Multiple sclerosis (MS) is a disease that occurs when the immune system attacks the myelin sheath, a protective layer that covers nerve fibers, causing damage to nerve cells in the brain and spinal cord. Deterioration of the nerve cells limits communication between certain parts of the nervous system and consequently leads to the development of physical and cognitive problems.
Clinical Presentation of Multiple Sclerosis
There are four distinct types of multiple sclerosis:
Relapsing-Remitting Multiple Sclerosis
Relapsing-Remitting Multiple Sclerosis (RRMS) is the most common form of the disease, account for 80% of diagnoses. The majority of patients are initially diagnosed with RRMS before the disease progresses into another form. It is characterized by outbreaks of new symptoms or worsening of existing symptoms. These relapses are followed by periods of remission, during which the symptoms reduce or in some cases disappear completely.
Primary Progressive Multiple Sclerosis
Primary Progressive Multiple Sclerosis is less common, observed in just 10% of patients. It is characterized by the progressive evolution of symptoms, without episodes of relapse or remission. Improvement of symptoms is rare, however in some cases patients experience periods of time where the condition seems to stabilize.
Secondary Progressive Multiple Sclerosis
Secondary Progressive Multiple Sclerosis accounts for 50% of diagnoses. It usually develops as a result of disease progression in patients initially diagnosed with RRMS. The symptoms of the disease worsen steadily over time while the number of flare-ups decrease.
Recurrent Progressive Multiple Sclerosis
Recurrent Progressive Multiple Sclerosis is the rarest form of the disease, affecting 5% of patients. This is the most severe form of the disease, characterized by worsening symptoms, acute relapses, and no remission.
Multiple sclerosis is recognized by neurological signs and symptoms, such as vision problems, loss of sensitivity, numbness, muscle weakening, muscle spasms, difficulty moving, coordination & balance issues, intestinal problems, and difficulty speaking or swallowing. In addition to these physical challenges, patients can also experience difficulty concentrating, mood swings, and depression.
Incidence and Prevalence of Multiple Sclerosis
Multiple sclerosis is the most common auto-immune disease that affects the central nervous system. In 2010, approximately 2.5 million people around the world were living with multiple sclerosis (30 cases for every 100,000 people). The incidence varies widely across different regions.
In Africa for example, the incidence rate is 0.5 cases per 100,000 people, while the rate in Europe is 80 cases per 100,000 people. The European rate increases to levels as high as 200 cases per 100,000 people in Northern European populations.
Causes and Risk Factors of Multiple Sclerosis
The exact cause of multiple sclerosis is unknown, but scientists believe that it is an auto-immune disease. This means that the immune system treats the myelin sheath as if it is a foreign body, attacking it in the same way it would a virus or bacteria.
The main risk factors include:
- Age: Diagnosis is most common in those aged 20-50 years
- Gender: Women are more likely to develop multiple sclerosis than men
- Ethnicity: It is more common in North European populations
- Genetic Factors: It can be passed on genetically.
The rate of multiple sclerosis is higher in populations who live further from the equator, which ahs led to the assumption that sun exposure could have an impact on the risk of developing multiple sclerosis.
The following risk factors and their link to the development of multiple sclerosis have been studied, however they are currently not supported by any scientific research. Further studies are required to confirm whether or not they are related to the condition.
- Exposure to a toxic substance such as heavy metals or some solvents.
- Infections: Viruses, particularly the Epstein-Barr virus, mononucleosis, and chicken pox could also be associated with multiple sclerosis.
- Salt: In 2013, a study suggested that excessive salt intake in the diet could trigger this auto-immune reaction.
Treatment of Multiple Sclerosis
There is no medical treatment that can cure multiple sclerosis. The treatment can only help to control the disease by alleviating symptoms and preventing new outbreaks. Steroids are typically used to speed up recovery during relapses and disease-modifying therapies are used to slow or reduce the progression of RRMS. The medication used to treat multiple sclerosis is associated with side effects that are difficult to tolerate and unfortunately it is not effective in all patients.
Treatments that target the specific symptoms of multiple sclerosis are also recommended. Physiotherapy can help people improve their mobility and increase or preserve their ability to accomplish daily tasks.
Physiotherapy involves educating patients about how to remain as mobile as possible and conserve their capacity to complete daily activities both at home and at work.
In general, doctors prescribe physiotherapy to maintain and re-establish muscle strength.
Occupational therapy is used to adapt the environment to an individual's disability. For example, installing ramps in an individual's home to make it wheelchair accessible.
For individuals experiencing difficulties with their speech or swallowing, a speech and language therapist can provide care and support to manage these symptoms.
Orthopedics
One of the most frequent symptoms of multiple sclerosis is difficulty walking due to the disease's effect on balance. In these cases, orthopedic care can contribute to improving the patient's daily mobility.
The main way that increased mobility can be achieved is through the use of orthoses, devices that provide support to the body, which can stabilize the affected joints.
The latest generation of orthoses can be made specifically for each patient according to their exact measurements. They can also contain a built-in microprocessor which can adapt to real-time situations according to the body's movements. Completely flexible, these orthoses are suitable for patients with either complete or partial leg paralysis.
Useful Apparatus and Accessories
Multiple sclerosis can cause significant challenges in a patient's daily life. In some cases, equipment is a mandatory step in maintain mobility and independence.
When balance or gait disorders progress, wheelchairs remain the most effective solution. Whether it's a powered or manual wheelchair, it is important to choose the correct device according to the patient's activity level and ability. The use of an electric mobility scooter can also be considered enabling patients to maintain their independence and to allow them to continue to participate in the activities they enjoy.
Wheelchairs can be adapted for patients very easily thanks to many recent developments. Posture aids such as a headrest, an ergonomic backrest, an anti-pressure sore cushion, or support structures of various sizes and functions can be added and removed to ensure the patients' transition to using a wheelchair goes as smoothly and as comfortably as possible.
Pressure sores can be avoided by using posture aids such as modular or clinical mattresses, memory foam pillows, or anti-decubitus cushions. These can also alleviate pressure on the limbs and maximize patient comfort.
Many solutions have been developed to improve everyday life for those with multiple sclerosis, from horizontal ergonomic handles to support bars, footboards, and non-slip mats.
Multiple sclerosis is a debilitating disease that severely limits the mobility and independence of those living with the condition. Despite this, it is possible to remain autonomous thanks to specialized equipment which makes daily tasks easier and reduces the impact of multiple sclerosis on a person's life.
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