It is the most common demyelinating disease; There are ~ 2.1 million people in the world that suffers from MS. Incidence of multiple sclerosis (MS) 2-150: 100,000 depending on the country.
MS is thought to be an autoimmune disease that occurs in genetically predisposed people and through external factors. The damage is caused by the body’s immune system attacking the structures of its own nervous system.
The lesion is usually localized in the white matter of the brain periventricular, in the trunk, basal ganglia and spinal cord, and often affects the optic nerves.
In MS, oligodendrocytes, the cells that make up myelin, are damaged. In parallel with the demyelinating process, an inflammatory reaction takes place, in which T lymphocytes take part, crossing the blood-brain barrier.
T lymphocytes attack myelin – a trigger that triggers an inflammatory process involving cytokines and antibodies. They have shown B lymphocytes to be involved in the process alongside T lymphocytes.
The diagnosis of the disease is relatively complicated, because the symptoms of the disease are like other diseases. Diagnostic criteria (McDonald criteria) have been developed and revised in 2010. They base the criteria on clinical, radiological and laboratory findings.
We base radiological criteria on dissemination or propagation in time and space, so it is not possible to make a diagnosis at one point, sometimes even magnetic resonance imaging must be performed repeatedly.
Oligoclonal antibodies (IgGs), which indicate a chronic inflammatory process, can be identified by lumbar puncture. In MS patients, up to 85% of oligoclonal antibodies in the blood are positive.
Symptoms of MS depend on the affected part of the CNS. The classic symptoms are internuclear ophthalmoplegia, Lhermitte’s symptom, vascular sensory disturbances, pyramidal symptoms, neurogenic bladder, optic neuritis.
The onset of symptoms is unpredictable and lasts for 24 hours or more. Symptoms usually decrease slowly, and remission may be incomplete. We should remember it that any infection can provoke a pseudo-relapse.
Multiple sclerosis has a clinical classification that is determined clinically. The treatment depends on it.
- Relapsing-remitting course –
The most common form of MS (40%). There are sudden outbreaks of the disease, between which there is a stable state of health. Occasionally, after relapses, the patient’s general health may deteriorate. Because of this form of MS, the health condition of the MS patient deteriorates (50% change to a secondary progressive course within 10 years if left untreated);
- Secondary progressive course –
This form of the disease mainly develops where relapsing-remitting MS has not been treated. In this form, recurrences are possible and do not always occur. Patients’ health deteriorates. In about 15 years, the disease can lead to the need for assistive devices (cane to wheelchair);
- Primarily progressive –
Patients do not have an outbreak of the disease, but the symptoms of the disease progress regularly and stably.
Health deteriorates over the years, although some MS patients experience months and even years during which the disease does not progress.
This form of the disease is not characterized by exacerbations or rapid improvements. This form of MS is most common in women and men over 40 years of age. The initial symptoms are gait disturbances and difficulty walking. Health deteriorates faster than with other forms of MS.
MS is not a completely curable disease.
We distinguish between the treatment of acute episodes, immunomodulatory treatment, symptomatic treatment and rehabilitation.
The goal of treatment is to reduce the inflammatory and demyelinating process to delay further relapse and reduce the progression of disability.
To treat acute relapses, Methylprednisolone 1000 mg / day is used for 3-5 days depending on the defect. Sometimes, plasmapheresis is used when there is no effect from methylprednisolone.
Immunomodulatory therapies include medications that reduce the number of relapses in a relapsing-remitting process.
These include Interferon beta 1a (Avonex, Rebif), Interferon beta 1b (Betaferon, Extavia), glatiramer acetate (Copaxone), immunosuppressive therapy – Natalizumab (Tysabri), mitoxantrone.
We have set inclusion criteria for patients who can receive public funding for a medicine by decision of the council. Of course, these medications have side effects that can cause the patient to stop taking them.
Of course, these medications have side effects that can cause the patient to stop taking them.