What is MS (Multiple Sclerosis)?
MS (Multiple Sclerosis) is a disease that occurs when the immune or defense system of our body damages the nervous system (brain, spinal cord) and attacks it as foreign.
Normally, our nervous system is in a hidden environment, away from the immune system. However, for reasons we do not fully understand, our immune system, which is out of control, attacks and damages its own nervous system. Depending on the location of the damage, symptoms and signs vary. Since MS is an immune system disease, other immune system diseases can be frequently observed in people diagnosed with MS.
Table. Other diseases commonly associated with MS
- Thyroid/goiter
- SLE
- M. Gravis
- D. Mellitus/Sugar disease
- Ankylosing spondylitis
- Inflammatory bowel disease
- Scleroderma
- Behcet's disease
What are the Symptoms of MS?
1. The most common initial symptom of the disease is sensory complaints. Usually, it is not numbness, tingling or tingling, but rather numbness, tingling or tingling. Sensory symptoms occur in 50-70% of patients as immediate symptoms.
Sensory symptoms
- Numbness
- Tingling
- Pins and needles
- His decline
- Stress
- Feeling of numbness
- The feeling of walking on sand
- Itching
- Combustion
- Electrification
- Sudden electric shock to the face
- It can be a sudden electric shock from the neck to the back and feet.
2. After sensory complaints, motor deficits are most common. Symptoms related to strength or power problems are initially seen in 32-40% of patients, but over the years, 60% of patients suffer from varying degrees of loss of strength. This may be a direct loss of strength in a limb, or it may be "heaviness", "stiffness", "resistance" or "pain". Such symptoms often start in the legs.
3. Thirdly, vision loss or impairment (optic neuritis = inflammation of the optic nerve). This is the initial symptom in 15-20% of patients. It usually starts as a weakening of one-sided vision. Blurred vision is accompanied by light discomfort and eye pain with eye movements. Loss of color vision is often added to this condition. Black and white vision may occur. The visual nerve can be affected by inflammation of the beginning of the visual nerve just behind the eyeball (papillitis), or it can affect more distant parts of the nerve after it leaves the eye (retrobulbar neuritis). Blindness is rare despite these effects.
The optic nerve can be affected as an initial symptom on its own or in people with a late diagnosis of MS. In some cases, the risk of developing MS is increased when the optic nerve is affected first or when the disease manifests itself with the first optic nerve involvement. These risks are: occurrence between the ages of 20-40 and in women, positive results of the oligoclonal band test in the spinal marrow fluid, recurrence and plaques in the brain on eMaR imaging, which increases the risk of developing MS by 36%. In contrast, the risk is less than 6% in the case of a normal brain MRI and a negative oligoclonal band test.
Symptoms that may bring MS to mind, especially in a young person, include
- One-sided vision loss
- Incomplete spinal cord injury
- Sudden and severe electric shock sensation/pain in the facial area
- Extreme fatigue of unknown cause
- Heat-sensitive, neurological complaints that increase in heat
What is an MS Attack?
An attack is the unpredictable occurrence of MS symptoms at different times. It is when one or more of the clinical findings occur for at least 24 hours and continue for at least 1 month in between. Attacks can last for hours, days, weeks and months. They are usually followed by a period of recovery. Although the attacks vary according to the patient and the type of disease, the timing and frequency of attacks cannot be predicted in advance.
Temporary/Momentary Symptoms
They are short-term, sudden onset and disappearance, recurring in similar ways, and are not usually called attacks. They last between 30 seconds and 2 minutes.
- Sudden pain in the face
- Sudden contractions in muscles
- Sudden speech impairment
- Sudden attack of itching
- Contraction on one side
- Decreased muscle tone
- Sudden expression and speech impairment
- Sudden convulsions in the hand-foot
What Triggers MS Attacks?
1) Viral infections
2) Both physical and psychological stress can cause worsening of MS. However, MS attacks can be reduced under high stress. In Israel during the Gulf war, under constant threat of SCUD missiles, exacerbations and attacks were significantly reduced during this period.
3) Surgery or anesthesia
4) Increased body temperature. Although it does not directly cause an attack, it may cause temporary (false) worsening. Numbness, tingling and weakness in the body or blurred vision may increase during a hot bath.
5) Traffic accidents: The evidence for an attack is not very strong.
6) Although the number of attacks decreases during pregnancy, the risk of attacks may increase after childbirth due to hormonal changes, stress and exhausting newborn care. However, even if there are pregnancy-related attacks, they do not cause long-term negative accumulation. According to some data, pregnancy may even cause positive progression.
What is the age of onset of MS?
In many studies, the age of onset of MS is 29-32 years. In women, the most common age of onset is 5 years earlier than in men. In the primary progressive type, the age of onset is slightly older at 35-39 years. In 5% of patients, the age of onset is below 8 years and above 70 years.
What is the relationship between MS and infection?
Although many viral infections have been suggested to cause MS, there is no certainty that it occurs directly after an infection. This debate has been going on for many years and seems to continue. Infection scans, autopsy results and other studies give conflicting results. It is accepted that viruses seduce the immune system, causing it to attack the wrong target. Viruses include rabies, herpes simplex, the herpes virus, and Epstein Barr virus. Recently, human herpes virus-6, Epstein Barr virus and Chlamydia pneumonia have attracted interest as possible triggers of MS. However, the final word on the impact of microbial infection on MS has yet to be said.
Is MS a genetically inherited disease?
The fact that identical twins have a significantly higher rate of MS is the clearest evidence of genetic influence. Out of 100 identical twins, 24 out of 100 fraternal twins have MS, while 2.4% of twins born from different eggs have MS. This means that MS occurs 10 times more frequently in identical twins. Brain imaging (eMaR) or other examination methods can detect disorders that may occur in MS in twin siblings who have no complaints. Overall, there is a 20% chance that a first-degree relative of MS patients will be diagnosed or develop MS. However, MS is not only a genetic disease. It occurs with the interaction of genetic influence and environmental causes.
How is MS Diagnosed?
As in many other diseases, the diagnosis is based on neurological history, examination findings and tests. Various diagnostic criteria have been developed in the past for a definitive diagnosis and these criteria are partly modified with new information obtained over time. The new diagnostic criteria were revised in 2005. According to these criteria, a diagnosis of definite MS, probable MS or a diagnosis is excluded. The common idea is based on the spread of symptoms and signs over time and space. Patients who do not meet the diagnostic criteria in the early stages of the disease have been confusing. In some cases, there is an attack with clinical symptoms but diffuse plaques are detected on eMaR imaging. This is referred to as a clinical isolated disease picture, although it is not directly named MS.
A common mistake is that bright areas, which are sometimes detected incidentally on eMaR imaging, are overly assumed to be equivalent to MS. Clinical symptoms should also be consistent with MS. These images are frequently seen in patients with frequent headaches (migraine), in the elderly, and in some diseases affecting the vascular wall (Sjögren's syndrome, sarcoidosis, systemic lupus erythromatosus, polyarteritis nodosa, Behçet's disease).
If there is a RED FLAG or LIGHT condition after the diagnosis of MS, the diagnosis should be reconsidered. In this case, other diseases other than MS should also be investigated: 1. a family history of neurologic disease, 2. plaques in the lower parts of the spinal cord and not in the brain, 3. persistent back pain, 4. symptoms related to a specific region, 5. onset of the disease above the age of 60 or below the age of 15 and 6. progressive disease. If these are present, other diseases should also be searched for before accepting the diagnosis of MS.
What Causes MS?
According to our current knowledge, no definitive cause of MS has been identified. In various studies, various causes (previous viral infections, certain toxic substances from the environment, dietary habits, geographical factors, disorders in the body's defense system...) have been suggested, but none of them has been established as a definitive cause. Today, it is accepted that there is a genetic/familial predisposition to the disease and that the disease manifests itself when environmental conditions and other causes are added to this genetics.
How is MS treated?
MS can be summarized as attack treatment, preventive treatments, problem-specific treatments and complementary treatment.
Attack treatment; drug treatment.
Preventive treatment; treatments used to reduce the frequency and severity of attacks or the damage/scars/scars left by patients diagnosed with a certain type of MS.
Problem-specific treatments: There are treatments for problems that are different at the onset or course of MS, that can be seen without any disease, or that are a direct result of MS. These include treatments for depression, fatigue, forgetfulness, insomnia, muscle stiffness, urinary problems, sexual problems and other problems that arise.
Complementary therapies; This treatment can be specified as diet, herbal treatments, changes in daily life patterns, exercises (yoga, relaxation exercises).