MS is a chronic inflammatory autoimmune disease. The immune system attacks the body’s own cells in the patient’s brain and spinal cord.

Despite worldwide research, the causes of MS are not yet clear. Classical MS theory assumes that three factors cause the condition to manifest:

• Genetic predisposition: Approximately 15% of MS patients have immediate or extended family members who were also diagnosed with MS
• Environmental influences in childhood: Viral infections (e.g. Epstein-Barr virus) or vitamin D deficiency
• Trigger event in adulthood: It is not yet absolutely clear what such a trigger event might be. In most cases, emotional stress precedes the first acute episode of the disease.

There is a consensus in the scientific community that complex interactions of environmental, genetic, and epigenetic factors are the probable cause for onset of the disease.

The symptoms are varied and manifest differently in each patient. This is why MS is also called the “disease of a thousand faces”.

There are different types of MS. In most cases (85-90%), the disease is intermittent-relapsing.

The neurological symptoms appear relatively suddenly, subside over the course of several weeks, and often regress completely.

MS is not always diagnosed immediately. A diagnosis could take years.

As the disease progresses, the symptoms may not regress completely after the acute episode and residual symptoms remain. It is possible that the condition becomes chronic and symptoms may worsen gradually over time.

In rare cases, the disease progresses from the onset (10-15%). This form knows no clear, separate acute episodes.

The symptoms are varied and depend on the areas of the brain and/or spinal cord where inflammatory lesions occur. Some of the possible symptoms are listed below:

• Optic neuritis (inflammation of the optic nerve) Common first symptom – Deterioration of vision; usually occurs in one eye only; foggy/hazy vision; pain may occur
• Paresthesia Common first symptom – Sensory impairments such as tingling, tightness around the joints; often symmetrical, often described as feeling sock-like or glove-like; difficulties with determining temperature (hot/cold); numbness
• Ocular motility disorder – e.g.: double vision; nystagmus (uncontrolled horizontal or vertical eye movements)
• Paresis (weakness) / plegia (paralysis) – Patients often report initial mild weakness, such as a “tiredness” in the arm/leg; frequent twisting of the ankle, or joint stiffness; Paralysis rarely occurs in the early stages.
• Problems with coordination – Often develop during the course of the disease; e.g. episodes of rotary vertigo, loss of balance, tremors
• Vegetative dysfunction – Change in bladder function (e.g. frequent urges to urinate; frequent urinary tract infections); sexual dysfunction; increased or decreased sweating
• Psychophysical symptoms – Fatigue (abnormal fatigability) – marked exhaustion/fatigue that improves with rest
• Psychological changes – Cognitive impairment: e.g. reduced attention or cognitive performance; depression

MS has many faces:

• Appoximately1/3 of patients with MS experience no significant impairment throughout their life.
• Approximately 1/3 of patients with MS experience limitations that interfere with everyday activities. Living a normal life is mostly possible (e.g.: professional occupation, family planning).
• Approximately 1/3 of patients with MS experience significant impairments (e.g.: inability to work, loss of ability to walk).

Preparing a detailed medical history and good patient documentation are critical for diagnosing MS.

If MS is suspected, the suspicion can be verified by taking a sample of cerebrospinal fluid from the spinal canal or with the help of an MRI.

During an acute episode, cortisone therapy can help to shorten the episode and reduce its consequences.

Options for long-term therapy depend on the form of MS. Various medications are used to influence the immune system. The immune system is either suppressed (immunosuppression) or influenced (immunomodulation). An effective immunotherapy can have a significant positive impact on the progression of the disease or the impairment caused by it.

Rehabilitation for MS patients is designed to help preserve physical, social, and/or occupational skills. The treatment options are as varied as the symptoms of the condition itself. Physical and occupational therapy, speech therapy and psychotherapy can help patients to cope with everyday activities.

Rehabilitation goals:

• Preserving or improving functional capabilities
• Promoting independence and mobility
• Promoting and maintaining involvement in family life, social environment, and work
• Preventing and/or treating possible deficits caused by MS
• Alleviating psychological changes
• Reducing the amount of care required

An essential part of outpatient therapy is an active lifestyle – whenever possible. Studies show that physiotherapy increases patient mobility and muscle strength, reduces fatigue, and improves the quality of life.

Sources:

Wiendl, H., Korsukewitz, C. & Kieseier, B. (2021). Multiple Sklerose: Klinik, Diagnostik und Therapie. 2. Erweiterte Auflage. Kohlhammer Verlag

Hansen, S., Wettinger, L. & Keune, P. (2021). Multiple Sklerose. Hogrefe Verlag. 

Epigenetic aspects of multiple sclerosis and future therapeutic options (2021)

Multiple Sclerosis Epidemiologic, Clinical, and Therapeutic Aspects (2017)

Differential diagnosis of multiple sclerosis and other inflammatory CNS diseases (2019)

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews (2019)

Sensor-based technology for upper limb rehabilitation in patients with multiple sclerosis: A randomized controlled trial (2020)