Multiple sclerosis:
development, signs and treatment

Multiple sclerosis (MS) is a type of chronic inflammation of the nerve cells in the central nervous system, especially in the brain or spinal cord. However, the optic nerve may also be affected. It often progresses in flare-ups and manifests itself in a variety of symptoms. The exact causes of multiple sclerosis are unknown. It is probably an autoimmune disease in which the immune system attacks the sufferer’s own body. Although it is not curable, multiple sclerosis can be treated effectively with medication. Around 15,000 people live with multiple sclerosis in Switzerland.

In multiple sclerosis, the protective sheaths of nerve fibres in the brain or spinal cord are damaged. The defective areas become inflamed and harden (sclerosis). Since MS attacks numerous (multiple) nerves over time, the disease was named “multiple sclerosis”.

It is unclear why the myelin shell of the nerve fibres is damaged in multiple sclerosis. What is known is that certain white blood cells (T lymphocytes and B lymphocytes) are defective in MS sufferers. These immune system cells are supposed to protect the body from pathogens instead of attacking it.

• Genetic predisposition: even though multiple sclerosis is not inherited directly, it occurs frequently in some families.
• Viruses: infections with the Epstein-Barr virus (EBV), a herpes virus, significantly increase the risk of developing MS. According to one study, the risk is increased by a factor of 32.
• Vitamin D deficiency: low vitamin D levels seem to increase the likelihood of developing multiple sclerosis.
• Smoking: smokers are more likely to develop multiple sclerosis than non-smokers.
• Nutrition: experts suspect that high-fat diets which lead to obesity can promote the development of multiple sclerosis. However, studies that clearly prove this are lacking so far.
• According to current research, the risk of MS is increased by a combination of genetic factors and external influences.

Symptoms of MS may manifest themselves in a variety of ways through many different symptoms. These include:

• Movement disorders such as difficulty walking
• Symptoms of paralysis and muscle cramps, especially in the legs
• Increasing loss of control over individual muscles or muscle groups
• Visual disturbances such as double or blurred vision
• Sensory disorders such as numbness or tingling in the arms or feet
• Speech disorders
• Fatigue and exhaustion
• Reduced muscle strength
• Bladder dysfunction such as urinary urgency or incontinence
• Mood disorders such as lack of drive
• Psychological symptoms such as depression, anxiety disorders

Multiple sclerosis can occur at any age, but it often develops between the ages of 20 and 40. Seven out of ten MS sufferers are female. It is not known why women are significantly more at risk than men.

There are three forms of multiple sclerosis:

• Relapsing-remitting MS (RRMS) is the most common form of the disease. The MS symptoms develop suddenly and last for several days to weeks; between flare-ups, the patient completely or partially recovers (remission). Symptom-free periods are possible.
• Primary progressive MS increases steadily from the outset, without any flare-ups. The symptoms progress gradually, accumulate and become chronic.
• Secondary progressive MS also progresses steadily, but not from the outset. This form of multiple sclerosis develops from relapsing-remitting MS. As the disease progresses, flare-ups become less frequent and symptoms increase.
• Psychological issues, such as stress, feelings of being overwhelmed and traumatic events, can trigger relapses.

Multiple sclerosis does not follow a uniform pattern, because every clinical picture is different. Therefore, an individual prognosis of the course of multiple sclerosis is not possible. In general, however, it can be said that multiple sclerosis is not a fatal disease and that nowadays, those affected have a similar life expectancy to that of the general population.

The first point of contact if MS is suspected is the neurologist. Once the patient’s medical history has been recorded, a neurological examination first excludes other diseases, such as Lyme disease, HIV infection or various metabolic disorders. Other diagnostic procedures include:

• Cerebrospinal fluid analysis: examination of the brain and spinal fluid to analyse protein components and cells
• Magnetic resonance imaging (MRI)
• Electrophysiological measurements, in particular testing the performance of optic nerves
• Blood and urine testing

Even though multiple sclerosis is not curable, modern medications can slow the course of the disease. Some of these drugs target the immune system – they either change (immunomodulating effect) or suppress it so that it does not attack the patient’s own body so much (immunosuppressive effect).

In relapse therapy, acute MS relapses are treated with glucocorticoids (cortisone). In such cases, a blood “cleansing” procedure (plasmapheresis or immunoadsorption) can also alleviate the symptoms. Antispasmodic medicines are particularly used for muscle spasms.

If the disease is taking an aggressive course, autologous stem cell transplantation is an option. In this process, the patient’s own blood stem cells are taken from their blood or bone marrow. The immune system is then destroyed with chemotherapy and rebuilt with the help of the previously extracted blood stem cells. After this “restart”, the immune system should no longer attack the nerve cells.

Other forms of therapy that aim to reduce symptoms and improve quality of life are physiotherapy, occupational therapy and rehabilitation.

In everyday life, multiple sclerosis can lead to a wide range of problems (e.g. visual disturbances, difficulties with walking) and has a major impact on the areas of work, hobbies, partnerships and family planning, in particular. Nevertheless, it is possible to live with the disease for decades with the help of suitable treatment. A good family or social environment can provide the best possible support for those affected if they experience relapses.

If the symptoms are very stressful and debilitating, or if there are severe restrictions in everyday life, psychotherapy can be helpful. The Swiss Multiple Sclerosis Society (multiplesklerose.ch) offers psychological advice and tips on living with multiple sclerosis for MS patients and their relatives.