Course of multiple sclerosis
introduction
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. This is made up of the brain and spinal cord and is known to be responsible for controlling all body functions. Multiple sclerosis is still an incurable disease. Although enormous resources are being made available for research, neither the cause nor a possible treatment has been found so far. Only the course can be positively influenced by various treatment approaches. The course can be different for different patients and is divided into three main forms.
Gradient forms
The different forms of multiple sclerosis can be seen in three groups subdivide.
So-called relapses occur in two of the three forms. A thrust is subject to certain criteria. New symptoms or symptoms related to renewed damage to the nervous system appear within hours to days. The symptoms must last longer than a day. In order to be able to distinguish between two attacks, a month (more precisely 30 days) lie between the events. An episode has a variable duration of several days, but can also last for a few weeks.
- thrust-like course:
The most common form is the so-called relapsing remitting (regressive) multiple sclerosis (RR-MS). In this form, unpredictable flare-ups occur, in which new symptoms appear or already known symptoms worsen. The symptoms often regress completely at the beginning of the disease. Only in the later course of the disease do residual symptoms persist after an attack, which remain more permanent. - secondary progressive course:
Another progression that is very similar to the previous one is called secondary progressive (advancing) called multiple sclerosis. In this form, too, the disease progresses in a relapsing manner. However, here the neurological functions steadily deteriorate without the occurrence of flare-ups. The relapses also accumulate as the disease progresses and thus cause an overall increase in symptoms. The course is called secondary because the clinical picture does not only progress through the course of time. The relapsing-remitting MS often develops into this form during the long-term illness. - primarily progressive course:
The primarily progressive (advancing) multiple sclerosis is characterized by a creeping course in which there are no flare-ups. The slowly progressing symptoms no longer recede. This form is observed especially in old patients.
End-stage multiple sclerosis
A concrete one End stage exists in multiple sclerosis Not. The severity of the symptoms varies from patient to patient. Thus, the clinical picture of MS in the period before the patient's death is also different. The more moderate the course and the better the care, the more likely it is that a condition that could be described as an end stage will not occur. Even more severe courses are nowadays largely kept within limits thanks to modern drug therapy approaches.
But if one had to describe an end stage, it would probably be represented by extreme symptoms. The multiple (many) lesions that developed in the brain and spinal cord during the course of the disease bring extensive and varied limitations with them. Movement is difficult or is no longer possible.There are severe ones Sensory disturbances and possibly the patient has Pain. Language is also changing, as the facial muscles can no longer be coordinated properly. This can go so far that the ability to speak is completely lost. In the late course it can also lead to a dementia which is a consequence of the breakdown of the brain mass.
Life expectancy
The symptoms are different for each patient, but they have a major influence on mortality. If there are no severe disabilities due to the nerve damage, life expectancy can come close to that of a healthy comparison person. Often times, people with MS die a few years earlier. If there are severe disabilities or if vital centers in the brain (brain stem) are damaged too much by the inflammation, the patient can also die earlier. Any age at which the disease exists is possible - from 20 to 70 years old, with early death extremely rare. A particular example associated with premature death and a low life expectancy is the so-called Marburg variant of multiple sclerosis. This form is characterized by an extremely aggressive course with severe disabilities, but occurs extremely rarely.
after 10 years
How multiple sclerosis looks after 10 years of illness differs from person to person. Even after such a period, it is possible with proper treatment of the relapses and comprehensive care symptom-free to be. Nor can any symptoms be determined that have occurred or persist in all patients after 10 years. However, there are symptoms that often appear at the beginning of the disease and thus make it more likely that they will be present after 10 years of illness. For example, the nerves that control the muscles of the eye can be damaged, causing them to Double vision (Squinting) leads. Sensory disturbances in the face or limbs can occur. Also an imprecise pronunciation, Hoarseness or difficulty swallowing can be symptoms of longstanding MS. After 10 years there are many Reflexes weakened and difficult to trigger. In addition, the course of multiple sclerosis can change after 10 or 15 years of illness. For example, it has been observed in the past that some patients who have suffered from relapsing-remitting MS suddenly develop a progressive component. The resulting secondary progressive MS is associated with an increased number of existing symptoms.
forecast
When multiple sclerosis is diagnosed, it is by the individually very different disease course hardly possible to make a definitive prognosis. This uncertainty can be stressful, but patient education should focus on the majority of positive outcomes. A tendency can be estimated from the severity of the initial symptoms, which usually turns out to be correct. Even if you cannot completely rely on it, a good prognosis can be assumed if the symptoms are initially moderate. Life expectancy is hardly limited with good long-term and relapse therapy. Multiple sclerosis is by no means a death sentence, but the diagnosis must be handled responsibly - on the part of the doctor as well as the patient.
Mortality in Multiple Sclerosis
Multiple sclerosis (MS) is not a principally fatal disease. Many patients live to be over 70 years old despite having MS. Death can occur from the consequences of the symptoms. As a result, people with MS can lose the ability to move efficiently in old age. This often makes them bedridden, which can also be the case with other diseases in old age. Bed restraint is at an increased risk for Pneumonia socialized to which older and immunocompromised patients can die.
The pressure of suffering caused by the restrictions, which may build up over the years, can psychological damage left on the patient. A resulting depression and life crisis could possibly drive the patient to suicide. Psychological support also plays an important role in the treatment of the chronically ill. The majority of all MS patients therefore die of natural causes or other illnesses. In the rarest of cases, a lesion in the brain caused by MS is responsible for death. The damage must be relatively great and exist in a brain area from which vital processes are controlled.
Can you stop multiple sclerosis?
Since there is still no treatment method that completely cures multiple sclerosis, the therapeutic options focus mainly on controlling the course slow it down or even to Standstill bring to. As part of this therapy goal, various drugs have been developed that both reduce the rate of relapses and slow down the progressive course. Below are three examples.
Glatiramer acetate: This is a compound made up of four natural amino acids. The daily injection under the skin (for example on the abdomen into fatty tissue, such as insulin spikes) leads to less frequent flare-ups of inflammation. With long-term treatment, a quarter of the treated patients are completely relapse-free after 6 years of disease. If long-term therapy is continued, 75% of patients will not experience any new permanent symptoms.
Beta interferon: This is a Protein compoundwhich can also be produced by the body's own cells. Interferons are mediators of the immune system and control various processes. In this way, they also bring the inflammation in MS under control and thereby extend the symptom-free phases between the significantly less frequent episodes of the disease. Beta interferon is injected under the skin or into the muscle (like a vaccination) one to three times a week.
Natalizumab: This drug is a so-called monoclonal antibody. This is a laboratory developed antibody, similar to those produced by the body's immune system. Instead of attacking certain pathogens or foreign substances, it binds to cells of the immune system. This prevents these cells from migrating into the central nervous system and causing inflammation. The thrust rate is thus reduced by 60 - 70%. Natalizumab is a very powerful drug with dangerous side effects. That is why it is only used for particularly severe courses of MS.
More information about therapy Therapy of multiple sclerosis
Trigger factors for MS
Trigger factors are events or circumstances that can worsen the condition of the disease and thus negatively affect the course. In multiple sclerosis, such deterioration becomes visible as relapses. Are a very important factor Infectious diseases. Does an MS patient get one Flu or gastrointestinal illness, the immediate consequence may be a flare-up of illness.
Although the pregnancy is a protective factor, but the risk of relapse is increased in the first three months after the baby is born. Whether the patient's psychological state has an influence on the likelihood of relapse is still being discussed. There seems to be a connection, this is being investigated in current studies.
