Worldwide about 2 to 2.5 billion people suffer from multiple sclerosis although the pattern of prevalence of the disease varies from country to country or one ethnic group of people to other ethnic group. It is considered to be an inflammatory disease in which the immune system of the body wrongly attacks the protective sheath of the nerves (the myelin cover) leading to damage to the nerves.
Multiple sclerosis may lead to all type of nerve related symptoms including physical, emotional and even psychiatric problems. Common presenting symptoms include weakness of the limbs of the body along with difficulty in maintaining normal posture, normal gait and co-ordination, slurring of speech, difficulty in swallowing, loss of control over urination and defecation, visual problems ranging from double vision, blurring of vision to complete lack of vision etc.
The course of progression of the disease usually takes either of the two main forms; the relapse form characterized by sudden episodes of worsening of symptoms without any prior warning symptom lasting for weeks to months followed by period of improvement of the symptoms (occurring in about 85% of the patients) and progressive form characterized by gradual deterioration of the existing symptoms over years without any period of improvement in between (occurring in about 10-15% of the patients). Sometimes combination of both the above mentioned pattern of disease progression may co-exist in the same patient.
Episodes of relapse are precipitated by certain triggering factors like sudden change in environmental temperature, stress, injury, immediately after giving birth, following certain type of viral infections like common cold, influenza etc.
Multiple sclerosis is more common in women in comparison to men (about two times) and usually women of 20 and 50 years of age are commonly affected.
There is no permanent cure available for the disease however treatment can modify the course of the disease by relieving symptoms, halting the progression of the disease to some extent etc.
Causes
The specific underlying causes of multiple sclerosis is not known however it is believed that interplay among several environmental factors may lead to multiple sclerosis. These factors include having certain types of genes although this disease is considered to be a hereditary disease, infection by certain microbial agents like common cold, mumps, rubella, influenza, measles viruses etc., Smoking is another such important environmental factor association with causation of multiple sclerosis.
Multiple sclerosis is also considered to be an autoimmune disease in which the cells of the immune system wrongly attacks the body’s own myelin sheath cells resulting into damage of the nerves and interruption of the electrical signal conduction through them.
Risk factors
Common risk factors for multiple sclerosis include
1. Age: although people of any age group can be affected. the disease is more common between 15 and 60 years of age
2. Being a woman
3. Family history of multiple sclerosis especially in parents or in sibling increases the risk of multiple sclerosis in future
4. Suffering from certain type of viral infections
5. Ethnicity: people with Northern European origin are at increased risk in comparison to people with Asian, African background
6. Climate: commonly people living in temperate environment (like those living in Australia, Northern Europe, New Zealand, Canada, etc. is at increased risk.
7. History of smoking
8. Suffering from other autoimmune diseases like type I diabetes, inflammatory bowel disease etc.
Treatment
There is no cure for multiple sclerosis however drugs are available for relieving symptoms, management of symptoms and halting of disease to certain extent if not completely.
For acute attack of multiple sclerosis corticosteroids namely oral prednisolone and intravenous methyprednisolone are administered. Another option for managing acute attack is plasmapheresis or exchange of plasma (the liquid part of the blood) is done. In this procedure as the liquid portion is separated from the cells (both the blood cells and the harmful inflammatory cells) hence the damaging effects of these inflammatory cells on the nerves is minimized resulting into relieve of symptoms.
Certain drugs are shown to reduce the episodes of relapse attack and formation of new lesions although no effect is seen on older lesions. These drugs are beta interferons, glatiramer, dimethyl fumerate, fingolimod, natalizumab, mitoxantrone, etc.
For relief of symptoms physical therapy, administration of drug to relieve pain, muscle spasm, fatigue etc. is prescribed.