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Multiple sclerosis is a progressive disease of the Central Nervous System (CNS). It causes demyelination of the covers of the nerves in the brain and spinal cord. This demyelination disrupts the ability of the nervous system to send and receive symptoms between its parts, and that leads to several symptoms, including physical and mental problems, partial blindness, muscle weakness, others.
Sometimes, multiple sclerosis occurs in bouts, which means that the individual experiences symptoms followed by relief, and then a reoccurrence. In between these bouts, sometimes all the muscular and nerve symptoms disappear completely.
The nervous system is the network of nerves in the brain and spinal cord. The brain is the control centre, and it coordinates all the actions that take place in the body. The spinal cord is the source of all the nerves, and it can be seen as the major channel of communication between the brain and the rest of the body.
Together, the brain and spinal cord from the Central Nervous System, and they coordinate the actions and reactions including sensation (sight, touch, taste, smell, sound) and motor function (movement of any parts of the body). Because the brain and spinal cord are to central to bodily function, any damage to the brain or spinal cord leads to a series of severe symptoms in the individual, and that’s why multiple sclerosis is very debilitating.
The myelin sheath in the central nervous system is another protective covering, but it is responsible for protecting the nerve fibres. It surrounds the axons of the nerves and aids them in the transmission of impulses. Damage to the myelin sheath not only exposes the nerves, but it also slows down the rate of nerve conduction — the more advanced the damage, the slower the impulses.
To protect itself from injury, the CNS is protected by the skull and vertebral column. However, diseases that affect these bony structures can also affect the CNS. The severer the attack on these protective coverings, the more debilitating the effects tend to be on the body. Examples of conditions like these include spinal arthritis, spondylolisthesis, and disc hernias.
This slowed rate of transmission accounts for several of the symptoms seen in multiple sclerosis, as we’ll see shortly.
Even though multiple sclerosis has been confirmed to be an autoimmune disease, it is unclear what triggers it. Autoimmune diseases are conditions in which the body’s immune system turns on itself and begins attacking tissues in the body. In Multiple sclerosis, it attacks the myelin sheath of the nerves.
Other autoimmune disorders that affect the Nervous System include Guillain-Barre syndrome and Chronic inflammatory demyelinating polyneuropathy. Some others affect other parts of the body besides the brain and spinal cord, like rheumatoid arthritis
Multiple sclerosis acts via two other mechanisms besides demyelination—forming lesions, and causing inflammation. The disease is progressive, which means that it leads to more damage in the CNS and more severe symptoms as time goes on. The disease is not yet fully understood, and as a result, research is still being conducted on slowing down and stopping its progression (more on this under “treatment”).
The cause of multiple sclerosis is unknown. However, it has been liked to a combination of genetic and environmental factors. There still isn’t an explanation of how these contribute to the progression. Such environmental factors include infectious agents like microbes as well as living in a particular geographical location.
Multiples sclerosis is the most common autoimmune disorder of the central nervous system. In 2010, it was estimated that about 2-2.5 million people and multiple sclerosis in the world. The prevalence in each part of the world is different from other parts. Since the cause is still unknown, its prevalence can only be assessed once it begins.
In Africa, the prevalence is about 0.5 per 100,000. It is 2.8 per 100,000 of the population in Southeast Asia, 8.3 per 100,000 in North and South America. In Europe, about 80 in 100,000 people are known to develop multiple sclerosis.
Multiple sclerosis is not considered a hereditary condition. However, it has been linked with some generic factors which are shown to increase the chances of getting the condition. People whose relatives develop multiple sclerosis have a higher chance of developing the condition than people whose relatives do not. Additionally, the chances are higher with close relatives.
Because the cause of multiple sclerosis is unknown, risk factors are difficult to determine. However, based on the information thus far, some of the risk factors of multiple sclerosis could include the following:
The more common symptoms include:
There are several more symptoms of multiple sclerosis, and as mentioned earlier, they depend heavily on the part of the brain and spinal cord that was affected.
A diagnosis of multiple sclerosis is made based on the symptoms presented. There are no blood markers that can be screened; neither can any nerve conduction tests yield any useful result. This limitation in diagnosis options are due to two factors:
Imaging scans are also used to check for areas of demyelination. Testing the Cerebrospinal fluid (CSF) can also indicate inflammations in the CNS. The markers for these inflammations are shown to be present in 75% to 85% of people who have the condition.
Besides non-invasive means of diagnosis like scans and CSF tests, a tissue biopsy can also be conducted to confirm the diagnosis.
There is currently no cure for multiple sclerosis, and so, the treatment is focused on recovery from attacks, since they sometimes occur in bouts. The treatment is also focused on slowing down the progression of the disease and managing the symptoms that result.
Symptoms of multiple sclerosis, like muscle weakness and impaired sensation, can be treated with therapy, either physiotherapy or occupational therapy. (insert physiotherapy citation). This would include stretching and strengthening exercises to maintain movements and muscle function. The symptoms may also be treated with muscle relaxants, analgesics, and antibiotics.
The drug called ocrelizumab is the primary drug in the United states used to treat multiple sclerosis and prevent its progression. Others include
The cause is unknown: Compston A, Coles A (October 2008). “Multiple sclerosis”. Lancet.372 (9648): 1502–17. doi:10.1016/S0140-6736(08)61620-7.PMID 18970977.
Berer K, Krishnamoorthy G (November 2014). “Microbial view of central nervous system autoimmunity”. FEBS Letters. 588 (22): 4207–13. doi:10.1016/j.febslet.2014.04.007. PMID 24746689.
World Health Organization (2008). Atlas: Multiple Sclerosis Resources in the World 2008 (PDF). Geneva: World Health Organization. pp. 15–16. ISBN 92-4-156375-3. Archived (PDF) from the original on 4 October 2013.
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