Multiple sclerosis (MS)

What is multiple sclerosis?

Multiple sclerosis (MS) is an immune-mediated inflammatory disease that affects the myelinated axons of the central nervous system, destroying myelin and axons to varying degrees, resulting in significant damage over a 20-25 year period in more than 30% of patients. The characteristic feature of MS is symptomatic recurrent episodes (impulses) that occur periodically (months or years usually elapse between episodes). Often these impulses cause a disability that develops gradually, but often not completely.

Is there a treatment for multiple sclerosis?

The therapeutic approach to MS has two sides: immunomodulatory therapy, which targets the underlying immune disease, and treatment to improve symptoms. Immunomodulatory therapy aims to reduce the frequency of pulses and slow the course of the disease.

What are the initial symptoms of multiple sclerosis?

The most common symptoms that initially manifest in patients are the following:

  • Sensory disturbances (tingling, paresthesias) usually an early symptom
  • Symptoms from the spinal cord (kinetic): muscle spasms due to spasticity
  • Spinal cord (autonomic nervous system) symptoms: bladder dysfunction, bowel dysfunction, and sexual dysfunction
  • Paracellular symptoms: dysarthria, ataxia and tremor
  • Ocular neuritis
  • Triangular neuralgia
  • Facial muscles (involuntary contractions of facial muscles)
  • Symptoms from the eyes: Diplopia (in 33% of patients)
  • Heat intolerance
  • Easy fatigue (70% of patients) and dizziness
  • Pain: observed in 30-50% of patients during the disease
  • Subjective cognitive difficulties: in attention span, concentration, memory and judgment
  • Depression
  • Euphoria: Less common than depression
  • Symptoms of transverse myelitis

How is the diagnosis performed ?

The diagnosis of MS is based on the history, clinical picture and findings from the paraclinical examinations. A key role in diagnosis is now brain imaging with magnetic resonance imaging (MRI), while monitoring cerebrospinal fluid with lumbar puncture has an additional role. Clinically, the episodes should match the pattern of neurological deficits that occur in MS, and the duration of the episode should last from a few days to a few weeks.

Physical and Rehabilitation Medicine

Patients with multiple sclerosis can benefit greatly from an intensive rehabilitation programme based on physiotherapy, occupational therapy and speech therapy. The role of the Physical and Rehabilitation Medicine specialist in the rehabilitation of patients is crucial and is based on assessing the patient’s motor skills (e.g. walking) and evaluating and developing a recovery programme with appropriate assistive devices. The Physical and Rehabilitation Medicine specialist will evaluate and educate the patient with appropriate exercise programs to reduce spasticity, maintain range of motion of body parts, address pelvic-reservatory disorders, and strengthen muscles and improve coordination and speech disorders. The rehabilitation programme aims to improve gait, balance and flexibility, increase aerobic capacity and ultimately provide functional independence for the patient.

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