Multiple sclerosis

Multiple sclerosis (disseminated encephalomyelitis) is a chronic disease of the brain and / or spinal cord, characterized by inflammation of the sheaths of nerve fibers (myelin sheaths) occurring in various parts (hence disseminated) of the nervous system and leading to the formation of scar tissue (sclerosis).

Causes

The incidence of multiple sclerosis in Europe is in the range of 50/100,000 inhabitants. The disease usually begins between the ages of 20 and 40. It proceeds paroxysmal (85%), with complete or partial disappearance of symptoms. Less common (15%) is a primary chronic progressive course of the disease, that is, a gradual, slow worsening of symptoms without attacks.

The cause of multiple sclerosis is unknown. It is assumed that this is an autoimmune disease, that is, a disease in which, without the presence of an infection caused by a specific pathogen, the immune system reacts to the tissues of its own body. In this case, the myelin sheaths (sheaths of nerve fibers) are usually damaged, so that we are talking about the so-called demyelinating (destroying myelin) disease, less often directly nerve fibers (axons) are affected. A previous viral infection is also discussed, which is a possible cause of this “erroneous” immune response of the body.

Symptoms

The symptoms of multiple sclerosis are varied, since any part of the central nervous system can be affected. Most often found:

• decreased visual acuity (due to inflammation of the optic nerve);
• double vision;
• movement disorders (stiffness);
• sensitivity disorders;
• violations of coordination;
• loss of control over urination;
• concentration disorders, memory problems.

Diagnostics

Important elements of diagnostics are patient questioning, clinical neurological examination, MRI of the head (magnetic resonance imaging), as well as the cervical and thoracic spinal cord, examination of the cerebrospinal fluid, measurement of the conductivity of nerve fibers using weak electrical impulses. (visual evoked potentials (VEP), somatosensory evoked potentials (SEP) or motor evoked potentials (MEP).

Treatment

In the treatment of multiple sclerosis, a distinction is made between the treatment of an acute attack, the prevention of an attack, and symptomatic (treatment of the manifestations of the disease) therapy.

In the treatment of an acute attack, after exclusion of the presence of infection and with existing symptoms, treatment with cortisone 3-5 x 1000 mg is carried out, cortisone is administered intravenously, at the same time prevention of the occurrence of gastric ulcers (for example, pantozol) and prevention of blood clots (heparin subcutaneously) are carried out. If there is no obvious improvement after two weeks of treatment, a second course of cortisone treatment is carried out up to a maximum of 5 x 2000 mg. In exceptional cases, plasmapheresis (purification of blood plasma) is indicated.

In the prevention of an acute attack immunomodulatory therapy is carried out, which suppresses the “erroneous” immune response of the body. The best medicines for this are interferon preparations (Rebif, Avonex, Betaferon) or glatiromer acetate (Copaxone), which are administered using an injection pen. Therapy with second-line drugs - immunosuppressive therapy using imurek ( taking pills suppresses the entire immune system), in rare cases, treatment with immunoglobulin (intravenous administration of antibodies) is possible.

If, despite immunomodulatory therapy, repeated attacks occur or the number of symptoms and their severity increase, drugs that suppress the immune system or chemotherapy drugs such as mitoxantrone (Ralenova) or a drug belonging to the Anti-Alpha 4-Integrin- monoclonal antibody group are used. Antikörper Natalizumab (Tysabri).

Equally important is the symptomatic therapy of possible disorders that have not completely disappeared. It includes physiotherapeutic treatment of movement disorders (stiffness), supplemented, if necessary, with medications (antispastics). Classes with a speech therapist can help with violations of speech function and the act of swallowing. In case of loss of control over urination, after a urological examination, drug therapy or self-catheterization of the bladder by the patient is indicated.

With the help of adequate and timely prescribed treatment, it is possible in most cases to prevent a severe course of the disease.

Why you should contact us: 

• The diagnosis and treatment of multiple sclerosis is one of the main activities of our private neurological practice at EuromedClinic.
• We can urgently carry out both a neurological examination and the necessary additional examinations using special devices (including MRI in the X-ray department of the hospital), as well as an examination of the cerebrospinal fluid (spinal puncture).
• If necessary, long-term treatment, removal of acute attacks, as well as inpatient treatment are possible. In addition, the practice's attending physician explains various forms of therapy, and a nurse, specially qualified to work with patients with multiple sclerosis, will teach you how to use a syringe - injector on your own.