This is an important cause of long term disability in adults.Multiple Sclerosis is a chronic autoimmune demyelinating and neurodegenerative disease condition of the central nervous system where the protective coverings of the nerves are eaten by the body’s immune system.This disease condition is characterized by changes in sensation,visual problems, weakness,difficulties with co-ordination and speech with impaired mobility and didability.
FACTS ON MULTIPLE SCLEROSIS
It’s also known as encephalomyelitis disseminata.
In the UK,it’s prevalence is 12 per 10,000 persons with an annual incidence of 7 per 100,000.
It’s twice as common in the females than in the males
It’s neither contagious nor infectious
It’s incidence is higher in Northern Europeans.
WHAT ACTUALLY HAPPENS IN MULTIPLE SCLEROSIS?
We already know that it’s an autoimmune inflammatory central nervous system disorder where infection-fighting white blood cells begin to eat the protective coverings of the brain and spinal cord (nerves).
This demyelinating condition occur because the myelin sheath that protects nerves is stripped off when inflamed.As a result of this, the nerves cannot conduct electricity very well as they are considered to.This disease condition occurs more in the caucasians and there has been research which has shown the link between this disease condition and the reduced intake of Vitamin D or low exposure to sunlight.Other studies has considered the increased exposure to Epstein-Barr Virus(EBV) as one of the causes of this ailment.
WHAT ARE THE PREDISPOSING FACTORS TO MULTIPLE SCLEROSIS?
1. Females are more predisposed to this disease than the males especially those within 15-60 years of age.
2. Presence of other autoimmune diseases such as Diabetes mellitus Type 1, systemic lupus erythematosus (SLE),Grave’s disease, etc.
3. Hereditary Predisposition: Having a parent with multiple sclerosis will definitely increase the chances of one having multiple sclerosis.
TYPES OF MULTIPLE SCLEROSIS
1. Relapse-remitting Multiple Sclerosis:This is the most common form of multiple sclerosis.People with this type of multiple sclerosis have relapses where symptoms occur.Later these symptoms tend to disappear, only to emerge again after a certain period of time.
2. Primary-progressive multiple sclerosis: This is characterized by slow progression of the disease condition with no relapse or remissions.
3. Secondary-progressive multiple sclerosis: Here, these symptoms get worse over time, whether there is a relapse and remission or not.
4. Progressive-relapsing multiple sclerosis : This uncommon form of multiple sclerosis.It worsens at a constant rate with relapses although here, there are no remissions.
WHAT ARE THE SYMPTOMS OF MULTIPLE SCLEROSIS?
Individuals with multiple sclerosis may not present with the same symptoms as they vary, but the most common and important symptoms of these includes
a) Loss of feeling or numbness in various parts of the body, because there is reduced nerve conduction
b) Difficulty in walking
d) Fatigue and weakness
e) Blurred Vision
g) Lhermitte’s phenomenon
h) Staggering Gait
i) Slurred Speech
j) Tremor and muscle spasms
k) Heat sensitivity
l) Bowel and bladder problems
m) Urinary Symptoms such as urgency, frequency in urinating.
TREATING MULTIPLE SCLEROSIS
Multiple Sclerosis bas no cure, although there are several medications which has proven to slow down the progression of the disease.It’s treatment falls into these classes;
Slowing disease progression (with disease-modifying therapies- DMTs)
Disease modifying therapies(DMTs)
These are drugs that slow down the rate of progression of the disease, these drugs act on the immune system so that they do not continue to destroy the myelin sheaths of nerves.They are
– Beta interferons: They lower the number of white blood cells which can consequently increase the rate at which you get infections.Examples include interferon beta 1a (Avonex), interferon beta 1b (Extavia) and peg interferon beta 1a (plegridy)
– Cladribine(pills): This drug is taken with special supervision as it has side effects(such as rashes and hair loss)
Glatiramer(injections): prevents your immune system from further attacking the myelin sheath that surrounds and protects your nerves.
Dimethyl fumarate: Taken twice in a day, it lowers the immune cells and patients could experience stomach pains, nausea and vomiting, flushing, etc.
Diroximel fumarate: Has less side effects than dimethyl fumarate,it’s used to treat relapsing forms of multiple sclerosis.Other drugs include
– Monomethyl fumarate
– Ozanimod( Zeposia)
– Teriflunonimde( Aubagio)
Here, in managing this condition, each symptom noticed is treated accordingly .For example ;
Fatigue: drugs like modafinil(provigid), amantadine(amantrel), armodafinil.
Depression: antidepressants like fluoxetine, sertraline, etc
Bowel and bladder dysfunction: tolterodine(detrol), oxybutynin