Multiple Sclerosis (MS) is a neurological disease resulting from the immune system targeting nerve fibers in the brain and spinal cord. In this process, the myelin sheath surrounding nerve fibers is damaged, which may disrupt electrical transmission. This disruption can manifest as various neurological complaints affecting a person's daily life. MS typically begins in young adults and varies in progression among individuals, making early diagnosis and regular follow-up very important.
What is MS Disease?
Multiple Sclerosis (MS) is a central nervous system disease that causes a slowdown or disruption in nerve transmission between the brain and the body. This process can lead to various neurological symptoms such as muscle weakness, vision problems, difficulty walking, and balance and coordination disorders.
MS is a multifactorial disease that does not progress the same way in every individual and can feature periods of relapses and remissions. During relapses, new symptoms and findings may emerge, or existing complaints may worsen. In remission periods, symptoms may partially or completely regress.
What are the Types of MS Disease?
Multiple Sclerosis (MS) is a disease that can show different progressions in each patient and is clinically divided into various subtypes. This classification is important for determining the disease's progression rate, attack frequency, treatment approach, and long-term follow-up.
Relapsing-Remitting MS
Characterized by periods of relapse and the subsequent partial or complete remission periods. During a relapse, new symptoms may arise or existing complaints may become pronounced. In remission periods, symptoms may completely disappear or continue at a mild level.
Secondary Progressive MS
The disease that begins as RRMS can evolve into a more consistent progressive process over years, even if relapses decrease. In this period, neurological findings tend to worsen slowly but steadily. In some patients, relapses may disappear entirely, while others may show progressive progression with relapses.
Primary Progressive MS
This type of MS progresses with a gradual decline without relapses from the onset of the disease. Neurological findings worsen slowly and steadily. Although PPMS is less common, its treatment approach and follow-up differ from other subtypes. In this type, muscle weakness and walking problems in the legs can be more prominent.
Clinically Isolated Syndrome
A condition where initial neurological findings suggestive of MS emerge. CIS develops as a single attack, and MS-compatible lesions may be found in MRI imaging. This form of the disease is not sufficient for a definite MS diagnosis; however, the emergence of new attacks or new lesion formation during follow-up is effective in diagnosing MS.
Radiologically Isolated Syndrome
A situation where MS-compatible lesions are detected in MRI imaging despite the absence of any symptoms. Since there is a possibility of MS developing in these individuals in the future, close neurological follow-up is recommended.
What are the Causes of MS Disease?
The emergence of MS disease is known to involve a misdirection of the immune system, genetic predisposition, environmental factors, and some biological mechanisms working together.
- Immune System Disorders
MS is primarily considered an autoimmune disease. In this situation, the immune system mistakenly perceives the myelin sheath as a foreign structure and attacks it. Damage to the myelin layer disrupts nerve transmission and leads to symptoms specific to MS.
- Genetic Predisposition
MS is not a hereditary disease; however, the incidence of the disease is higher in people with family members who have MS compared to the general population. No single gene causes MS; it is thought that the effects of multiple genes on the immune system increase the risk.
- Environmental Factors
Research indicates that environmental factors play a significant role in MS development. The most emphasized environmental factors include:
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Geographical location
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Viral infections
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Smoking
While these factors are not the sole cause of the disease, they can trigger the process by causing disruption to the immune system.
- The Effect of Hormones and Gender
MS is approximately twice as common in women as in men. This is due to the regulatory effect of hormonal differences on the immune system. The impact of certain hormones in altering immune responses may play a role in increasing the risk of MS in women.
- Microbiome and Gut Health
Recent studies highlight the influence of the gut microbiota on the immune system. Imbalance of certain bacteria can lead to excessive or incorrect functioning of the immune system, contributing to the development of MS.
What are the Symptoms of MS Disease?
Multiple sclerosis (MS) may present symptoms such as weakness on one side of the body, tingling or numbness in the arms or legs, difficulty walking, and balance and coordination issues due to damage to the nerve fibers in the central nervous system.
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Tingling or numbness in different parts of the body
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Muscle stiffness, spasms, and pain
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Blurred vision, double vision, and vision impairment
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An electric shock sensation triggered by bending the neck forward
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Cognitive difficulties with thinking, learning, and planning
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Depression, anxiety, and mood changes
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Speech and swallowing difficulties
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Bladder function disorders such as incontinence and frequent urination
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Persistent fatigue, weakness, and a sense of exhaustion
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Walking difficulties, balance loss, and coordination problems
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Constipation and digestive issues
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Sexual dysfunction
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Short-term memory problems
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Tremors in the hands or a decline in fine motor skills
How is MS Disease Diagnosed?
The diagnosis of MS (Multiple Sclerosis) is a process that cannot be established with a single test. It involves using clinical evaluation, imaging methods, laboratory tests, and neurophysiological examinations together.
Neurological Examination
The first step in diagnosis is forming a neurological assessment. A neurologist evaluates all central nervous system functions, including reflexes, muscle strength, coordination, balance, sensory functions, and eye movements.
Magnetic Resonance Imaging (MRI)
MRI can visualize plaques resulting from myelin loss in the brain and spinal cord. Information about the disease's course is obtained by evaluating the number, distribution, and whether these plaques are new or old.
Cerebrospinal Fluid (CSF) Analysis
Cerebrospinal fluid obtained by lumbar puncture may contain oligoclonal bands, which are immune system proteins characteristic of the disease. The CSF analysis is a test that strengthens the diagnosis, especially in early, suspicious cases.
Evoked Potential Tests
Tests that measure the electrical conduction speed of nerve pathways.
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Visual evoked potential (VEP)
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Somatosensory evoked potential (SEP)
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Auditory evoked potential (AEP)
Clinical Follow-up and Attack Assessment
For the diagnosis of MS, the presence of a single finding is not enough. The diagnosis requires demonstrating damage occurring in different regions of the central nervous system at different times. Therefore, the patient's complaints, attack history, MRI findings, and examination results are evaluated together.
How is MS Disease Treated?
The treatment for MS should be planned individually and started in the early stages. The earlier the disease's onset age, the more aggressive its course may be. A person who has an MS attack may never have another attack throughout their life, or attacks may recur at different intervals.
In types of MS without attacks, the disease progresses continuously and can be clinically more severe. There are also types that start with attacks and later turn into a regular progressive structure. Therefore, it is important to initiate treatment without delay during attack periods.
Frequently Asked Questions
What causes MS disease?
Although the exact cause of MS is unknown, the immune system mistakenly attacking the myelin sheath is considered the primary mechanism. Genetic predisposition, viral infections, and environmental factors may play a role in the development of the disease.
What is an MS attack?
An MS attack is a period of symptom worsening caused by the emergence of a new inflammation area in the nervous system, lasting at least 24 hours. Attack periods often require prompt medical intervention and can usually be controlled with corticosteroid treatment.
Can MS patients exercise?
Yes. Regular and controlled exercise with the guidance of an expert helps preserve muscle strength, manage fatigue, and enhance overall quality of life. However, the exercise program should be tailored to the individual.
Is MS disease progressive?
While MS progresses slowly in some individuals, some types can be more aggressive. Early diagnosis and regular treatment can significantly slow the rate of disease progression.
