What is it?

Multiple sclerosis (MS) is a common disease among young people that tends to develop around the age of 30 years, with attacks (flares) of neurological symptoms such as loss of strength or sensation in the legs or arms, instability in walking, double or blurred vision. Attacks last about one month and are followed by recovery, but with sequelae. If no specific treatment is given, the sequelae can start to accumulate over time and develop into a progressive form for the disease, with more severe symptoms. There are also patients who do not suffer attacks and their disease is always progressive. Without treatment, half of all patients will have severe symptoms (unable to walk) after 20 years.

What causes it?

The causes of MS are not fully understood but there are several factors that are though to be involved, such as certain genetic factors and common infections. The main mechanism of the disease is the production of an inflammation induced by the body's natural defences that attacks the nervous system, injuring the nerves.

Diagnosis

The disease is diagnosed via the patient's medical history and a physical examination, magnetic resonance imaging of the brain and a study of the brain-bathing cerebrospinal fluid. Evoked potential tests, an optical coherence tomography and blood tests are also done. Treatment involves the use of immunomodulating drugs to partly prevent attacks. First-line therapies are interferon beta and glatiramer acetate, second-line therapies are natalizumab and fingolimod and third-line therapies are chemotherapy and bone marrow transplant. Symptomatic treatments are also available, including rehabilitation and corticosteroid treatment of attacks. Our center is also participating in the development of new therapies such as treatment with mesenchymal stem cells or new neuroprotective drugs.

Critical aspects when assessing a person with multiple sclerosis

The most important thing for a person with MS is to find out what type of MS it is, what is the prognosis (if the disease will be very active, if it will leave sequelae) and what treatment must be followed. We therefore use knowledge accumulated from numerous international studies on the disease that allow physicians to identify which factors from the patient's medical history and diagnostic tests can help predict the course of the disease. Once disease activity has been established, it is necessary to determine the most appropriate treatment for the patient after assessing possible risks and benefits, given that these are long-term treatments with certain side effects.

Interesting resources

MS in focus magazine by the Multiple Sclerosis International Federation.

http://www.msif.org/en/resources/msif_resources/msif_publications/ms_in_focus/index.html

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