Although Multiple Sclerosis is incurable, after recovery, patients can benefit from improved living conditions and prevent complications.
Multiple Sclerosis occurs because the immune system attacks the myelin (a substance that insulates axons and speeds up nerve impulse conduction), slowing or blocking the communication between nerve cells.
Lesions occur mainly in the white matter, optic nerves, brain stem, cerebellum and spinal cord. Genetically susceptible individuals can get it in terms of viral or bacterial infections, lack of sun exposure or smoking.
In general, there are four types of presentation of the disease:
1. with remissions and exacerbations;
2. progressive with exacerbations;
3. primary progressive;
4. secondary progressive.
In the first case, symptoms are solved completely, followed by months or years of silence, until a new exacerbation. The cycle is repeated several times until no longer complete remissions and disease begins to progress, becoming so-called secondary progressive Multiple Sclerosis.
Approximately 85% cases of Multiple Sclerosis manifests in this way. Women are 2.5 times more likely than men to make this form and age of onset ranges for 30 years.
For the other 15% of cases, evolution has no remission, it is called primary progressive, so is affecting equally men and women around the age of 40 years.
A small part of these patients shows progressive form with exacerbations. Symptoms of nerve conduction changes are multiple, different from patient to patient, depending on the areas of the brain or spinal cord which are affected.
No other neurological disease is not manifested by the coexistence of so many problems. Listed in decreasing order of frequency, they are: fatigue, loss of muscle strength, impaired sensitivity (tingling, numbness, insensitivity), balance disorder, sphincter dysfunction (constipation, urinary or fecal incontinence, urinary retention, feeling urgency) and sexuality dysfunction, spasticity, cognitive impairment (decreased memory, attention), depression, pain, decrease or loss of vision, tremor.
On average, it takes about 20 years to use stick and about 30 until they will need a wheelchair. Being female, younger age at onset, complete recovery after the first attack lasted more than five years between the first attack – all these are associated with a positive prognosis.
There is an effective treatment for Multiple Sclerosis?
Some immunoactive drugs seem to be effective in a certain degree, can induce remission and slow down evolution. Firstly, using immunomodulatory substances such as interferon beta (beta-1a, Betaseron, beta-1b, Avonex) and glatiramer acetate polymer (Copaxone), which inhibits cells that destroy myelin.
Another category of drugs have antiproliferative or cytotoxic effect on inflammatory cells (mitoxantrone, methotrexate, azathioprine and so on). The third category uses ways of blocking extracellular processes that influence disease (intravenous immunoglobulin, plasmapheresis, monoclonal antibodies, methyl-prednisolone).
Rehabilitation in Multiple Sclerosis
Multiple Sclerosis seems to be the disease whom’s results are less satisfactory in terms of long-term evolution. Despite the medications mentioned above, during the patient’s condition worsens. In no other neurological disease are not affected so many areas of the central nervous system. Rehabilitation approach involves intervention on each disturbance occurred.
Motor function and balance
To improve motor function, aerobic exercise are the best. Besides maintain normal muscle fibers innervated,aerobic exercise can reduce significantly fatigue and depression. Exercises to increase muscle strength are using weights adjusted after Multiple Sclerosis possibilities.
Three sets of 10 reps seem to be an appropriate program. Exercise should not be too intense, not to cause a significant rise in body temperature.
Also, exercise must be regularly done and on long-term, a way of life. Patients with a higher degree of disability can do some lighter activities, which require unused segments. It’s about simple daily activities such as toilet, dressing, feeding or showering.
Management of spasticity
Is based on frequent use (20 minutes every few hours, if possible) of muscle stretching (stretching). Preferred are mild and long stretches instead of intense and short stretches. Antispasmodic drugs may be related to decrease muscle tension, such as baclofen, botulinum toxin injections, cold applications.
Approximately 50% of Multiple Sclerosis patients experience significant degrees of pain, most often having neuropathic origin.
Treatment of pain is using AEDs (gabapentin, pregabalin). Other causes of pain recognize muscle pain, especially in the lumbar spine inflammatory pain. To treat them Multiple Sclerosis patients can use lumbar orthosis, analgesics, NSAIDs, stretching exercises.
Cognitive and affective disorders
The most common cognitive impairment are related to memory. Treatment is based on identifying the problem, then on scheduling different activities, memory usage exercises, environmental restructuring, notes using. Fatigue, depression, intolerance to heat can contribute to memory loss, and is requiring treatment.
Are very common, with a particular psychological and social impact. Treatment requires a good diagnosis of the type of dysfunction, and then if it is necessary the use of anticholinergics, alpha-blockers or flashing survey.
Fatigue and sleep in people with Multiple Sclerosis
Certain drugs used to combat fatigue appear to have adverse effects on neuronal plasticity. Due to massive loss of neurons in Multiple Sclerosis patients, performing tasks is with higher energy expenditure than in healthy individuals. Sleep is very necessary for energy recovery of neurons and the development of new connections between neurons.