The number of people with multiple sclerosis is high! Do you know the warning signs?

Have you forgotten something trivial? Can't you think of a word?
Do you have a momentary lapse of memory of what you did or said yesterday, today or a minute ago?

I'm sure you've been teased more than once about having multiple sclerosis.

In real life with a real patient with a real diagnosis, however, it's not so funny.

Multiple sclerosis is indeed a very serious neurological disease that predilectively affects the young population.

Usually, it breaks out fully quite early, between the ages of 20 and 40. However, this is not the rule. The elderly, and even young children, are no exception.

The incidence is much higher in women, even 2-3 to 1 in relation to the male sex.

But men are not to be comforted either. Although we see this insidious disease less often in them, it is usually a more progressive form with a much worse course.

Incidence of cerebrospinal sclerosis

Sclerosis is characterised by a specific geographical incidence. This means that it is observed more frequently in some parts of the world than in others.

The incidence is higher in the more northern latitudes of the northern and southern hemispheres. Conversely, it decreases towards the south. Overall, about 2.5 million people suffer from it.

What is the insidiousness of the disease?

The insidiousness of the disease lies not only in the disease itself, but also in its early manifestations (initial manifestations) and in its heterogeneous course (different manifestations in different individuals).

It is the non-specific initial symptoms and their heterogeneity in humans that make it impossible to set uniform criteria for symptoms, thus impeding early diagnosis and treatment.

We do not mean to imply that there are no criteria. There are several, but given the differences in humans described above, they are inapplicable for some of them.

Multiple sclerosis is not a mere forgetfulness

Sclerosis (Latin: sclerosis cerebrospinalis multiplex - SM), translated as multiple sclerosis, is an immune-mediated, inflammatory, neurodegenerative disease of the central nervous system (CNS).

It can also be referred to as demyelinating axonal disease because the immune-mediated pathological process (inflammation) affects both the white and grey matter of the brain.

Pathophysiology of multiple sclerosis: What is happening in our brain?

In multiple sclerosis, there is a sudden breakdown of the myelin sheaths with an accompanying axonal lesion.

Explanation.

Inflammatory lesions, on the other hand, heal slowly (several weeks). Secondary to this, glial tissue is formed.

This tissue is stiffer and therefore the healed deposits become stiffer - sclerotic. However, they never heal ad integrum (in full).

Classification of sclerosis according to CNS involvement:

1. focal CNS involvement - isolated demyelinating lesion
2. diffuse CNS involvement - multiple (scattered) demyelinating foci

Warning, often overlooked symptoms of multiple sclerosis

Multiple sclerosis develops slowly and subtly. It breaks out suddenly, but the exact onset of the disease cannot always be detected.

The manifestations of the disease and their intensity are varied, depending on the location of the scattered inflammatory deposits in the CNS. These are most often found near the ventricles of the brain, in the brain stem and spinal cord.

Their size is usually around 3 mm, but can reach up to 1.5 cm. The size and location of the lesions also determine the symptomatology, which is usually subtle to malignant and progressive.

Interesting:
Very often the first symptom is fatigue. This symptom is, of course, easy to miss, as its occurrence in many other diseases is almost regular.
The more typical symptoms of sclerosis are characterised by attacks (flares) followed by remissions (remittances).

Example: a patient experiences a loss of visual field within a few hours. Subsequently, he or she starts to see normally and this condition recurs several times. Of course, attacks and remissions refer to different symptoms. They do not necessarily involve vision.

Table with the most typical manifestations of multiple sclerosis:

Early diagnosis of multiple sclerosis is of utmost importance!

Due to the high incidence of multiple sclerosis, education of the population is very important.

Ultimately, it is the patient who first notices that something is not as it used to be. Therefore, it is important to know at least the basic manifestations and to seek help early.

Unfortunately, until now, the vast majority of these diseases are diagnosed purely incidentally and therefore late on closer examination for other reasons.

It is true that the brain is time. The most significant damage to the brain and nervous system occurs in the first years of disease development!!! After 10 to 20 years of untreated multiple sclerosis, irreversible damage to the CNS and permanent disability occurs.

The basic diagnostic pillars of multiple sclerosis

There is no definitive test to diagnose MS that can confirm this tricky disease with certainty. However, the diagnosis relies on three basic pillars, namely the patient's clinic, MRI and laboratory parameters.

1. Clinical picture
2. Magnetic resonance imaging (MRI) T2 and Flair lesions
3. Laboratory examination
4. Electrical potential test

A thorough analysis of the patient's objective as well as subjective complaints should be performed for each patient. The patient should be examined not only by a general practitioner but especially by a specialist in neurology.

If the neurologist suspects multiple sclerosis, the patient should be referred for further investigation (e.g. the presence of multiple sclerosis symptomatology, namely alternating episodes of attack/relapses, indicating neurological damage to the CNS lasting from one to 21 days).

The most important examination is MRI of the brain and spinal cord with contrast agent (enhancing lesions). It can show multiple lesions, as well as signal changes in PD, T1, T2 and FLAIR sequences (so-called hypersignaling or enhancing lesions). MRI has been used in the diagnosis of multiple sclerosis since 2001.

When multiple sclerosis is suspected, the MRI scan is supplemented by a lymphatic analysis. This is taken by lumbar puncture, which means that the spinal canal is pierced with a lumbar needle, from where a sample is taken. G-type immunoglobulins or oligoclonal immunoglobulins are usually present.

Equally important are the blood samples. Basic parameters are normal, monocytes are elevated and specific antibodies are present.

One of the examinations are also tests of electrical brain activity. On the basis of various stimuli (visual patterns, electrical impulses), the electrical signals of the nervous system and the speed of their transmission are recorded using special electrodes.

However, there are a number of diseases that are strikingly similar in their manifestations to sclerosis. Even some examinations have similar results.

Diseases with similar symptomatology and examination results:

• cerebral ischaemia
• neuroinfections (encephalomyelitis, Lyme disease, syphilis)
• paraneoplastic diseases
• migraine
• arterial hypertension
• Hashimoto's thyroiditis
• diabetes
• thrombophilic conditions
• sarcoidosis
• drug and alcohol poisoning
• vitamin B12 deficiency