Multiple sclerosis

What is Multiple Sclerosis?

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system). This is because the body's immune system mistakes healthy cells to "intrusive" and attacks causing brain damage. The immune system of the patient erodes the protective sheath covering the nerves, called myelin.

Damage to myelin causes interference in communication between the brain, spinal cord and other areas of your body. This condition may result in deterioration of the nerves themselves in an irreversible process. Over time, degeneration of the myelin caused by the disease will cause brain damage which can lead to atrophy or loss of brain weight. In general, patients with multiple sclerosis show brain volume loss of up to five times faster than normal.

Symptoms vary widely, depending on the amount of damage and the nerves are affected. Multiple sclerosis (MS) is characterized by being a potentially debilitating disease. People with severe cases of multiple sclerosis may lose the ability to walk or speak clearly. Multiple sclerosis can be difficult to diagnose early, once symptoms appear at intervals and the patient becomes months without any sign of disease.


Multiple sclerosis affects about 2.5 million people worldwide. The disease has no cure, but treatments can help control the symptoms and reduce disease progression.

                      

causes

The exact causes of multiple sclerosis is not known, but there are interesting data suggest that the genetic the environment where one lives and even a virus may play a role in disease development. While the cause is still unknown, multiple sclerosis has been the focus of many studies around the world, which has enabled a constant and significant improvement in the quality of life of patients.

Genetics and environment

It is believed that multiple sclerosis may in part be inherited. Thus, second and third degree relatives of people with MS are at increased risk of developing the disease. Siblings of a person with the disease has a 2% risk to 5% more likely to have multiple sclerosis.

However, experiments with identical twins indicates that heredity may not be the only factor involved. If multiple sclerosis was determined exclusively by genetic, identical twins have similar risks. However, an identical twin has only 30% higher chance of developing multiple sclerosis its dual already have the disease.

Some researchers theorize that multiple sclerosis develops in people born with a genetic predisposition that, when exposed to an environmental agent triggers an autoimmune response excessive, giving rise to multiple sclerosis. The lack of sun exposure in the first months or years of life is also considered by experts as an environmental factor that predisposes the onset of multiple sclerosis.

Viruses and Multiple Sclerosis

Some studies suggest that some viruses, such as Epstein-Barr virus (mononucleosis), varicella-zoster and those present in the hepatitis vaccine may be related to multiple sclerosis. So far, however, this belief has not been proven.

Other factors

There is increasing evidence suggesting that hormones, including sex, can affect and be affected by the immune system. For example, both estrogen as progesterone, two important female sex hormones, can suppress some immune activity. Testosterone, the principal male hormone, can also act as a suppressor of immune response.

During pregnancy, estrogen and progesterone levels are very high, which may help explain why pregnant women with MS usually have less disease activity. The higher levels of testosterone in men may partly explain the fact that women are more likely to develop the disease than men, since testosterone can also inhibit the immune system.

                                          

Risk factors

Several factors can increase the risk of multiple sclerosis, including:

Age: multiple sclerosis can occur at any age, but most commonly affects people aged 20 to 40 years. In this age group are made 70% of diagnoses

Gender: Women are more likely than men to develop MS. The actual proportion is three women for every man
Family history: If one of your parents or siblings have multiple sclerosis, you have a chance of 1 to 3% of developing the disease - compared to the risk in the general population

Race: Caucasians, especially those whose families originate from northern Europe, are at greater risk of developing multiple sclerosis. People of Asian, African or American descent have lower risk

Geographical regions: multiple sclerosis is more common in areas such as Europe, southern Canada, northern United States, New Zealand and southeastern Australia. It is not known why

Other autoimmune diseases: you can be a little more likely to develop multiple sclerosis have another disease that affects the immune system as thyroid disorders, type 1 diabetes or inflammatory bowel disease.

Symptoms of multiple sclerosis

People with multiple sclerosis tend to show the first symptoms between the ages of 20 to 40 years. Some may come and go, while others remain.

There are two people who strictly have the same symptoms of multiple sclerosis. This is because the events will depend on the nerves that are affected. However, the first symptoms of multiple sclerosis in general are:

blurred or double vision
Fatigue
tingles
Power loss
Lack of balance
muscle spasms
chronic pain
Depression
sexual problems
Urinary incontinence.
You can have a single symptom and then spend months or years without any. The problem can also happen just once, go away and never come back. For some people, the symptoms become worse within weeks or months.

These are the most common symptoms of multiple sclerosis:

muscle symptoms

Feeling of "pins and needles" in the skin
dormancy
itch
burning
Loss of balance
muscle spasms
Problems to move arms and legs
Difficulty walking
coordination problems and to make small movements
Tremor one or more members
Weakness in one or more limbs.
Symptoms bladder and intestine

To urinate several times a day
Urgency to urinate, especially at night
Difficulty emptying the bladder completely
constipation.
nervous symptoms

Dizziness or lightheadedness
Attention and decreased judgment
Memory loss
Difficult to reason and solve problems
Depression or feelings of sadness
Hearing loss.
sexual symptoms

dryness vaginal
Erection problems
Less sensitivity to touch
lower sex drive
Problems reaching orgasm.
speech problems

Long pause between words
slurred speech or difficult to understand
speaks nasally
swallowing problems at later stages.
Symptoms eyes

double vision
Nuisance eyes
rapid, uncontrollable eye movements
Loss of vision (usually affects one eye at a time).
Fatigue

About eight in 10 people with MS feel always very tired. This sensation usually occurs during the afternoon and makes the muscles become weaker, slower thinking and leaves the sleepy person.

This fatigue is generally not associated with the amount of work you do. Some people with MS feel tired even after a good night's sleep.

Severity of symptoms

The symptoms of multiple sclerosis are divided into three groups: primary, secondary and tertiary:

primary symptoms: caused by damage to the protective sheath of the nerves in the spine or brain (myelin). This process can lead to poor bladder or bowel, loss of balance, numbness, paralysis, tingling, tremors, vision problems or weakness

Secondary symptoms: are close to the primary symptoms, but more serious. For example, the person is no longer able to empty the bladder, and this can cause an infection in the body

Tertiary symptoms: social, psychological and work-related. For example, multiple sclerosis can be difficult to walk or drive.

Because the symptoms of multiple sclerosis varies greatly, it is better not to compare with others who have the disease. His experience is probably different. Most people learn to control their symptoms and can lead a full and active life.


Diagnosis of Multiple Sclerosis

The diagnosis of multiple sclerosis can be difficult, since there is a great variety and remission of symptoms. In general, the first medical range to be searched according to the presenting symptom. Why only after different symptoms the patient is referred to a neurologist, who with the help of additional tests can make the diagnosis. The criteria for diagnosing MS are:

Symptoms and signs indicating disease brain or spinal cord
Evidence of two or more injuries - or abnormal areas in the brain - from a magnetic resonance imaging

objective evidence of disease of the brain or spinal cord in medical examination

Two or more episodes with symptoms lasting at least 24 hours and place in at least one month interval

No other explanation for the symptoms.

The diagnosis is primarily clinical and should be complemented by MRI. It may be, however, that medical workpiece several tests to exclude other conditions that may have similar symptoms:

Bloodtests

A blood test can help rule out some infectious or inflammatory diseases that have symptoms similar to multiple sclerosis.


Lumbar puncture

In this procedure, a doctor or a nurse inserts a needle into the lower back in order to remove a small amount of spinal fluid for laboratory analysis. The fluid is tested to identify anomalies associated with multiple sclerosis, such as abnormal levels of white blood cells.

This procedure can also help rule out viral infections and other conditions that can cause neurological symptoms similar to multiple sclerosis.

Magnetic resonance imaging (MRI)

An MRI produces detailed images of the brain, spinal cord and other areas of your body. An MRI may reveal lesions related to loss of myelin in the brain and spinal cord. However, these types of lesions can be caused by rare conditions such as lupus, or even in communal conditions such as migraine and diabetes. The presence of these lesions is not definitive proof that you have multiple sclerosis.

evoked potential test

This test measures the electrical signals sent by the brain in response to stimulation. A potential test evoked can use visual stimuli or electrical stimuli applied to their legs or arms. This test can help detect injuries or damage to the eye nerve, brainstem or spinal cord, even when you do not have any symptoms of nerve damage.


Multiple Sclerosis Treatment

Multiple sclerosis has no cure but can be controlled. Treatment generally focuses on handle crises, controlling the symptoms and reducing disease progression. Today, in Brazil, since there are several treatment options, through daily oral capsule or daily, weekly and monthly injections. Some people have mild symptoms and so do not require treatment.

interferon

Interferon is a group of proteins - alpha, beta and gamma - produced by the body and part of the immune system. They act by controlling the activities of this system in various ways, besides having antiviral properties. (Remember the theories about the relationship between multiple sclerosis and viral infections). Until now, experts have found that interferon-beta is effective in the treatment of multiple sclerosis.

How does it work: slowing the process of MS by reducing the number of seizures and decreasing its complications. Interferon is administered via intramuscular injection, it may be applied daily, once a week or three times per week. The medicament may be used in conjunction with other treatments such as fingolimod.

Interferon can cause many side effects, including:

flu symptoms (fatigue, chills, fever, muscle pain and sweating during the initial weeks of treatment)

Reactions at the injection site (redness, swelling, discoloration and pain). Contact your doctor if the injection site gets dark and not inject more in this area

Sadness, anxiety, irritability and guilt. People with a history of depression should be carefully monitored

Lack of concentration and confusion
Trouble sleeping or eating.
All symptoms should be reported to a health care professional as soon as they occur.

Women who are pregnant, nursing or trying to conceive should not use drugs interferon base. Express this wish to the doctor so they can be discussed other forms of treatment. For those using interferon, for birth control measures should be used.

Interferon can affect liver function. Some drugs have been linked to serious liver damage and failure. The drug can also affect the blood cells and the function of the thyroid gland. Therefore, you should perform regular blood tests to ensure that the liver is functioning normally and monitor your blood cells and thyroid.

Interferon-beta is distributed by the Unified Health System (SUS) for the treatment of multiple sclerosis since 2001.

Glatiramer acetate

Glatiramer acetate is a protein administered via infection with the aim of reducing the number of multiple sclerosis attacks. It is not known exactly how it works, but doctors believe it to be able to block the attack of the immune system on myelin.

You will inject this drug under the skin (subcutaneously) once per day. This treatment is approved for relapsing forms of multiple sclerosis. It is administered subcutaneously (under the skin) three times a week. As interferon, this drug is able to reduce the frequency of recurrence of the crisis. It can be used in conjunction with other medications, according to medical advice.

Side effects are rare but may include:

Pain, swelling and redness at the injection site. The injection sites should be rotated according to a schedule provided by the health care provider
Pain or chest tightness, heart palpitations, anxiety, flushing, and difficulty breathing.
Do not use this product if you are pregnant. If you are planning to become pregnant, talk to your doctor to seek other forms of treatment. If you are breastfeeding, discuss the security to continue using this medicine.

Glatiramer acetate is distributed by the Unified Health System (SUS).

fingolimod

The fingolimod is an oral drug, the first active principle of a new therapeutic class, modulators of sphingosine-1-phosphate receptors (S1PR). These drugs act in the selective trapping of lymphocytes "sick" in the lymph nodes known as buboes, preventing them from entering the central nervous system and destroy the cells responsible for transmitting electrical impulses throughout the body.

It has an effective 52% increase in the reduction of outbreaks caused by the disease compared to interferon. To be oral, the product also facilitates adherence to treatment. More than 100,000 patients have been treated with fingolimod in the world.

After migrate from the injection therapy with interferon for the treatment with oral fingolimod, about 50% of the patients were free of disease activity, and even those with active disease had decreased brain volume loss sustained for up to 4.5 years .

Oral treatment with fingolimod offers improvement in key metrics of multiple sclerosis: loss of brain volume; activity of the lesion as measured by magnetic resonance imaging; relapse rates (outbreaks); and progression of disability.

Today, in Brazil, since there are several treatment options, through daily oral capsule or daily, weekly and monthly injections.

For taking this drug, the patient needs to have his heart rate monitored for six hours after the first dose, because the first dose may slow down your heart rate (bradycardia). The patient will also need to be immune to the chickenpox virus (varicella-zoster virus). Other side effects may include diarrhea, coughing and headache.

The Ministry of Health approved the merger of fingolimod in the treatment of multiple sclerosis in July 2014 and, therefore, the product will be offered for free by the Unified Health System (SUS).

natalizumab

Natalizumab drug is administered by intravenous infusion once every 4 weeks. It is believed that their effectiveness is in blocking the interaction of adhesion molecules expressed by inflammatory cells and molecules in blood vessels and the brain parenchyma cells. However, the specific mechanism by which natalizumab exerts its effects in multiple sclerosis is not fully defined.

In multiple sclerosis, the lesions occur when cells called leukocytes cross the brain barrier protection. For leukocytes to pass through this barrier interaction is required between special molecules called adhesion molecules found on the surface of inflammatory cells and cells lining the blood vessel wall. Natalizumab is able to prevent this interaction.

Headache, joint pain, redness at the injection site, swelling hands, feet and ankles or changes in the menstrual cycle may occur with the use of natalizumab. If any of these effects persist or worsen, notify your doctor immediately. Natalizumab also increases the risk of infection rare but very serious brain. This risk may be greater the more you use natalizumab and if you recently used or are using medicines that weaken the immune system. Natalizumab drug is distributed by the Unified Health System for the treatment of multiple sclerosis.

mitoxantrone

This immunosuppressant medication is usually used to treat severe multiple sclerosis. It is administered intravenously and can be used once every three months or four times a year. Because it can be harmful to the heart and is associated with the development of blood cancers such as leukemia, it is prescribed based on clinical assessment and MRI scans. This drug can be used individually or in combination with other treatments, as medically indicated.

Vitamin D: Efficacy divided expert opinion

Vitamin D is already being used to treat autoimmune diseases, a condition that occurs when the immune system attacks and destroys healthy tissues of the body by mistake. Vitamin D is an immunoregulatory that selectively inhibits the type of immune response that causes the response against the organism itself. The treatment of autoimmune diseases with vitamin D is a recent phenomenon, but is seen by experts as a breakthrough medicine.

A survey at Harvard and published in January 2014 in JAMA Neurology showed that vitamin D contributes to a slower progression of multiple sclerosis. The authors of the study show that patients in early stage had a lower 57% risk of new brain lesions if they had adequate levels of vitamin D. They also had a 25% lower to suffer from the worsening of existing lesions. Another study by the Harvard School of Public Health made in 2006 suggests a decrease of 41% risk of multiple sclerosis for each 50 nmol / L increasing levels of vitamin D. In addition to these, there are about five thousand publications in the world about the benefits of vitamin D in multiple sclerosis. However, still lack conclusive studies showing that vitamin D may be administered as the sole treatment for multiple sclerosis.

In order to achieve the necessary effect in the treatment of multiple sclerosis, vitamin D should be administered at doses above the recommended daily. The sooner it is used, the best benefit, since vitamin D in large doses can reverse recent sequelae, but not those prints. The certain extent depends on each case, but can vary 20 thousand to 150 thousand units for most patients, while the recommended daily requirement for adults are 10 thousand units a day.

It is not known whether low levels of vitamin D may be related to the cause of multiple sclerosis. One hypothesis is that multiple sclerosis patients metabolize vitamin D that differently than healthy population.

This form of treatment, however, does not have scientific evidence, and therefore the medical community is divided as to its application. One of the concerns is the risk that an overdose can cause the body once the nutrient strength exaggerated calcium absorption from food, may calcify the kidneys and impair kidney function. Thus, along with appropriate supplementation is required and strict diet with the accompanying doctor.

The Brazilian Academy of Neurology (ABN) has developed a medical consensus on the therapeutic use of vitamin D in patients with multiple sclerosis. According to the publication, it is recommended to carry vitamin D dosing in patients with multiple sclerosis, regardless of the stage of the disease, particularly in patients that make frequent use of corticosteroids and anticonvulsants. However, vitamin D levels above 100 ng / mL in the peripheral blood should be avoided until new settings are established for vitamin D daily recommendations Finally, the consensus of the Brazilian Academy of Neurology affirms that there is no scientific evidence that justifying the use of vitamin D as the sole treatment for multiple sclerosis.

Strategies to treat symptoms

Physiotherapy: a professional can teach you stretching and strengthening exercises, and show how to use devices that can make performing tasks easier

Muscle relaxants: if you have multiple sclerosis, you may experience painful muscle stiffness or uncontrollable spasms, particularly in the legs. Muscle relaxants can improve these symptoms

Drugs to reduce fatigue: drugs such as amantadine can help reduce fatigue due to multiple sclerosis

Other medicines may be prescribed drug treatments for depression, pain and bladder control or bowel that may be associated with multiple sclerosis.



Living / Prognosis

Take a rest

Fatigue is a common symptom of multiple sclerosis. Although it is generally not related to your activity level, the rest can make you feel more willing.

Practice exercises

Regular exercise such as walking, swimming, weight training and other physical activities, may offer some benefits if you have mild to moderate multiple sclerosis. Benefits of physical activity include improved strength, muscle tone, balance and coordination, bladder control and bowel, and less fatigue and depression.

Maintain a balanced diet

Eating a healthy and balanced diet can help you maintain a healthy weight, strengthen the immune system and maintain healthy bones.

Relieve stress

Stress can trigger or worsen the symptoms of sclerosis, so try to find ways to relax. Activities such as yoga, tai chi, massage, meditation, deep breathing or just listen to good music can help.

Adapt the workplace

Because of fatigue and motor difficulties, may be more complicated for a person with multiple sclerosis perform their activities at work the same way as healthy people. The adaptations that may be offered are:

Greater schedule flexibility
Possibility of regular breaks
varied tasks
Matching the skills, limitations and function performed
guarantee of confidentiality of sensitive and private information.
Avoid heat

Patients with multiple sclerosis are highly sensitive to heat. Therefore, it is important to avoid hot baths and excessive sun exposure when possible. Wear light clothing and keep the body refreshed can also help.

seek support

There are several support groups, both in-person and online, patients with multiple sclerosis. If you interest, look for these communities to exchange experiences and better understand the disease.

possible complications
In some cases, people with multiple sclerosis may also develop:

Muscle spasms and chronic weakness
Paralysis, usually in the legs
permanent bladder problems
permanent sexual difficulties
Forgetfulness and difficulty of permanent concentration
Depression
Epilepsy.