Understanding Multiple Sclerosis
There are effective treatment options to maintain a good
quality of life.
Multiple sclerosis (MS) is an autoimmune, chronic inflammatory disease of the central nervous system. There are three forms of MS: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS).
Although symptoms in the first two forms might disappear after acute treatment, each form of MS involves an underlying progression that needs to be treated. This makes early initiation of disease-modifying immunotherapy crucial to slow down the progression, which over time can lead to increasing limitations and disabilities. Despite these challenges, there is much that can be done to maintain quality of life.
TREATMENT OPTIONS
Multiple Sclerosis (MS) cannot yet be cured. However, there are a number of treatments available, some of them highly effective, which can slow down the progression of the disease, prevent acute symptoms and shorten or avoid relapses. It is important to work with a neurologist specialized on MS or to be treated in an MS center, such the Multiple Sclerosis Center at the University Hospital Zurich.
Standard therapies
In the therapy of relapses, treating MS exacerbations with methylprednisolone (MP) is an established standard. For therapy escalation, plasmapheresis (Wikipedia def.) or immunoadsorption (Wikipedia def.) may be considered. Each form of MS involves an underlying progression that also needs to be treated, making early initiation of disease-modifying immunotherapy crucial. Despite intensive acute and immunosuppressive therapy, complete symptom control is not guaranteed. In such cases, neurorehabilitation can be very helpful in addressing persistent impairments.
Treatment of persistent impairments
In addition to primary symptoms, MS often brings accompanying issues such as depression, fatigue, pain, articulation and swallowing disorders, urinary retention, and digestive disturbances. At cereneo, impairments are individually evaluated by a multidisciplinary team using objective, standardized assessments. These assessments not only help identify the exact impairment profile but also, when repeated every two weeks, track the results of intensive, individualized therapy.
At cereneo, we tailor therapies to our patients' individual needs, offering personalized treatment with a therapist on a 1:1 basis using state-of-the-art therapy equipment and diagnostic procedures.
cereneo works in close cooperation with the University Hospital Zurich (USZ), which is very convenient if acute therapy adaptation is necessary. Additionally, the MS center at USZ can offer blood stem cell transplantation in special cases.
To find out about a personalised rehabilitation at cereneo, you can book an online consultation with one of our experienced neurologists.
Promising & effective therapy for highly active Multiple Sclerosis
A promising and very effective therapy under specific circumstances for patients with highly active MS is aHSCT (autologous blood stem cell transplantation). The treatment leads to disease remission in 70-75% of cases. Although no large clinical trials have yet been conducted, several smaller clinical trials and observational data from several hundred MS patients indicate that aHSCT is more effective than all approved substances. However, due to the risks of the treatment, this procedure is only used in MS in individual cases and after extensive preliminary clarification. Click her for more information on this therapy at the USZ.
SYMPTOMS OF MULTIPLE SCLEROSIS
In most cases, the disease occurs between the age of 20 and 40 and is considered the most common chronic disease of the central nervous system with women being more often affected than men.
With MS, the body's own inflammatory cells, the so-called T and B lymphocytes, destroy the sheath covering the nerve fibres, the so-called myelin, as well as the nerve cells and their processes in the brain and spinal cord. The myelin layer of the nerves ensures that the brain cells are able to send stimuli to different regions of the body. The inflammation damages the myelin, causing nerve conduction to be temporarily interrupted or slowed down causing various symptoms impairing body movements (motor function) and body sensation (sensory function).
Three types of Multiple Sclerosis
Relapsing-Remitting MS (RRMS) is the most common form of MS. Patients with RRMS experience clear episodes of new or worsening symptoms, called relapses, followed by periods of partial or complete recovery, known as remissions. Usually, people with RRMS have periods where they feel better and symptoms improve, but then there are times when symptoms recur or new ones appear.
Secondary Progressive MS (SPMS) usually develops from RRMS. Over time, people with RRMS may transition to SPMS, where the disease begins to progress more steadily without the clear relapses and remissions. Symptoms gradually get worse over time, and patients may not experience the periods of improvement that they had with RRMS.
Primary Progressive MS (PPMS) is a less common form of MS. In PPMS, symptoms gradually worsen from the beginning without any relapses or remissions. From the start, patients might notice a steady progression of symptoms, with no periods of improvement or recovery.
Signs & Symptoms
Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. Early symptoms and signs of MS that occur particularly often include:
Sensory disturbances: Sensory disturbances, such as numbness or tingling, initially in the fingertips or feet, which later spread to the arms or legs. Tightness around joints and hips, pain and reduced sensitivity, for example to temperature, are also common. If the spinal cord is affected, the so-called neck flexion sign often occurs. This is when you feel an electrifying, sudden sensation along the spine when you bend your head forward.
Visual disturbances: Visual impairments often occur as the result of a temporarily inflamed optic nerve (optic neuritis).
Other symptoms that can affect vision include blurred vision as if through a veil, impaired colour vision or when reading small print, double vision, flashes of light or failures of the visual field.
Muscle paralysis: Typical for MS is reduced muscle strength up to paralysis, which can be accompanied by faster fatigue when walking, but also tension and stiffness.
CAUSES & RISK FACTORS
The exact causes of Multiple Sclerosis aren't fully known, but both genetic and environmental factors play a role with a large number of immunologically relevant genes as well as environmental factors including smoking, low vitamin D3 levels, Epstein-Barr virus (EBV) infection, and obesity during adolescence and early adulthood. These factors can trigger the disease and affect its course.
MS is an autoimmune disease, meaning the immune system mistakenly attacks the body's own tissues. This can happen when the body reacts incorrectly to infections that resemble its own structures. As a result, the immune system attacks myelin and nerve cells.
If a close relative has MS, your risk of getting it is 20 to 40 times higher, about 2-4%. MS is more common in areas farther from the equator, likely due to less sunlight and lower vitamin D3 levels.
Certain viruses, especially EBV, which causes Pfeiffer’s glandular fever, and some gut bacteria are linked to MS. Other possible triggers include stress, hormonal changes, some vaccinations, and certain medications, though evidence for these is less clear. It's important to note that natural infections, like the flu, pose a higher risk than vaccinations.
PREVENTION
It is not yet possible to prevent MS. However, affected persons can have a positive influence on the course of the disease by starting treatment early on and by taking some simple yet effective measures:
- Stop smoking
- The vitamin D level should be examined and, if necessary, adjusted to the upper normal range
- Engage in regular sport activities of medium intensity
- A balanced diet rich in fruit, vegetables, pulses, and fish (mediterranean diet). Fatty red meat should be reduced.
We accompany you on your entire recovery journey
No matter where you are in your recovery process, we are can support you to maximise your health.
A fully personalized therapy programme based on your needs and wishes in one of your clinics.
Assessment of your home environment and safe transition back to anywhere in the world.
Together with a cereneo therapist you start your rehabilitation at home and integrate it in your daily routine.
Continue your rehabilitation at home via online channels and stay connected to the clinical expertise and network of cereneo.
