Multiple sclerosis • What is MS?

Multiple sclerosis (MS) or encephalomyelitis disseminata, as the disease of the central nervous system (CNS) is called in medical jargon, is small inflammatory changes at various points in the CNS in the so-called white matter. The focus of inflammation leads to malfunctions, for example in the transmission and processing of nerve impulses. Multiple sclerosis Visual disturbances, Limitations of motor skills or different Feeling disorders occur. The large number of symptoms, which can vary greatly from patient to patient, are characteristic of this disease.

In the case of MS patients, their own immune system erroneously against the body's own structures. If the resulting inflammation on the nerves subsides again, scars remain on the affected areas, which harden. The multitude of these pathological changes gives the disease its name: multiple stands for multiple, sclerosis for hardening. Most of the patients develop MS Spurts. This means that disease symptoms appear at certain time intervals, which, however, disappear completely or at least partially. However, as the disease continues, it becomes more and more likely that some of the complaints will persist.

Who and how many are affected by multiple sclerosis?

According to the treatment guideline for doctors, around two million people worldwide live with MS. In Germany there are more than 120,000 patients. Between 3.5 and five people per 100,000 inhabitants develop new diseases every year Autoimmune disease of the central nervous system, with an upward trend. It is the most common chronic inflammatory disease of the CNS and, after epilepsy, the second most common neurological, i.e. nerve-related, disease. As a rule, MS is diagnosed between the ages of 20 and 40, with the peak of the disease being around the age of 30. Seldom does the disease begin under ten years of age or beyond the age of 60, although these age groups are also becoming increasingly ill. The frequency of multiple sclerosis is increasing, especially among women.

Why are women affected much more often?

Female Brains tick a little differently than male ones. This common-sounding insight could take the understanding and therapy of multiple sclerosis (MS) a big step forward. This is suggested by results that researchers from the University of Washington (School of Medicine) have achieved. For their study, they examined mice on the one hand, and people who had MS and who had already died on the other. Using the mice, the team identified 20 genetic differences between MS brains and the thinking organs of healthy animals. One of these genes carries the code for a protein (protein) called S1PR2 – which the researchers also found in the brains of human MS patients. "It was a 'bingo' moment," said study author Robyn Sue Klein.

The protein found makes the barrier between the blood vessels and the brain that Blood-brain barrier, apparently permeable to immune cells. These cells trigger the symptoms of multiple sclerosis in the case of MS. This includes paralysis, vision and speech disorders. The protein found to be the culprit is far more common in female mouse brains. The author is now hoping for a method to measure the S1PR2 concentration in the brain of living MS patients. "This is an exciting, first step towards solving the puzzle, which is why MS is so dramatically more common in women," says Klein.

Multiple sclerosis in people with fair skin tones

That multiple sclerosis is more common in northern latitudes less sun exposure has led researchers to conclude that there may be a connection between the development of the disease and vitamin D. Our skin can only produce vitamin D if we spend enough time in the sun. In various studies, scientists had symptoms in children and adults at the time of the first symptoms decreased vitamin D levels proven.

Multiple sclerosis affects almost exclusively fair-skinned people: the disease is less common in countries near the equator than in countries further north or south. The risk of MS is particularly high among people of Scandinavian origin, i.e. among Norwegians, Swedes or Finns. African Americans, on the other hand, have a ten times lower risk of getting sick. The genetic background the patient seems to play a role in this.

Causes of Multiple Sclerosis

In multiple sclerosis, the body's own defense cells attack the medullary sheaths, a protective covering that surrounds the nerves. This happens because the immune cells – the so-called antibodies – confuse the cells' own structures with those of bacteria or viruses that they are actually there to fight. In short: the immune system attacks your own body. That is why MS is an autoimmune disease. A variety of foci of inflammation ("plaques") develop, which can result in damage to the nerves. This in turn leads to nerve signals not being passed on properly, which can result in vision problems or gait disorders, for example.

How the disease MS develops and what causes the immune system to attack the protective covering of the nerves has not yet been clarified. There have been and still are different theses and assumptions, but none has so far been scientifically confirmed. For example, it was discussed that a certain pathogen causes multiple sclerosis. However, this was never found. Therefore, based on current knowledge, it is assumed that many different factors play a role in the development of multiple sclerosis (multifactorial genesis). It seems certain that genetic predisposition and environmental factors affect the risk of disease and the course of the autoimmune disease. Also factors like Stress and a negative outlook on life apparently promote emergence

Disrupted nervous system in MS

MS is a nervous disorder in which the nervous system no longer works properly. The central nervous system (CNS) consists of the brain and spinal cord. At the base of the brain and from the spinal cord, nerves emerge, branch out and influence the function of every part of the body and organ. This part of the nervous system is called the peripheral nervous system (PNS) because of its strong branching and spread throughout the body. The flow of information from the periphery to the central nervous system runs in the opposite direction via other nerve tracts. In this way, the sensory organs, for example the skin, eyes and ears, transmit information (“sensory impressions”) in the form of electrical impulses.

The rough plan of the nervous system is not a tangled tangle of cables, but the same for everyone. The extensions of each nerve cell, so-called axons, pull through the CNS in an orderly and fiber-like manner in order to interconnect brain parts. Sometimes the path of these bundled nerve cell extensions is quite long. Microscopic nerve cells form axons up to one meter long to reach their target area. So that the electrical impulses are conducted as quickly as possible over such long distances, the axons are wrapped with a kind of insulating layer.

It consists of the membrane, i.e. the cell envelope, of another cell type, the glial cells. This special insulating tape is also called Myelin(-layer). In the inflammatory foci of multiple sclerosis, the myelin is damaged, one speaks of demarking or demyelination. The result of this damage is an impaired forwarding of Nerve impulses in the nervous system. Therefore, there are various failures in MS: disorders of sensory functions and disorders in the control of organ functions.

After a multiple sclerosis episode, when the inflammation subsides, the myelin can be partially regenerated by the glial cells. However, these regenerated myelin sheaths are usually thinner than before demyelization, which is why it becomes one slower transmission the nerve impulses can come. If the regeneration process of the myelin sheath in the nervous system is not complete, or maybe the axon is already damaged, permanent damage and signs of the disease appear.

MS symptoms such as blurred vision and muscle weakness

Signs of multiple sclerosis vary widely. This can be explained by the numerous tasks of the nervous system. Almost every symptom can be understood as a failure or impairment of a function in the central nervous system. Most of the patients develop MS Spurts. If there are previously nonexistent disorders and failures due to one (or more) acute focus of inflammation that persist for at least 24 to 48 hours, one speaks of a relapse. This does not come suddenly, such as an epileptic seizure, but develops over several days or weeks.

After a push, the person affected can become symptom-free again. However, symptoms can also remain due to the scarred healed inflammation in the nerve tissue. How often relapses occur and how long they last cannot be predicted, however, as the duration of the illness increases, it is more likely that some of the complaints will persist. In some patients, the relapsing sometime in one progressive course pass over. This means that the impairments slowly but steadily increase and do not recede. However, there are also multiple sclerosis patients who do not feel particularly affected by the disease throughout their lives.

Typical symptoms are listed below, but not all of them have to occur in every patient. In addition, the symptoms can vary in severity.

• Severe fatigue: It is one of the most common symptoms, affecting approximately two thirds of the patients. Leaden fatigue can last for months and appear in the morning, usually increasing during the day (fatigue – the chronic fatigue syndrome – can also be a symptom of other diseases).
• Muscle weakness: At the beginning, it can simply be expressed by the fact that at the end of the day you can no longer lift a leg with normal effort. In the advanced stage, walking aids are sometimes required.
• Sensitivity disorders, sensations: Some patients have numb feet, others have tingling fingers. They feel like ants are running over their skin, or walking feels like walking on cotton wool. Sometimes there is a painful burning of the limbs.
• Sudden visual disturbances: These can be phases of fog vision or fog in front of one eye that last for a few days. Color vision disorders are also possible. Sometimes there is even temporary blindness. Another form of vision disorder is double vision, which is due to (temporary) paralysis of one or more eye muscles. Many sufferers also suffer from optic nerve inflammation.
• Paralysis: Due to damage to the central nervous system, the muscles contract and contract. Doctors call this spastic paresis. Depending on the severity, those affected are only slightly restricted in their movement or, in extreme cases, severely impaired.
• dizziness
• a headache
• Concentration and memory disorders
• Swallowing disorders
• Speech disorders
• involuntary eye movements
• Coordination and gait disorders: They are based on an impaired function of the movement center in the central nervous system, which gives the instructions to the muscles. This can result in a wobbling gait, but also tremors (tremors) when trying to grip something. Coordination disorders often also affect the speaking muscles, so that those affected speak slowly, unchecked and washed out (chanting language).
• Bladder and bowel disorders: Very strong urge to urinate, which can no longer be controlled, is typical. Constipation can be caused by the disease itself or a lack of exercise.

Other possible symptoms in MS:

• Pain: Cramped muscles and poor posture can be the cause. Trigeminal neuralgia is pain that is triggered by the facial nerve.
• depressions Multiple sclerosis can have two causes. Sometimes they arise in response to the disease itself, in other cases they are a direct result of the central nervous system's focus of inflammation.
• Sexual disorders: Erectile dysfunction in men as well as reduced sensitivity, pain during sexual intercourse and dry vagina in women – these can also be consequences of multiple sclerosis.

Multiple sclerosis: the diagnosis

Diagnosing the disease is not easy. Symptoms such as visual disturbances or numbness in the limbs can have numerous other causes: Similar symptoms appear in tumors of the spinal cord, infectious diseases such as Lyme disease and toxoplasmosis as well as genetically caused myelin diseases. The diagnosis of exclusion is often lengthy, on average three to four years pass from the first symptom to the diagnosis.

In order to make or rule out the diagnosis of multiple sclerosis, the doctor will first ask what symptoms the patient has. It is also important for the doctor to find out whether autoimmune diseases are common in the family. If the symptoms indicate MS, the doctor will usher in a series of tests and examinations that will provide him with information about possible damage (lesions) in the central nervous system.

The most important examination methods include:

1. Neurological examinations

During the neurological examination, the doctor checks the cranial nerves by Muscle strength, fine motor skills, sense of touch, coordination, sensitivity, muscle tension, reflexes, visual acuity, smell, swallowing and speaking judged. For all of these functions, it is important that the body properly transmits nerve signals. The conductivity of electrical impulses in the central nervous system is reduced in multiple sclerosis. The doctor can determine this conductivity by stimulating the nerves with certain stimuli and by using electrodes to transmit the information transmitted by the nerve to another part of the brain. This is also called measuring the Nerve conduction speed. The following neurological examination methods are distinguished:

• visually evoked potentials (VEP): The eye is stimulated by a monitor. Electrodes on the back of the head measure the time until the nerve impulse arrives and thus the conductivity of the optic nerve.

• somatosensitive evoked potentials (SEP): The conductivity of sensitive webs is checked using weak electrical stimuli in the wrist or ankle. Here, too, the electrodes are applied to the head for dissipation.

• acoustically evoked potentials (AEP): An acoustic signal serves as a trigger for a nerve impulse, the derivation also takes place on the head.

2. Lumbar puncture (CSF examination)

Brain-spinal fluid (cerebrospinal fluid) is removed from those affected. Certain changes typical of multiple sclerosis can be detected. However, this does not apply in all cases.

3. Magnetic resonance imaging (MRI)

Magnetic resonance imaging can be used to detect lesions in the brain and spinal cord. Small inflammations and scarring in the brain are clearly visible on it. Active inflammatory foci during an episode can also be detected with the MRI. Other studies that can provide information about multiple sclerosis include:

• Computed tomography (CT)
• Perimetry: method of determining the visual field
• Myelography: Examination to show the space between the spinal cord and the meninges
• Electroencephalography: measurement of potential in the brain
• Optical coherence tomography (OCT): method for examining the retina in the eye

The course forms of multiple sclerosis

The course of MS is usually divided into three phases:

1. The most common form of multiple sclerosis manifests itself relapsing. Women are affected two to three times more often than men. Most patients experience symptoms of a relapse within six to eight weeks. If the disease is not treated, the relapse rate at the beginning of the disease is an average of 1.8 relapses per year. Several weeks, months or even years can pass before the next batch. The recurrence of the relapses is also called relapsing-remitting course designated. In the early stages of MS, doctors speak of clinically isolated syndrome (HIS). After ten or more years, this course usually turns into a chronic progressive.

2. If left untreated, at least 50 percent of patients experience an average after 10 years chronic progressive Gradient shape multiple sclerosis. It stands for the gradual increase in symptoms (secondary chronic progression). The disabilities no longer disappear completely, but continue to increase regardless of the occurrence of a relapse. This form is often referred to as the second stage of multiple sclerosis.

3. The primarily chronic Gradient shape Multiple sclerosis affects about ten percent of those affected. Here, the symptoms worsen continuously from the beginning without clearly delineated episodes. This form is also called primary progressive course (PPMS) denotes and affects patients with a later onset of illness from the age of 40.

About a third of patients with MS have to retire early. Those affected today have one due to the medical care and the available aids normal life expectancy. Only in very rare cases when inflammation causes respiratory paralysis does it lead to death. However, a therapy that cures the disease does not yet exist. Those affected have to live with the disease and the resulting restrictions, since only the symptoms can be alleviated. The unpredictability of the disease is an enormous burden for many sufferers. In Germany, however, as in many other European countries, there are numerous associations and self-help groups in which those affected can exchange ideas and find help with legal matters.

Medicines and physiotherapy: this is how MS is treated

With a relapsing course of the disease, which occurs in about 80 percent of patients in the first years, the Acute therapy used. The Basic therapy or immunoprophylaxis aims to slow the progression of the disease. This happens through preventive action on the immune system, which attacks the protective covering of the nerve fibers in multiple sclerosis and causes inflammation there. The aim is to reduce the number and severity of the flare-ups. The symptomatic therapy of MS is aimed at alleviating the diverse symptoms that can accompany the disease.

Medical cannabis: areas of application

Acute therapy for multiple sclerosis

An MS flare does not necessarily have to be treated with medication. The underlying inflammation also heals on its own, through a Cortisone therapy however, this process is greatly accelerated. Cortisone has both an anti-inflammatory and an immune suppressive (immunosuppressive) effect. Cortisone (also Glucocorticosteroids or glucocorticoids) restore the blood-brain barrier, which, according to recent findings, becomes permeable to certain immune cells during episodes of illness. For this purpose, the drug is injected into the vein in high doses for three to five days. The active ingredient may then be taken in the form of tablets for a further two weeks. In contrast to continuous cortisone therapy Shock therapy usually well tolerated in an MS relapse. The process is also called GKS pulse therapy or GKS shock therapy designated. The active ingredient of first choice is included Methylprednisolone, an artificial corticoid. An initial GKS pulse therapy should stationary be carried out in the hospital in order to be able to react quickly to any side effects that may occur with this therapy. Repeated treatments can also vary depending on the severity of the relapses, susceptibility to infection and the home situation outpatient be made.

Another way to treat the flare-ups is Plasma operation or Plasmapheresis. It is a kind Blood wash: Blood is drawn from the body via the neck or arm vein and the liquid plasma is separated from the blood cells in a centrifuge. The plasma is replaced by foreign plasma or human albumin and then returned to the body. The goal is to remove components of the blood that cover the nerve fibers Myelin, damage. This treatment is usually used when there is no improvement with GKS pulse therapy.

Basic therapy for MS

The beneficial effect on the immune system is the main goal of long-term therapy for MS. For the basic therapy of multiple sclerosis see the guidelines of the German Society for Neurology on the one hand Glatiramer acetate in front. The composition of the synthetic protein molecule resembles the protective cover of the nerve cells and reduces the inflammatory reactions. It is injected under the skin daily, and the injections can also be carried out by the patient after instruction.

Play an increasingly important role in the continuous therapy of multiple sclerosis Beta interferons. You are one of them Cytokines. This includes the body's own proteins that help the immune system to activate other cells. Among other things, beta interferons have an anti-inflammatory and regulating effect on the immune system. In addition to the drugs glatiramer acetate, they are part of the basic therapy for multiple sclerosis. Beta-interferons, like glatiramer acetate, must be injected under the skin.

Symptomatic therapy for multiple sclerosis

Also the symptomatic therapy which the Alleviate symptoms of multiple sclerosis should play an important role. Complications such as respiratory and urinary tract infections caused by the patient's inactivity are treated with medication. Spasticity can also be inhibited by drugs called muscle relaxants. So-called intrathecal baclofen therapy is one option. An important part of therapy is conservative treatment with physiotherapy, occupational therapy and speech therapy. These can alleviate, correct or prevent muscular problems. Consequences of immobility should be prevented and existing skills should be preserved. There are a number of special types of therapy, such as the Bobath concept (based on neurophysiology), hippotherapy (therapeutic riding) and pelvic floor exercises, but also relaxation techniques such as yoga or autogenic training.

Involve other specialists

The neurologist will examine the therapy at regular intervals to determine whether and how the disease is progressing. Based on the findings, the disease can be classified on an internationally common scale such as the EDSS (Expanded Disability Status Scale). All subsequent examinations can then determine whether and to what extent the disease has changed.

In addition to the neurologist, MS patients should also involve other specialists in the treatment. The ophthalmologist should be consulted for visual disturbances and the urologist or gynecologist for bladder dysfunction or sexual dysfunction. The relationship of trust between patient and doctor is crucial for the success of the treatment. The patient should be able to discuss all questions that concern him in detail.

Can you prevent multiple sclerosis?

Since the causes of MS are still unclear, it is also not possible to prevent it. However, the sooner adequate therapeutic measures are used, the better the progression of the disease can be delayed. Just as crucial as the doctor, the medication and other therapeutic measures is your own cooperation in therapy and dealing with the disease. The lifestyle influences the course immensely. A healthy, balanced diet has a positive effect. However, factors such as stress, overexertion and a negative outlook on life encourage the emergence of a new surge. Heat is also not good for those affected. In hot summer months, cool showers provide relief.

Nutrition in MS

Between Salt consumption and the course of the disease in multiple sclerosis is related. This is the result of a study led by MS researcher Mauricio Farez from the University of Buenos Aires. The team led by the scientist examined 70 patients with relapsing multiple sclerosis on a regular basis for two years, thereby taking images of the brain using magnetic resonance imaging / magnetic resonance imaging (MRI). At the same time, the researchers analyzed the Saline consumption of the subjects. They observed a worsening of the disease in patients with average salt consumption 2.7 times more often and in patients with high salt consumption four times more than those who ate a low salt diet. There was also the appearance of new ones Brain damage in connection with salt consumption: study participants who liked to eat salted food often had an average of eight new brain lesions more than those who used salt sparingly. Every gram of salt beyond the five gram mark was associated with an average of 3.7 additional brain lesions. Study leader Farez concludes from the data that MS patients may be affected by one low salt diet benefit. However, this conclusion cannot be drawn with certainty. Because it is still unclear whether a salt reduction actually slows the progression of multiple sclerosis, since it cannot be ruled out that severe multiple sclerosis increases the need for salt.

Multiple Sclerosis Nutrition

Special diet only in consultation with the doctor

The professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany, Austria, Italy and Switzerland have so far been advising on their platform "Neurologists and psychiatrists online" none specified diet. "So far, no particular diet or diet has had a positive, effective impact on the course or symptoms of multiple sclerosis prove it, "it says there. MS patients who want to test a special diet like the ketogenic diet based on the previous study situation should only do this in consultation with their neurologist (neurologist), the specialists advise. Otherwise, a balanced, Vitamin and fiber-rich diet is recommended.

In her lecture on the occasion of the 2nd Bad Mergenheim MS Day, Ulm-based nutritionist Friederike Preiß went into detail about how this could look like. Accordingly, people with MS should stop taking limit animal fats and instead increased valuable fatty acids use vegetable fats such as walnut, rapeseed, soy or linseed oil. Your recommendation: a maximum of two meat or sausage meals per week, daily milk and milk products, little egg yolk, low-fat products and whole grain products, at least two fish meals per week and at least two liters of liquid per day, whereby tea, water and fruit juices are particularly suitable.

Several studies have already shown that fat people are at a much higher risk of developing multiple sclerosis. Scientists are therefore trying to find out what is causing this link between being overweight and MS and how much the extra pounds increase the risk of MS. At MS Boston 2014, the world's largest congress on this disease, experts presented the current state of research.

Obesity in women doubles the risk of multiple sclerosis

Several studies prove that the risk of MS for Overweight is twice as large as for slim ones. However, this only applies to women. This relationship was not found in men. The risk of MS appears to be particularly high for overweight people girl To be: One of the studies showed that they have a four times higher risk of developing MS later in life than normal age peers.

Various studies are currently dealing with the issue of why fat deposits favor MS. The scientists tracked down investigations with mice:

• Fat people have remarkably low vitamin D levels. This favors nerve disorders.

• Fat cells form certain cytokines that spark inflammation in the body and change the immune response. This could have an impact on the body attacking the nerves in MS and destroying their envelopes.

• Hunger, on the other hand, defuses these auto-aggressive cells.

Ein gesundes Körpergewicht beziehungsweise eine Reduzierung von Übergewicht kann für Frauen also das Risiko für die Entstehung einer Multiple Sklerose verringern.

Leben mit Multipler Sklerose

Betroffene fühlen sich häufig extrem müde und schlapp. Die Planung mehrerer regelmäßiger Pausen im Tagesablauf hilft dann, die Energie einzuteilen. Den Alltag erleichtern können sich MS-Patienten ebenfalls, indem sie häufiger Haushaltsgeräte verwenden, Einkäufe besser planen und dadurch seltener in den Supermarkt gehen müssen. Bei Koordinations- und Gangstörungen sollte das Bad mit Griffen ausgestattet und mit Matten rutschfest gemacht werden. Stolperfallen wie hochstehende Teppiche am besten beseitigen. Wenn Probleme mit starkem Harndrang auftreten, darf auf keinen Fall die Trinkmenge reduziert werden. The Trinkverhalten sollte stattdessen dem Tagesablauf angepasst und entsprechend eingeteilt werden. Auf Bier und koffeinhaltige Getränke besser verzichten, sie wirken harntreibend.

Zu erheblichen Schwierigkeiten im Leben mit MS können sogenannte kognitive Dysfunktionen beitragen. Dazu gehören vor allem Aufmerksamkeits- und Gedächtnisstörungen. Um diesen zu begegnen, sollten MS-Patienten Stresssituationen meiden. Durch vorausschauendes Planen können Aufgaben nacheinander ohne Stress erledigt werden. Merkhilfen wie Notizzettel, Familienpläne bis hin zu elektronischen Hilfen unterstützen. Bei der Urlaubsplanung sollte Zeit für ausreichend Ruhe berücksichtigt werden. Es ist auch wichtig, sich keine unrealistischen Ziele zu setzen und Hilfe von Familie, Freunden und Bekannten anzunehmen.