Multiple sclerosis can go away
Multiple sclerosis (MS)
multiple sclerosis (MS, Encephalomyelitis disseminata, ED): Chronic inflammatory disease of the brain and spinal cord, which begins abruptly or gradually, often in episodes, and is characterized by focal demyelinating of nerve cords. The disease usually begins between the ages of 20 and 40; women are more likely than men. In the western industrialized countries, multiple sclerosis is the most common chronic neurological disease among those under 50; in Germany there are around 120,000 people affected.
The course of the disease varies from (apparent) healing to rapid disability; Overall, it is cheaper than usually assumed: two thirds of those affected do not require care if they start therapy early, even after a long course, whereby the prognosis of the relapsing form is better than that of the progressive form.
- Sensory disturbances, especially numbness ("being furry"), tingling sensation ("pins and needles"), decreased sensation of touch
- Visual disturbances (usually one-sided), especially blurred vision, double vision, often also eye pain
- Feeling of weakness and paralysis, often in the legs, possibly with an insecure, broad-stepped (broad-based) gait ("seaman's gait")
- Persistent tiredness and exhaustion (fatigue)
- Speech disorders, especially slurred, "choppy" speech
- Possibly bladder and / or rectal dysfunction.
The nature and intensity of the symptoms vary from person to person, depending on which areas of the central nervous system are affected.
When to the doctor
The next day if
- Inexplicable sensory disturbances and / or feelings of weakness occur in the legs or you or others think your language or gait has changed.
- you suddenly have the feeling that you can see worse or that (slight) paralysis occurs.
- severe visual disturbances occur or bladder or bowel control is impaired.
The information in the nervous system is passed on via long, thin nerve cell extensions, which are isolated by an insulating fatty tissue Medullary sheath (Myelin sheath) are surrounded. As a result of the autoimmune process, the body's own defense cells destroy these myelin sheaths (demyelination) and lead to inflammation in many places in the brain and / or spinal cord. This makes it difficult or even impossible to convey information at these points. If critical areas are affected by this "information freeze", failures such as visual disturbances occur. But it can also be that the inflammation focus (plaque) goes completely unnoticed. In the further course, the inflammation subsides again, the symptoms improve or even disappear again, until after months or years a new focus of inflammation with corresponding symptoms arises. In this case one speaks of the relapsing-remitting form of MSwhich is the most common at around 85%. As a rule, it remains unclear what triggered the individual surge.
Over time, the nerve processes themselves can perish, but scarring as a reaction to the inflammation also worsens the transmission of information. This could explain why, after an initially relapsing course, the symptoms of quite a few sufferers increase after years without relapses being detectable. Here the doctor speaks of the secondary progressive MS, which always begins as a relapsing-remitting form and is therefore regarded as the second stage of the disease. If treatment is given in good time, the transition to the secondary progressive stage can be delayed.
The second most common form (15% of all those affected) is primary progressive MS. The first symptoms usually appear around the age of 40. The classic attacks are missing here, rather the symptoms increase slowly but steadily from the beginning of the disease.
The rarest form with just under 2% is the so-called fulminant MS, which is also known as the malignant MS or Marburg variant and which mainly affects young people. The rapid progression, which can lead to death within a few weeks to months, is typical.
The symptoms that arise depend on the place where the focus of inflammation is located. In principle, a lot of symptoms are possible, but some disorders are particularly common, e.g. B. Visual and sensory disturbances at the beginning of the disease. The complaints are usually mild and only last a short time, so that they are often misinterpreted.
Over the years, more than 80% of those affected develop paralysis, which varies in severity. Sections of the extremities distant from the trunk are more frequently affected than those near the trunk, the legs more than the arms. Typically, the basic muscle tension is too high (spastic paralysis), which makes movements even more difficult. The fine-tuning of the movements is also disturbed; this is shown e.g. B. by slurred or "choppy" speech, shaky or excessive movements.
Also rare in the beginning, but more common the longer the disease lasts, are disorders of the bladder function, especially a sudden urge to urinate, which can become so violent that those affected can no longer reach the toilet in time. Disorders of the sexual function are also typical.
Psychological changes such as euphoria, depressive moods and concentration disorders are possible and their frequency is more difficult to quantify than "measurable" complaints. So-called fatigue is a characteristic of multiple sclerosis - increased tiredness, which can be so severe that those affected are no longer able to work.
Causes and Risk Factors
The cause of multiple sclerosis is still unclear. As far as we know today, external influences based on a hereditary predisposition lead to autoimmune processes ("self-fighting processes") in the brain and spinal cord, which then lead to the disease 10–20 years later.
The weight of the hereditary predisposition and the external factors cannot be precisely stated. Hereditary predisposition probably plays a far less important role. Although close relatives have a higher risk of disease, it is low in absolute terms (around 1%).
Little is known about the external influences that set the autoimmune process in motion. Studies suggest that they act in the first 15-20 years of life. The most likely factors are infections, especially viral infections. For example, several studies indicate that infection with the Epstein-Barr virus - the causative agent of Pfeiffer's glandular fever - increases the risk of developing MS in early childhood or adolescence. However, there is currently no clear evidence of this.
Smoking and reduced vitamin D levels are also discussed as risk factors.
If, after a neurological examination, there is an initial suspicion, the evoked potentials and a nuclear spin of the brain and / or the spinal cord should reveal further, previously unnoticed foci, with foci on different Points of the central nervous system are an essential diagnostic criterion.
Magnetic resonance imaging of a 40-year-old man with an acute MS attack (left cross-section, center longitudinal section through the brain). The large areas of inflammation can be seen as lightened areas. The magnetic resonance tomogram on the right shows a longitudinal section through the spine and the spinal cord. No sources of inflammation can currently be found here.
Georg Thieme Verlag, Stuttgart
Since the clinical picture is rarely really clear at first, and the diagnosis of multiple sclerosis has serious consequences, the definitive diagnosis is only made in practice if a number of criteria are met through follow-up examinations:
- Proven inflammation too different Points in time different Locations in the brain and / or spinal cord. Because there are quite a few people who have symptoms suspicious of multiple sclerosis only once in their life and for whom it is not possible to determine where they come from, despite the exhaustion of today's diagnostic possibilities. Here the doctors speak of a so-called clinically isolated syndrome (HIS, English CIS)
- Evidence of a delayed conduction of excitation in the evoked potentials, which corresponds to the nerve damage typical of MS
- Cell proliferation in the CSF (fluid that surrounds the brain and spinal cord) as an expression of inflammation and / or immunoglobulins that are missing in the blood. Here the doctors speak of A: 36e91 oligoclonal bands of immunoglobulin G (IgG). These are certain distribution patterns that can be detected with a special examination method. Oligoclonal bands, however, are not reliable evidence of multiple sclerosis, but only mean that immunoglobulins have been formed in the central nervous system itself
- The exclusion of other possible diseases such as Lyme disease through blood tests.
The goals of treatment are to resolve the symptoms as quickly as possible during the episode, to suppress further attacks, to combat distressing symptoms and to prevent complications. The most important pillar of therapy is the use of medication; Physiotherapeutic measures help to reduce (residual) disorders.
In drug treatment, a distinction is made between the Relapse therapy, i.e. the short-term treatment of acute relapses of MS, and the course-modifying therapywhich is designed as a long-term treatment and is intended to reduce both the frequency and the severity of the attacks. Starting treatment early is crucial to slow the progression of the symptoms. Ideally, therapy is started immediately after the first MS attack.
Standard drugs in relapse therapy are (glucocorticoids). Since cortisone and other glucocorticoids only differ in strength, but not in mode of action, we will stick to the term cortisone in the following. Cortisone often shortens an MS flare-up by reducing inflammation. Since an effect on the long-term course has not been proven, but cortisone has side effects, especially when taken continuously, it is not used in the long-term treatment of MS.
In the acute episode, high-dose cortisone infusions are administered over a few days as early as possible after the onset of the symptoms. In case of insufficient success, the treatment can be repeated after two weeks. You can then take tablets for about two weeks.
If the second series of infusions does not help either or if the symptoms even worsen, plasmapheresis (plasma exchange treatment) can be carried out, but this is only possible in special centers. Similar to dialysis, the patient's blood is passed through a machine so that the liquid components of the blood (the so-called plasma) are removed and replaced with a protein solution. This method removes harmful antibodies that have dissolved in the blood.
The aim of course-modifying therapy is to both reduce the severity and frequency of relapses and to improve the long-term prognosis. Medicines are used that change the immune system - and thus fight the presumed cause of MS. Here, too, treatment should be started as early as possible, ideally after the first attack. A number of drugs are approved for this in Germany. Detailed information on the active ingredients and active ingredient mechanisms can be found in the special text: Course-modifying therapy of multiple sclerosis.
Relief of complaints and avoidance of complications
It happens that once symptoms have arisen, they no longer completely regress. However, a large part can be alleviated with medication, such as spasticity or the urge to urinate.
The drugs of first choice for treating spasticity are the active ingredients baclofen and tizanidine. If these drugs do not work, a cannabis-containing spray (Sativex®) is available for MS patients, which is sprayed onto the oral mucosa and helps with moderate to severe cramps. Sativex® does contain THC (Delta-9-Tetrahydrocannabinol) - the psychoactive ingredient of the cannabis plant - but does not trigger any intoxicating states. The reason for this is the combination with the substance cannabidiol. An additional option is botulinum toxin (botox) injections. However, these only make sense if the spasticity is very severe, but limited locally (e.g. inner thigh muscles)
Aminopyridine has proven itself to improve walking ability and walking distance.
Pelvic floor exercises and a regular drinking schedule help you regain more control over your bladder function. Under no circumstances should those affected reduce their drinking too much just to be able to better control their urge to urinate.
In the case of coordinative disorders or speech disorders, it has proven useful to start early with accompanying measures such as physiotherapy, occupational therapy or speech therapy, as this can significantly improve the symptoms. The therapy is tailored to the problems of each individual patient, with movement exercises being integrated into everyday life as far as possible.
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What you can do yourself
The two letters MS stand for fear and uncertainty: What impact will the disease have on my everyday life and my future plans? Do I have to quit my job? What does my illness mean for the family? Will I become a need for long-term care sooner or later? In fact, no one can predict which restrictions and sequelae are to be expected in individual cases - the individual course of the disease is too different for that. This uncertainty is at least as stressful as coping with the complaints.
- Try to accept your illness! Focus on your skills, not the impairments associated with the condition. In your work and private life, you shouldn't impose more restrictions on yourself than absolutely necessary.
- If you need support, don't hesitate to ask for and receive it.
- Stay as active as you can. It speaks e.g. For example, don't mind exercising or traveling regularly - just make sure that you don't exceed the limits of your resilience.
- Stress can trigger flare-ups. Find out which stressors are unfavorable for you. Relaxation procedures also help to reduce stress.
- Multiple sclerosis is not a reason not to have children. In general, pregnancy should be planned in consultation with the neurologist and gynecologist, as MS medication must be changed or discontinued in good time.
Discuss your feelings and worries with loved ones and friends. Exchanging ideas with other people affected can also help to solve the practical problems.
A varied and balanced diet with plenty of plant-based products, enough fish and little meat is the best form of nutrition for people with multiple sclerosis. Some alternative healing methods prescribe rigid diet regulations or expensive special foods, but so far neither a special (MS) diet nor the intake of highly concentrated plant extracts, vitamins or special dietary supplements have been able to bring about a lasting improvement or even a cure. If you still want to try out certain nutritional programs: Make sure that the daily nutritional requirements are met and that the diet does not result in any unreasonable impairment of your quality of life. If you are unsure, discuss with your doctor whether he or she is in favor of changing your eating habits.
Smoking should be taboo.
Regular nicotine consumption is not only harmful to the heart, circulatory system and respiratory tract, but also seems to worsen the course of multiple sclerosis.
Infections can trigger flare-ups.
Therefore, get vaccinated against the flu regularly, if in doubt, avoid visiting a sick host and avoid shaking hands too often during flu times. Isolating yourself for fear of infection does not make sense either.
Even if high temperatures cannot make the disease itself worse, warmth causes a temporary worsening of symptoms in many sufferers. You should therefore avoid long stays in the sun, move particularly strenuous activities to cooler times of the day, avoid going to the sauna and bathe or shower in lukewarm water. The temperature should also be taken into account when choosing the holiday area.
Vaccinations affect the immune system, but according to the current state of knowledge, they have no effect on the course of the disease.Nevertheless, clarify each vaccination with your doctor and discuss the most favorable time with him - if the immune system is suppressed by drugs, the vaccination may not have any effect or may not be carried out at all.
Tips for relatives: Relatives also have to come to terms with the fact that the course of multiple sclerosis cannot be foreseen and therefore cannot be "planned". Ideally, even years after the onset of the illness, the patient is so little affected that he can continue to practice his job and fulfill his role in the family. But it can also be that he is in need of care or even bedridden and is dependent on all-round care. As soon as such a development becomes apparent, you should find out what help is available to you. The spectrum ranges from outpatient services to day or night care day or night care to full inpatient care in a nursing home. A temporary stay in a specialized rehabilitation center can also be considered, but it should be clarified beforehand whether the health insurance will cover the costs.
In general, you should - as long as you can and without overwhelming the person concerned - follow the principle of "helping people to help themselves": Encourage the patient time and again to use his existing abilities to cope with everyday life and only relieve him of as much as is absolutely necessary necessary.
Have naturopathic, exercise and relaxation exercises none Influence on the course of multiple sclerosis. However, some have been shown to alleviate certain symptoms and thereby improve quality of life.
Some sufferers report a positive influence on the course of the disease through regular intake of ginkgo extract (in the form of drops or tablets). In contrast, studies come to the conclusion that ginkgo can neither lower the relapse rate nor slow down the course of the disease. However, there is evidence that ginkgo could have a positive effect on cognitive disorders. Since highly concentrated plant extracts as well as synthetically manufactured drugs can have side effects, the relationship between benefit and risk must be carefully weighed.
Caution should be exercised when consuming cannabis yourself, which includes, among other things, cannabis. a nerve-protective function is said to be. Various studies indicate that the plant has an undesirable pro-inflammatory effect in MS. Of course, this does not apply to medically tested drugs with cannabis active ingredients.
Reflexology has proven effective for bladder, sensory and motor disorders. Its therapeutic effectiveness for these side effects has now been scientifically confirmed.
MS patients whose physical performance allows them to practice yoga regularly benefit in particular from the exercises that aim to improve body awareness and flexibility as well as relieve mental tension. In addition, yoga works against tiredness and exhaustion. With breathing exercises you can counteract a decreasing breathing capacity. It is important that you know and accept your personal performance limits.
Qigong, Tai Chi and Feldenkrais.
Qigong, Tai Chi and Feldenkrais help reduce stress, increase body awareness and maintain mobility.
Acupuncture can alleviate the symptoms in the early stages. Which acupuncture points are needled depends on the individual symptoms.
Some sufferers report positive effects from individually tailored constitutional treatment from homeopathy. If it is good, there is nothing wrong with such accompanying therapy - but it should never replace therapy with tried and tested conventional medical drugs.
All approaches in which animal substances are injected, such as "fresh cells" or thymus extracts, are to be assessed as extremely critical. As with all foreign proteins, there is a risk of an allergic reaction and, depending on the preparation, the risk of animal infections being transmitted to humans. "Immune-stimulating" procedures also appear more than questionable - it cannot be ruled out that destructive autoimmune processes are fueled in this way.
- www.leitlinien.net - Under the keyword search you will find the guideline of the German Society for Neurology on diagnostics and therapy for the term multiple sclerosis.
- www.dmsg.de - German Multiple Sclerosis Society, Bundesverband e. V., Hanover: Website of the largest German MS specialist society in which those affected are organized through patient advisory boards.
- www.kompetenznetz-multiplesklerose.de - The Competence Network Multiple Sclerosis creates therapy manuals in coordination with the German Society for Neurology, the MS guideline group and the medical advisory board of the DMSG. The necessary safety controls, contraindications and practical procedures for changing therapy are discussed here for each drug.
- G. Kramer; R. Besser: Multiple Sclerosis - Answer to the most common questions. Trias, 2006. Fact-rich specialist medical guide with extensive information and tips on mastering everyday life and illness. Helpful initial information for those affected, relatives and interested parties.
- www.multiple-sklerose-e-v.de - Initiative Selbsthilfe Multiple Sklerose Kranker e.V .: Here people with MS can find information on therapies, acute and rehabilitation clinics, and how to deal with authorities and institutions.
AuthorsDr. med. Nicole Menche in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections: Christian Pirzer. | last changed on at 13:56
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