Multiple sclerosis

What is multiple sclerosis?

Although the cause is still unknown, the immune system is understood to react in a way that damages the body’s myelin. Loss of myelin causes alterations to brain function, the spinal cord or the optic nerve, and may cause the loss of neuronal tissue. Long term, it can also directly destroy the neurones themselves. 

Areas where myelin is lost, called “lesions”, or “demyelinated plaques” appear as hardened areas in nervous tissue. These lesions can appear in multiple locations in the brain, the spinal cord or the optic nerve.

Symptoms

There are multiple symptoms that can appear in two contexts: in the form of specific episodes and/or with increasing disability. 

Flare-ups are periods of clinical changes lasting more than 24 hours and that tend to diminish with time, although in some cases there may be lasting effects. If the disease progresses, however, then symptoms appear gradually and accumulate fairly progressively and slowly. Some people only suffer a period of flare-ups, in others the disease is only progressive, and for others it may become progressive following a period of flare-ups.

Depending on the areas affected, symptoms can include:

• motor symptoms, difficulty moving a part of the body
• sensory symptoms, a change or lack of feeling
• visual symptoms, double or blurred vision  
• cognitive problems, changes in memory recall or concentration problems, amongst others  
• fatigue  

Balance and coordination may also be affected, as well as urinary function and sexual function.

Who is affected by multiple sclerosis?

The number of cases of multiple sclerosis is on the increase worldwide, and has reached a figure of 230 in every 100,000 people in some regions. In Spain, its prevalence is around 100 cases for every 100,000 people. 2.3 million are estimated to be affected around the world, of whom 45,000 were diagnosed in Spain and 7,500 in Catalonia. It is more common in women; two to three women are diagnosed with MS for every man affected. It is usually diagnosed in young adults. Although genetic factors do play a role, it is not considered an inherited disease. Studies show that the increase in cases diagnosed could be due to improvements in diagnostic methods and the quality of epidemiological studies, but also due to the increased risk posed by environmental factors. Vitamin D deficiency is currently associated with the disease.

Diagnosis

Diagnosis is complex and carried out by studying the patient's medical history, neurological testing, MRI scan, lumbar puncture and evoked potentials.

Typical treatment

Treatment for multiple sclerosis is divided into treating the cause and treating the symptoms. 

Treating the cause is based on administering drug treatments orally, endovenously or subcutaneously to try to slow the progression of the disease. Nowadays, a series of drugs of varying efficacy, safety and tolerability are available. The current challenge is to provide the right drug for the right patient; an approach known as “personalised” or “precision medicine”, in addition to quickly detecting patients who do not respond well to a given treatment.

Treating the symptoms: drug treatments are available for some symptoms but not others. A holistic approach to multidisciplinary rehabilitation is used where drug treatments are not available. This type of treatment has been shown to be effective at reducing the impact of the disease on patients’ social life and activities.

Prevention

Although there are no specific recommendations to prevent the disease, a healthy lifestyle is important (healthy diet, not smoking, moderate exercise, etc.). This will encourage better brain health and can prevent the disease worsening.