December 18 is National Multiple Sclerosis Day, a disease that affects 100 out of every 100,000 inhabitants in Spain. Dr. Yusta, an expert in Neurology, talks about the advances in treatments and research on Multiple Sclerosis, as well as the importance of the environment to have a better prognosis.
What is multiple sclerosis?
Multiple sclerosis is an inflammatory and neurodegenerative disease of the central nervous system (brain, brain stem and spinal cord), which affects the coating (myelin) that covers the extensions (axons) of neurons. This “attack” on myelin occurs because our organism does not recognize as its own some component of which it is formed. For this alteration to occur, a type of white blood cells called B lymphocytes and T lymphocytes will play a key role in the onset of the disease.
This pathology usually occurs in young people, between 20 and 40 years of age, more in women than in men, and is very rare before 15 and after 50 years of age. It is the leading cause of disability in young people in the developed countries of the northern hemisphere. In Spain the prevalence of the disease is 100 patients per 100,000 inhabitants.
What causes multiple sclerosis?
Genetic and environmental factors are involved in its development. Thus, the risk of suffering from the disease when one of the parents or siblings (not twins) suffers from it occurs in less than one out of ten cases. If the sufferer is an univitelline twin, in three out of ten cases there is a probability that the other twin will suffer from the disease.
However, there are environmental factors that would explain up to seven out of ten cases of multiple sclerosis. If we are born in a country and live there during the first 15 years of life, we will have the risk of suffering from the disease of that country. If we are born in this country, but move to live before the age of 15 in another country, we will have the risk of having the disease of the latter. Therefore, environmental factors in the first 15 years of life appear to be critical to the development of the disease.
These factors involved are still debatable and none has been found to be of paramount importance. It has been observed that people who had less intrauterine solar radiation (when their mothers were pregnant with them) have a higher risk of suffering from multiple sclerosis. This would explain, in part, why northern European countries with less solar radiation have a higher prevalence of this disease. It has also been observed that low levels of vitamin D would activate the immune system and would be a factor that would worsen the prognosis when already suffering from the disease. The same happens with tobacco. There is a compound in tobacco that would also stimulate the immune system.
Other factors have been found that could be risk factors for suffering it, such as high salt consumption, obesity in adolescence, infection by the Epstein-Barr virus that causes infectious mononucleosis, among others.
How is multiple sclerosis diagnosed?
Multiple sclerosis, by “breaking the myelin” will produce the so-called “plaques” of demyelination and, depending on their location in the central nervous system, they will produce neurological symptoms. The most frequent symptoms will be loss of vision in one eye, loss of strength or dexterity in a limb, alterations of sensibility in one part of the body, difficulty in walking or in urine control. These symptoms are called “flare” and will last more than a day and, in most cases, resolve in less than a month. It is very common that once the symptoms have passed, they may reappear when there is a fever or an increase in body temperature.
Given this clinical suspicion, the neurologist will perform a magnetic resonance image, in which images of the demyelinating plaques distributed throughout the brain and/or spinal cord will be observed. With a suggestive clinical picture and the images provided by the MRI, multiple sclerosis can be diagnosed. Subsequently, a lumbar puncture will be performed in which cerebrospinal fluid will be obtained to evaluate the inflammatory activity that the central nervous system is undergoing, by studying the so-called oligoclonal bands.
Treatment for multiple sclerosis
Once the diagnosis has been made, a personalized and individualized treatment is proposed to the patient.
At present we have multiple treatments that make it possible to reduce the frequency of outbreaks and to reduce disability throughout the evolution of the disease. In the last 20 years the prognosis of the disease has changed radically. We can now choose which treatment is best suited to a patient, according to sex, age, life expectations, type of activity and work, etc. With these treatments, almost half of the patients are now free of disease activity, although not cured.
We can also give different treatments depending on the activity or severity of the multiple sclerosis. If the MS is very active (repeated flare-ups, no recovery after a flare-up), we can give more potent treatments from the beginning. If it is not very active, we can use other treatments with less risk of side effects.
On the other hand, it is very important to treat the symptoms produced by the disease. One of the most frequent symptoms is intense tiredness and fatigue. We have pharmacological and physiotherapy treatments that will improve this tiredness. Also the symptoms of lack of sphincter control, pain, gait disturbance, increased muscle tone, sexual dysfunction, depression, … These can be treated and controlled properly by your neurologist, who will guide you on the best way to do it.
Much research is being done, and in the coming years more treatments will come out that will further improve the prognosis and quality of life of patients with multiple sclerosis.
The importance of family, work and society
It has been observed that family support is very important for patients diagnosed with this disease. Psychological support in a chronic disease such as this will be fundamental for a good quality of life and sense of well-being.
Follow-up studies have shown that about half of the patients with multiple sclerosis have reduced or stopped working. It is necessary to adapt the workplace to these patients with simple measures such as placing the workplace near a bathroom, adequate lighting and temperature or taking breaks every several hours to avoid fatigue. With these simple measures, the patient will be able to develop his activity, practically, as if he did not have the disease.
With the development of social networks, multiple sclerosis is becoming more visible. This has undoubtedly positive aspects in the general knowledge of the disease and in the sharing of experience, but there is also a lot of inaccurate and often misleading information on the “net”.
It is essential that the patient with this disease has a relationship of trust with his neurologist, who will explain the prognosis, the individualized treatment that can be applied, the treatment for the symptoms that appear and will be his support when he needs it.