Multiple Sclerosis – At A Glance

Multiple sclerosis is an autoimmune inflammatory demyelinating disease that affects the brain and spinal cord resulting in various presentations including disability, impaired vision, sensation and balance.

Incidence : Even though it can occur at any age, commonly it’s diagnosed at their early adulthood


Commonest cause of disability in young adults 


Hallmark of multiple sclerosis is the episodic nature of symptoms occurring years apart with features suggestive of a lesion in a different anatomical sites



Causes Of Multiple Sclerosis 


Exact cause is unknown
Believed to be affected by….

  •  Genetic factors 
    • Females
  • Environmental factors 
    • Vitamin D deficiency
    • Smoking 
    • Viral infection (IMN)



Pathophysiolgy Of Multiple Sclerosis 


MS is an autoimmune disease

           
Formation of myelin reactive T cells which express adhesion molecules in periphery 
           
Cross the blood brain barrier (As they express adhesion molecules)
           
Enter into the brain 
           
Binds with myelin and become activation to form cytokines (IL, gamma interferone, TNF)
Antigen presentation to APC
           
Destroys the blood brain barrier 
Attract more T cells, B cells, macrophages and inflammatory cells
Formation of antibodies against myelin peripherally and intrathecally
           
Destroy myelin 
           
Leading to a patchy destruction of myelin known as plaque 
Charcterized by myelin loss and destruction of oligodendrocytes 
           
Presentation occur. according to the anatomical site involved
           
Later, regulatory T cells, inhibits the inflammatory process
           
Remyelination takes place 
           
Again the inflammatory process will start 
Hence the episodic nature of multiple sclerosis
           

Type IV hypersensitivity (Cell mediated immunity) reaction occurs in multiple sclerosis




Classification Of Multiple Sclerosis


Classification is based on the following factors

  • Frequency of clinical relapses
  • Progression of the disease
  • MRI findings 

Categorized in to four types 

  • Relapsing-remitting MS (RRMS) – Commonest type
  • Secondary progressive MS (SPMS) 
  • Primary progressive MS (PPMS) 
  • Progressive-relapsing MS (PRMS)



Clinical Presentation Of Multiple Sclerosis

Presentation of multiple sclerosis varies from patient to patient.

Symptoms develops according to the anatomical location involved.
Episodic nature of symptoms is characteristic of MS  

Common presentations include….

  • Sensory involvement (Early presentation)
    • Parasthesia
    • Numbness
       
  • Motor involvement 
    • Weakness
    • Spasticity
       
  • Cerebellar involvement – Charcot triad
    • Dysarthria
    • Nystagmus
    • Intention tremor
       
  • Autonomic involvement 
    • Bladder bowel impairment
    • Sexual dysfunction
       
  • Eye involvement 
    • Optic neuritis leading to Blurred vision, colour blindness, blindness, scotoma
    • Diplopia
    • Gaze palsy
       
  • Fatigue
  • Pain
  • Cognitive dysfunction
    • Inability to concentrate
    • Memory impairment 
  • Depression, anxiety 


Investigations Of Multiple Sclerosis


It is hard to diagnose MS in the first episode.

A confirmed diagnosis can be reached after two separate attacks.

Diagnosis is difficult as there is no diagnostic investigation

To reach a clinical diagnosis McDonald criteria can be used.

Investigations has to be done to exclude other diseases.

  • MRI is very helpful in reaching the diagnosis which shows areas of scarring
  • Evoked potential tests
    • Visual evoked potentials (VEPs) 
    • Somatosensory evoked potentials (SSEPs) 
    • Brainstem auditory evoked potentials (BAEPs)


Treatment Of Multiple Sclerosis


No cure for MS

  • Acute relapses
    • Treated with steroids (Oral / IV)
    • If no responding plasmapheresis
       
  • For relapsing-remitting MS
    • Immunomodulatory therapy using interferones, monoclonal antibodies 
    • Reduce the frequency and severity of relapses
       
  • Symptomatic management 
    • Physiotherapy – Stiffness, mobility impairment 
    • Gabapentin – Neuropathic pain
    • Antidepressants
    • Support groups


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Renauld Clare
Renauld Clare
1 year ago

I was introduced to Herbal HealthPoint and their effective Multiple Sclerosis treatment. I immediately started on the protocol, it relieved symptoms significantly, even better than the medications I was given. Visit w w w. herbalhealthpoint. c om. First month on treatment, my tremors mysterious stopped, had improvement walking. After I completed the treatment, I recovered from the horrible disease.

Renauld Clare
Renauld Clare
1 year ago

I was introduced to Herbal HealthPoint and their effective Multiple Sclerosis treatment. I immediately started on the protocol, it relieved symptoms significantly, even better than the medications I was given. Visit w w w. herbalhealthpoint. c om. First month on treatment, my tremors mysterious stopped, had improvement walking. After I completed the treatment, I recovered from the horrible disease.

STACEY BELLIS
STACEY BELLIS
10 months ago

I was diagnosed with multiple sclerosis 1 month after I turned 50. My grandma is 96 and had it since she was in her 20s. I have been on WORLD HERBS CLINIC MS HERBAL FORMULA, the first TWO MONTHS was daily and now I am on 3 times a week. It has made a tremendous difference for me. The fatigue never gets to me again. When I do too much, I don’t feel weak anymore..