About 47,000 people are diagnosed with Multiple Sclerosis in Spain, according to data from the organization Esclerosis Múltiple España. Today, World Multiple Sclerosis Day, we wanted to count on the collaboration of the specialists in Neurology and members of Top Doctors, Dr. Murie Fernández, Dr. Mateos Marcos and Dr. Arias Gómez, to go a little deeper into this disease.
What is multiple sclerosis?
Multiple Sclerosis (MS) is a chronic disease of the Central Nervous System (CNS), which affects the substance that covers the neurons, the myelin, and for this reason we sometimes refer to it as a demyelinating disease, as defined by Dr. Murie Fernández.
The cause is unknown. “An autoimmune and multifactorial deficiency is suspected with the participation and interaction of different genetic factors and environmental factors, such as insufficient exposure to sunlight, a deficit in vitamin D levels or possible contact with some viruses during childhood” adds Dr. Murie Fernandez.
What are the symptoms?
Around 80% of MS patients start their disease with a “flare-up”. The first symptoms or signs of neurological dysfunction appear with a duration of more than 24 hours. Dr. Mateos Marcos indicates that the first frequent reasons for consultation are the manifestation of:
1) Sensory Symptoms: loss of sensitivity in one part of the body, especially suspicious if it affects one side or the trunk and both lower limbs.
2) Motor symptoms: weakness or loss of strength in one part of the body or in both lower limbs.
3) Brainstem symptoms: among which double vision is the main symptom.
4) Cerebellar signs: with gait instability (ataxia) as the primary symptom.
5) Ophthalmologic symptoms: onset with optic neuritis to the head and, consequently, decrease in visual acuity.
In 85% of cases, the disease most often presents in flares, although over the years, up to 40% of patients may progress to a progressive course.
The progression of a patient diagnosed with MS is unpredictable and cannot be compared to that of any other patient. “In addition, we are currently at a historic moment for the disease, since new treatments have come onto the market that are going to modify the course of the disease,” emphasizes neurologist Dr. Murie. The latest data are positive, as Dr. Murie explains. Arias Gómez: “one third of the cases maintain an active life, 20 years after the onset of symptoms; another third have moderate limitations and finally another 30% require a wheelchair”.
Genetics and motherhood vs. multiple sclerosis
It is important to emphasize that MS is not hereditary. For the moment, there does not seem to be a very negative influence of contagion during pregnancy from a mother with this disease to her child.
Unlike other pathologies, heredity does not play a decisive role in MS. Dr. Arias Gómez points out that if one parent is affected, the risk for their children does not exceed 5%. Although multiple sclerosis does not affect the reproductive system, several aspects should be taken into account, such as the fact that most of the treatments provided are contraindicated in pregnancy. Certain intravenous corticosteroids are relatively safe during pregnancy, but other medications such as Cyclophosphamide or Interferon Beta should be avoided or discontinued. Thus, there should be a pregnancy planning with the responsible physician, who should decide how to proceed with this medication. On the contrary, different studies have shown an increase in the rate of flares after childbirth.
Treatment of multiple sclerosis
There is currently no cure for MS. This does not mean that there are no “benign forms” of the disease, i.e. the patient remains functionally independent 15 years after diagnosis.
Regarding treatment, Dr. Mateos Marcos tells us that when recommending treatment, it must always be individualized according to the personal circumstances of each patient. In this sense, three ways of acting are considered: firstly to treat the outbreak; on the other hand, in the prevention of new outbreaks, relapses and/or long-term disability and, finally, in the treatment of specific neurological symptoms such as pain, asthenia, spasticity, tremor, among others. In the latter cases, the methodology does not differ from that used for other neurological pathologies with the same problems. One of the options is neurorehabilitation treatment, which offers very positive results in the control of symptoms, both in terms of movement and cognitive impairment, fatigue or mood problems. It is planned on a long-term basis, should be intensified when a flare-up appears and may include other therapies such as physiotherapy, occupational therapy, neuropsychology or speech therapy.
As a point of hope, we must highlight that thanks to the latest advances, drugs are available that, by acting on the immune system, are capable of modifying the course of the disease.