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The disease of many faces: what is multiple sclerosis (MS)?

Multiple sclerosis (MS) is the most common neurological disease in young people. MS is an autoimmune disease of the central nervous system (brain and spinal cord) with initial diagnosis, usually between the ages of 20 and 40. Children and adolescents can also be affected. MS affects women 2-3 times more often than men. Worldwide, about 2.3 million people are affected, in Austria about 13,000.

The Causes of Multiple Sclerosis

The cause of multiple sclerosis remains unclear. A multifactorial genesis is currently assumed (genetics, however, without direct inheritance, environmental factors e.g. viral infections as triggers and immunological factors). As soon as certain factors happen to coincide, the disease can be triggered. This is accompanied by an invasion of autoaggressive immune cells (T and B lymphocytes) through the now leaky blood-brain barrier. These activated immune cells damage the medullary sheaths (sheaths around the nerve cell processes) in the brain and spinal cord.

Course of the disease in multiple sclerosis

85% of this first phase of the disease is characterized by relapses (RRMS). A relapse occurs when such an autoimmune attack on the body’s own medullary sheaths leads to clinical symptoms in everyday life that last longer than 24 hours. Since this demyeling can occur anywhere in the brain and/or spinal cord, MS is also called the “disease of many faces”. Depending on where the damage occurs, the patient notices different functional failures (= complaints) such as blurred vision, double vision, loss of strength, tingling sensations, “ant walking”, a constricting belt feeling, clumsiness, dizziness, balance problems, unsteady gait, lower physical resilience with shorter walking distances, incontinence, sexual dysfunction and a pronounced tiredness “fatigue”.

If you notice such symptoms and they persist for more than 24 hours, it is important to consult a neurologist. The suspicion of multiple sclerosis can be clarified by means of a conversation, neurological examination (objectification of the symptoms by means of a specific scale “EDSS”) and magnetic resonance imaging (MRI) of the brain and spinal cord as well as subsequently a lumbar puncture. MRI can depict corresponding foci of inflammation in the brain and spinal cord, the activity of which can also be detected by contrast agent enrichment (= sign of a leaky blood-brain barrier).

If multiple sclerosis is diagnosed, intravenous cortisone shock therapy with 1g for 5 days should be administered during the relapse and subsequently, if special criteria (McDonald criteria) are met, long-term drug therapy should be started as early as possible.

Why should long-term therapy be started as early as possible?

Right at the beginning of the first symptoms, the disease is in the inflammatory phase. This is where anti-inflammatory therapies work. The aim is to keep the damage as low as possible over the years through early therapy.

After a period of time that varies from person to person – but usually after approx. 15 years at the latest– complaints may remain. This is the sign that the damage has progressed and the so-called progressive phase (SPMS) of MS disease begins. In dieser progredienten Phase ist das Gehirn- abgesehen vom natürlichen Altern – zusätzlich bereits durch die langjährige chronische Entzündung in Mitleidenschaft gezogen worden. Die progrediente Phase ist weniger entzündlich und daher derzeit nur eingeschränkt therapierbar.In this progressive phase, apart from natural aging, the brain has already been affected by long-term chronic inflammation. Therefore, according to randomized, placebo-controlled studies, it is important to start anti-inflammatory therapy as early as possible after the diagnosis in order to keep the damage and the resulting tissue loss as low as possible right from the start. All these drugs have their effects and side effects (= advantages and disadvantages). The same medication is not suitable for everyone. The appropriate therapy will be recommended and discussed by your neurologist depending on the inflammatory activity and individual course.

For ethical reasons, there are no studies for these medications during pregnancy/breastfeeding, so as a general rule, these therapies should not be taken during pregnancy or breastfeeding. The exception to this is natalizumab. Under strict risk/benefit assessment, there is no longer a strict contraindication to this during pregnancy, since in retrospect it has been shown that the miscarriage rate for surprise pregnancies on natalizumab corresponded to the normal population; however, it should still not be taken while breastfeeding.

Thanks to these therapy options, a completely “normal” life with work, family, sports, travel, etc. is now quite possible.

Since 2006, there have been many new long-term therapy options available depending on the indication.

Our specialist in neurology, Dr. Assunta Dal-Bianco, is responsible for the diagnosis and treatment of all neurological diseases. Headaches, migraines, back pain, nerve compression syndromes, polyneuropathies, movement disorders (e.g. tremor, Parkinson’s disease), restless legs syndrome (RLS), dementia, epilepsy, prevention and aftercare for stroke, seizure disorders, burnout, etc. are some of the common diseases that are treated in the CoOrdination. Dr. Dal-Bianco’s clinical and scientific specialty is multiple sclerosis.