virus or infectious agent causes multiple sclerosis. In this regard, according to a very recent study published this January in the journal Science – conducted by researchers at the Harvard T.H. Chan School of Public Health in Boston led by the Italian Alberto Ascherio – Epstein-Barr virus (EBV) infection is certainly a risk factor for the development of multiple sclerosis. For some time now EBV, herpes virus capable of causing mononucleosis, was suspected of being a possible trigger of multiple sclerosis, but this study would seem to leave no room for doubt in this regard
a genetic predisposition, even if this does not qualify multiple sclerosis as a hereditary disease in the strict sense; however, having a first-degree relative, such as a parent or sibling, affected by the disease increases the individual’s risk of developing it to many times that of the general population.

Understanding the causes of the disease will be essential to identify the most effective therapies.

This will serve to deal with this disease, as well as measures to possibly prevent its appearance.

Cure multiple sclerosis

At present, a treatment for the resolution of the disease is unfortunately not available.

However, there are several drugs approved by the Food and Drug Administration.

The US government agency in charge of regulating food and pharmaceutical products has listed a series of treatments that have been shown to be able to slow down the evolution of the disease.

These are the so-called “multiple sclerosis-modifying drugs”, which, however, can have several very important side effects.

The choice of one drug rather than another depends mainly on the form of multiple sclerosis.

Furthermore, we must not forget the existence of effective drugs and therapies in controlling the attacks.

And there are also treatments useful for the management of certain typical symptoms of multiple sclerosis.

For the control of multiple sclerosis attacks, the available therapies are some cortisone drugs and plasmapheresis.

The latter operate the separation of the blood plasma from the corpuscular elements of the blood and seem effective in buffering the effects of the symptoms of multiple sclerosis.

On the other hand, as regards the treatment aimed at alleviating the symptoms, in addition to the use of medicines (such as those to reduce spasms, or those for the sense of chronic fatigue), physiotherapy can be used.

The latter, through stretching and muscle strengthening exercises, has the function of relieving motor and coordination problems, as well as the feeling of general weakness.

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