Multiple sclerosis (MS)

Like a control centre, it transmits electrical impulses through nerve fibres. The nerve fibres are surrounded by an insulating layer.
A white fatty substance called myelin is the main component of this insulating layer. In people with multiple sclerosis, it is irreversibly damaged by a defensive reaction of the immune system. The individual impulses can thus be transmitted only slowly or not at all.
Around 200,000 people in Germany have MS, which often occurs for the first time between 20 and 40 years of age. For reasons that remain unclear, adult women account for more than half of the 2,500 new cases in Germany each year.

The causes for MS have not been determined to date. However, it has been established that, with this condition, specific defence cells normally used by the body’s own immune system to respond to external pathogens are incorrectly programmed. Instead of external structures, they target those of the body (namely, the myelin of the myelin sheath and myelin basic proteins).
Numerous theories regarding the onset of multiple sclerosis have therefore been discussed in the past, and corresponding studies were carried out. There appear to be connections with a genetic disposition, and the roles of the Epstein-Barr and HHV-6 herpes viruses were closely examined as well. At this point, it is suspected that a whole host of factors leads to the development of the disease.

Many different neurological symptoms may occur in MS patients. They include vision impairments (among them double vision), bladder function disturbances, spastic paralysis of the limbs, fatigue and fine motor disturbances. These symptoms are frequently expressed in the form of attacks caused, for example, by physical and mental stress or also infections. They can differ in severity and frequency.
The disease progression of MS is believed to be varied:

• Initially, MS mainly occurs in the form of attacks (approximately 85 to 90 per cent): one or more neurological symptoms occur for only a short time, meaning they abate again (almost) entirely after a few days.

• Around 30 to 40 per cent of patients who initially have attacks develop worsening impairments over a period of 10 to 15 years. This is then called a secondary, chronic, progressive disease progression.

• In 10 to 15 per cent of patients, the disease begins directly with the primarily chronic, progressive variant. Neurological symptoms that occur do not abate again with this disease progression. However, this is comparatively rare. Mixed forms of these basic forms of the disease occur as well.

The attending neurologist can use a broad range of diagnostic procedures to determine whether a patient has MS. However, this is preceded by taking down the individual’s medical history in detail (anamnesis).
If the anamnesis substantiates the suspicion of MS, clinical tests provide further information. Extensive analyses of the patient’s motor skills, coordination, reflexes, vision and strength are carried out. This makes it possible to determine the extent of damage to neurological functions and the affected areas of the brain. Electro-physiological tests (testing the sensation in the limbs) can also be used to determine the conductivity of the nerve fibres.
Magnetic resonance imaging (MRI) visualises the inflamed regions of the CNS. Another examination method is a lumbar puncture or spinal tap, in which the patient’s vertebral canal is punctured between two lumbar vertebrae to collect a sample of liquor.

There is currently no treatment that can address the root causes of multiple sclerosis. In contrast to previous assumptions, moderate sports activity is recommended with nearly all types of MS. When MS patients are affected by spasticity, regular physiotherapy (physical therapy) and/or the use of devices such as orthoses is recommended. The therapy can also be supplemented by administering medications when indicated.