Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune sclerotic disease of genetic or viral character affecting more than a quarter of a million people in the United States alone, it is caused by demyelination of the insulating layer surrounding neurons in the brain and central nervous system. The myelin sheath is vital for insulating and protecting the nerve fibers, as well as it accelerates the transmission of signals between the brain and the rest of the body.

The myelin membranes arise from the oligodendroglial cells in the central nervous system and the Schwann cells in the peripheral nervous system; However, MS is a progressive disease often altering myelination or myelinogenesis, which affects mainly the repair and recovery process of the myelin sheath. Moreover, in Multiple sclerosis T lymphocytes of the body’s immune system attack the myelin sheath leading to scar tissue formation over the affected areas (plaques), these plaques disrupt nerve communication, and often lead to symptoms affecting sensation, coordination, movement, vision, balance, muscle strength, and other corpuscular functions of the human body.[1]

MS affects more than 3 million people globally, It occurs commonly in people of Northern European ancestry, but people of other racial backgrounds can also be affected. Initial symptoms often occur between the ages of 20 and 40; Moreover, symptoms rarely begin before 15 or after 60. MS is at least three times more common in women than in men, especially in women between the ages of 20 and 49.

Recent studies showed that certain ethnic groups (such as Asians, American Indians, and Eskimos) have a markedly lower prevalence of multiple sclerosis. Location-specific incidence showed a peak in the United States, Canada, and Northern Europe than in other parts of the world.

Symptoms

MS is a systemic disease that may affect the whole organism, leading to systemic symptoms such as:

1. Common muscle symptoms include loss of balance, spasms, numbness, and weakness
2. Common bowel and bladder symptoms include leakage, constipation, urge, and difficulty defecating.
3. Eye symptoms include eye discomfort, double vision and in some cases unilateral vision loss
4. Brain and nerve symptoms include memory loss, depression, hearing loss, tinnitus, and impaired reasoning.
5. Sexual problems include issues with erection, problems with vaginal lubrication, and pain during intercourse or dyspareunia.
6. Speech and swallowing problems
7. Chronic fatigue syndrome

This disease may have remissions

Diagnostic procedures

1. Lumbar puncture (spinal tab)
2. Cerebrospinal fluid (CSF) analysis, which is a series of laboratory tests performed on a liquid sample of CSF.
3. MRI of the brain.
4. A nerve conduction study (NCS), which is a diagnostic procedure used to evaluate the function of sensory and motor nerves, especially the ability of electrical conduction.

Differential diagnosis

The differential diagnosis of MS is carried with the following disorders:

1. Postinfectious encephalomyelitis which is an autoimmune subacute syndrome arising in response to a viral infection. Patients complain of confusion, problems with bladder or bowel control and muscle weakness. demyelinating lesions can be seen on MRI images.
2. Primary Angiitis of the Central Nervous System (PACNS) which is a rare form of generalized systemic vasculitis restricted to the brain and spinal cord, often resulting in severe headaches and confusion. Characteristic diagnostic features include high protein levels in CSF, accelerated ESR (erythrocyte sedimentation rate), and a positive ANA test. A cerebral arteriogram may show vascular malformation (an abnormality in the cerebral vessels).
3. Lyme disease commonly cause Bell’s palsy, amnesia, numbness, and fatigue. Cerebrospinal fluid findings may resemble those found in Multiple sclerosis, and MRI test may show white matter abnormality.
4. Systemic lupus erythematosus may cause optic abnormalities, and encephalopathy with progressive systemic abnormalities. Characteristic diagnostic features include elevated antinuclear antibody, hematuria, leukopenia, and elevated ESR.
5. Behçet disease (syndrome) shows a pattern of MRI findings that overlap with MS; However, genital and oral ulcers are the distinguishing features of this condition.
6. Sarcoidosis and Sjogren’s syndrome are autoimmune conditions that affect multiple organs and should not be confused with MS, a chest X-ray may show Calcified Granulomas seen in granulomatous disease of the lungs, Characteristic diagnostic features include raised levels of IgG and Oligoclonal bands in CSF. ACE (Angiotensin-converting enzyme) determination can be used in the differential diagnosis, as it may be elevated in either serum or CSF; However, it is not reliably abnormal.
7. Vitamin B-12 deficiency and tertiary syphilis may result in similar dorsal encephalitic abnormalities and dementia.
8. Olivopontocerebellar degeneration or spinocerebellar degeneration (Hereditary degenerative disorders) may show a pattern of symptoms that overlap with chronic progressive Multiple sclerosis (CPMS); However, MS specific white matter lesions, which are usually detected on T2 weighted MRI scans are absent and the CSF is normal in patients with spinocerebellar degeneration.
9. Lesions detected on T2 weighted MRI scans in patients with progressive multifocal leukoencephalopathy, which is common in patients with AIDS, show a pattern of symptoms that overlap with MS, therefore it needs to be differentiated from it.

Treatment

Prompt treatment following an early diagnosis can help with the impact of MS. It’s important to learn all you can about relapsing the disease, and its symptoms with an aggressive disease modifying therapy (DMT).

Common disease modifying Drugs for relapsing MS

Avonex an Interferon beta-1a is a disease modifying drug (DMD) of choice for relapsing remitting MS.[2]

Fingolimod (gilenya) is a disease modifying drug of choice often used for treating multiple sclerosis (MS) and relapsing it. A recent review of its use in relapsing-remitting multiple sclerosis showed that it reduced the rate of relapses in multiple sclerosis by approximately one-half over a two-year period; However, it has been partially limited because it can exert deleterious effects on the cardiovascular system.[3][4][5]

Methotrexate “an immunosuppressant” is a simple short-term drug of choice used for relapsing and delaying disease progression in MS.[6][7][8]

IVIG  an Intravenous Immunoglobulin used to cope with ms progression and to delay nervous impairment in people who have relapsing-remitting MS.[9][10][11]

Oral Prednisone a corticosteroid commonly used to relieve inflammation, and other mild to moderate exacerbations of MS, especially in acute relapses.[12]

Benzodiazepine, or Baclofen are common antispastic agents often used to reduce muscle spasms in patients with MS.

Oxybutynin an anticholinergic drug often used to cope with urinary urgency and frequency in patients with MS.[13][14][15]

Amantidine is a drug of choice often used to cope with myalgic encephalomyelitis (in chronic fatigue syndrome) and encephalomyelitis disseminata (in multiple sclerosis).[16]

Anti depressants are often used for mood.

 

References

Multiple Sclerosis

 

Verified by: Dr.Diab (October 22, 2017)

Citation: Dr.Diab. (October 22, 2017). Multiple sclerosis Clinical Symptoms and Treatment. Medcoi Journal of Medicine, 19(2). urn:medcoi:article3197.