Multiple sclerosis or MS is an inflammatory disease that attacks the central nervous system.
The disease gets worse slowly in most cases and depends, among other things, on the severity of the signs and symptoms and the frequency of relapses.
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Multiple sclerosis affects the central nervous system, in particular the brain, the optic nerves and the spinal cord.
It alters the transmission of nerve impulses and can manifest itself through a wide variety of symptoms: numbness in one limb, visual disturbances, sensations of electrical discharge in one limb or in the back, movement disorders, etc.
Most often, multiple sclerosis progresses in the form of relapses, during which symptoms reappear or new symptoms appear.
After a few years, relapses leave sequelae (permanent symptoms) that can become very disabling.
The disease can affect many functions: movement control, sensory perception, memory, speech, etc. The disease can also affect a person’s ability to walk, walk, talk, etc.
Multiple sclerosis is a chronic autoimmune disease that varies greatly in severity and progression. It was first described in 1868 by French neurologist Jean Martin Charcot.
The disease is characterized by inflammatory reactions that lead in some places to the destruction of myelin (demyelination). Myelin is a sheath that surrounds the nerve fibers (see diagram below).
Their role is to protect these fibers and to accelerate the transmission of messages or nerve impulses.
It is said that the immune system of people with demyelination destroys myelin because it sees it as something foreign to the body (autoimmune reaction).
Therefore, in certain places of the nervous system, the flows are slower or completely blocked, which causes the various symptoms.
Apart from the outbreaks, the inflammation disappears and the myelin partially rebuilds around the fibers, leading to a complete or partial regression of the symptoms.
However, in cases of repeated and prolonged demyelination, neurons can be permanently destroyed. This causes a permanent disability.
The parts of the nervous system affected by the disease resemble plaques that can be seen on a magnetic resonance imaging (MRI) scan, hence the term multiple sclerosis.
What causes multiple sclerosis?
Multiple sclerosis is a complex disease that seems unexplainable. Researchers believe it occurs in the presence of a combination of environmental factors in people whose heredity predisposes them to the disease.
It could be a viral infection contracted during childhood, such as measles or Epstein-Barr virus or mononucleosis.
There are also many genetic predisposition factors. In recent years, several genes have been identified as potentially being involved that could increase the risk of multiple sclerosis.
See also the sections on People at Risk and Risk Factors for Multiple Sclerosis.
Multiple Sclerosis: understanding everything in 2 minutes
How do you recognize multiple sclerosis?
There is no test that can diagnose multiple sclerosis with certainty. Misdiagnosis remains common because many diseases can manifest symptoms similar to those of multiple sclerosis.
In general, the diagnosis is based on :
- A medical history, with a medical questionnaire to establish the history of problems related to the disorder and identify, if appropriate, previous neurological manifestations.
- A physical examination that assesses vision, muscle strength, muscle tone, reflexes, coordination, sensory functions, balance, and ability to move.
- Lumbar puncture which consists of taking cerebrospinal fluid (CSF) from the lumbar region. This procedure is used to check if the CSF – which circulates in the brain and the spinal cord – has an increase in certain proteins and contains molecules that cause it to produce abnormal antibodies.
- A record of electrical activity that measures the time it takes for visual information to reach the brain.
- Magnetic resonance imaging (MRI) is used to visualize lesions in the white matter (containing myelin) of the brain, cerebellum, and spinal cord.
Multiple sclerosis is difficult to diagnose and usually 2 or more relapses, with at least a partial remission, are needed to confirm the diagnosis.
To make a definitive diagnosis of multiple sclerosis, the neurologist must be convinced that there is myelin damage in two different places that cannot be the consequence of other diseases (spatial criteria).
In addition, the neurologist must also show that the damage occurred at two different times (time criterion).
Therefore, the medical questionnaire is crucial for a good understanding of the symptoms and for checking whether there have been neurological manifestations in the past.
How does multiple sclerosis progress?
The course of multiple sclerosis is unpredictable. Each case is unique. Neither the number of relapses, nor the type of disease, nor the age of diagnosis can predict or foresee the future of the person with MS.
There are mild forms of the disease that do not cause any physical difficulty, even after 10 or 20 years of illness. Other forms can progress rapidly and be more disabling. Finally, some people only have one relapse in their lives.
It is important to know that the life expectancy of people with the disease is reduced by 7 to 14 years, according to a large study.
Half of all deaths are related to the complication of MS. The mortality rate related to infectious and respiratory diseases, suicide and cardiovascular diseases is higher in people with MS compared to the general population.
What are the different forms of multiple sclerosis?
In general, there are 3 main forms of multiple sclerosis, depending on how the disease evolves over time.
Referral form. In 85% to 90% of cases, the disease starts with the remitting-recurrent form (also called “cyclic remitting-recurrent”), characterized by relapses interspersed with remissions.
A relapse is defined as a period of new neurological signs or recurrence of old symptoms lasting at least 24 hours, separated from the previous relapse by at least one month.
Generally, relapses last from a few days to a month and then gradually disappear. In most cases, after several years, this form of the disease can progress to a secondary form.
Primary progressive form (or progressive from the beginning).
This form is characterized by a slow and steady progression of the disease from the time of diagnosis.
It affects 10% of cases6. 6 Unlike the relapse form, there are no true relapses, although the disease can sometimes get worse. This form usually appears later in life, around the age of 40.
Secondary progressive form.
After an initial form of relapse, the disease can become steadily worse. This is known as the secondary-progressive form of the disease.
Relapses may occur, but they are not followed by clear referrals and the disability gradually worsens.
Most people with the relapsing-remitting form will develop the progressive form within 15 years of diagnosis.
Isolated clinical syndrome.
It is an initial episode characteristic of the disease (e.g. optic neuritis, brain stem symptom, myelitis) and has the characteristics of inflammatory demyelination, but does not meet all diagnostic criteria for multiple sclerosis.
The symptoms of the clinically isolated syndrome vary from person to person, depending on the location of the lesions in the central nervous system.
It is estimated that one in five people will develop multiple sclerosis after 10 years when the clinically isolated syndrome is not accompanied by the typical lesions of multiple sclerosis.
This percentage rises to 80% when the isolated clinical syndrome is characterized by lesions similar to those observed in multiple sclerosis.
How many people are affected by multiple sclerosis?
It is estimated that, on average, 1 in 1,000 people suffer from multiple sclerosis, but the prevalence varies from country to country.
According to Arsep, in France, 100,000 people are affected by multiple sclerosis (about 5,000 new cases diagnosed each year) for 2.3 million patients worldwide.
Northern countries are more affected than countries near the equator.
In Canada, the rate is reported to be among the highest in the world (1/500), making it the most common chronic neurological isease among young adults.
It is estimated that approximately 100,000 French people are affected, while Canada has the highest rate of multiple sclerosis in the world with an equivalent number of cases.
It is still not explained that there are twice as many women as men with multiple sclerosis. The disease is most often diagnosed in people between 20 and 40 years of age, but it can also, in rare cases, affect children (less than 5% of cases).
As part of its quality approach, Passeportsanté.net invites you to discover the opinion of a health professional.
Dr. Jacques Allard, a general practitioner, gives his opinion on multiple sclerosis:
Being diagnosed with multiple sclerosis and living with the disease requires a lot of courage and determination. There is a lot of important research going on around the world. So we must continue to wait. I have two pieces of advice for patients with multiple sclerosis:
– First, with the agreement of your primary care physician, make sure you have a good follow-up with a competent and trustworthy neurologist.
Can multiple sclerosis be prevented?
Currently there is no way to prevent multiple sclerosis, as the cause is unknown.
People who are at risk of developing multiple sclerosis can make the most of their possibilities by avoiding as much as possible the hypothetical risk factors listed above.
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