Multiple sclerosis

What is it?

Multiple sclerosis (MS) is a chronic disease of the central nervous system|(brain and spinal cord). The name ‘multiple sclerosis’ refers to the various inflammatory lesions in the central nervous system, or, more specifically, of the myeline.

Myeline is a type of insulating layer around the nerve cells that ensures good conduction of the nerve signals. Multiple sclerosis is an auto-immune disease: there is inflammation at the level of the myeline due to abnormal functioning of one own immune system. New inflammatory lesions can cause resurgences (also called flare-ups).

Initially, the nervous system can recover quite well from these flare-ups, but after a while, there can be permanent damage.

Causes

The precise cause of multiple sclerosis is not known. Multiple factors most likely play a role in the development of multiple sclerosis. Heredity is important: in the general population, the probability of multiple sclerosis is 1/1000 (10-15 people in Belgium). If there is multiple sclerosis in the immediate family (for example, first degree), then the probability of having the disease increases to approximately 2%.

Certain viruses, a deficiency of vitamin D and smoking also appear to play a role in the onset of multiple sclerosis. In addition, it appears that women are more frequently affected than men. The exact mechanism of why one person is affected by multiple sclerosis and why another is not is not known. Nor is it known why one person may have a much milder progression of the disease when compared to another.

The disease is usually discovered in young adults between the ages of 20-40 years old, but multiple sclerosis can have an onset during childhood or after the age of 50 years old.

Symptoms

The symptoms that first indicate multiple sclerosis are related to the place of inflammatory reaction in the nervous system. Common symptoms include loss of strength, tingling, movements that are less fluid, dizziness or double vision. As the disease progresses, it is common to experience symptoms such as:

• depression
• double vision
• concentration and memory issues
• pain
• sexual problems
• fatigue
• ...

At the onset of multiple sclerosis, there is a progression of resurgences (flare-ups) which can still be repaired in the nervous system. The symptom disappears after a few weeks. This a question of a ‘relapsing-remitting multiple sclerosis’.

Gradually, the damage caused by the inflammation becomes more difficult to repair and leads to permanent worsening, or even a temporary deterioration, of the clinical condition. This last phase is often called ‘secondary progressive multiple sclerosis’. The start phase varies greatly for each individual.

For a small group of people, this disease is often accompanied by a temporary, continuous deterioration, without clear attacks nor temporary recovery. In that case, we refer to it as ‘primary progressive multiple sclerosis’.

Diagnosis

If the clinical story and physical exam indicate possible multiple sclerosis, an NMR (nuclear magnetic resonance) scan of the brain and spinal cord is always performed. The central nervous system can be visualised and can detect any inflammatory lesions present.

A lumbar puncture is also often performed where a small quantity of the fluid that circulates around the brain and the spinal cord is drawn out using a thin needle placed in the lower back. The fluid is then analysed for signs of inflammation, which could indicate multiple sclerosis. There is often blood tests as well in order to rule out other diseases. Generated potentials can also be useful in the diagnosis and follow-up of multiple sclerosis. This measures the reaction of the central nervous system to various sensory stimuli.

Treatment

For recurrences (flare-ups), a high dose of cortisone is often given, with the hope that the clinical symptoms will disappear more quickly.

In recent years, there has been a significant increase in medications that greatly decrease the chance of new flare-ups of multiple sclerosis. These products may also reduce the period of permanent handicap.

They are available in so-called first-line and second-line medications. First-line medication is usually given first; if these do not appear to have a sufficient effect or if there is a particularly aggressive form of multiple sclerosis, it is possible to go on to a second-line treatmetn.

There are oral forms as well as subcutaneous, intravenous or intramuscular forms of the medication.

In each case, regular follow up (clinical exam, NMR, lab tests) are necessary in order to observe the progression of the disease and to quickly address any medication side effects.

In addition to these medications that can improve the progression of the disease, persistent symptoms can be addressed with:

• occupational therapy and psychological support
• physical therapy, speech therapy
• medication of symptoms

A social worker may also be helpful. Other physicians (urologist, physical therapist, gynaecologist, dermatologist, etc.) are consult in a multidisciplinary approach.

Our department also has an MS nurse who functions as a liason between the patient and neurologist. This nurse is readily available to discuss any and all sorts of problems that may arise. The nurse will then try to come to a solution in consultation with the neurologist, among others.

Our team strives to help and support the person affected by multiple sclerosis as much as possible.

Interesting link:

• Flemish MS League

Latest publication date: 01/12/2023
Supervising author: Dr Aers Isabelle