Multiple sclerosis is a neurological pathology that most frequently is diagnosed in the case of young adults and represents the third cause of invalidity amongst this group after trauma and arthritis. It is still considered a bizarre pathology with unknown etiology and which requires a long time to be correctly diagnosed. The prognosis tends to be impossible to foresee but even so, it is impossible to fully treat it at this time. The disease develops in spike episodes, some with almost total remissions, others with continuous progression. That is why, throughout the world, patients with multiple sclerosis are considered persons with special disabilities who must benefit from treatment throughout their lives. (Huang,Chen,Zhang,2017)
The main histopathological change in MS is represented by demyelination. Symptoms of the disease are polymorphous due to reaching all segments of the central nervous system. It has been shown that even the neuron and axon are affected by the destructive process of this disease. The destruction of myelin and axon appears to be due to an autoimmune inflammatory process with immunogenetic implications. The cause of the immune response remains unknown.Through the destruction of myelin and axon, motor deficits occur with walking and spasticity disorders, sensitivity disorders, ataxia, tremors, sphincter disorders, sexual dynamics disorders, dysarthria, swallowing disorders and oculomotricity. The occurrence of sclerosis plaques in the cerebral hemispheres can produce increasingly common cognitive disorders in MS.Combining all these symptoms results in a polymorph character of the disease, with a quite pronounced final disability. With all the progress made so far in terms of demyelination and axonal suffering, there are many unknowns about how the pathology evolves and what would be the appropriate therapeutic solution.
Although the arguments for the autoimmune mechanism are obvious, the results of new drug therapies are different. Valuable support is represented by MRI imaging. Until we can bring an etiological treatment to the market, we must be able to treat acute processes and its symptoms. Methylprednisolone can be used for the treatment of acute phases. Among the treatments that a doctor recommends to a patient suffering from multiple sclerosis may include: short corticosteroids (fight against vision loss or motor coordination), immunomodulatory drugs (interferon, natalizumab) that reduce the frequency of aggressive symptoms and delay the onset of functional disability, immunosuppressive drugs, antidepressants, pain medicines, medicines for gastrointestinal problems. .Apart from these features, the treatment consists of combating immobility which frequently leads to complications. Many patients require regular physiotherapy. This is why patients with MS should be supervised by a multidisciplinary team of physiotherapists, psychotherapists, social workers, and neurological physicians. In addition to the drug treatment, various therapies can also be used only at the doctor’s recommendation: physiotherapy and kinetotherapy (reduce pain, stimulate muscles and increase mobility), occupational therapy (helps the patient not to lose self-confidence and to be independent ), experimental treatments (those whose positive results are not guaranteed, but are possible and which are part of scientific research) (Dargahi,Katsara,Tselios,2017)
The biggest questions remain if multiple sclerosis can be prevented. As in the case of any other pathology which has an unknown etiology, there is no clear guideline of how a patient could prevent the onset of the disease. Many scientists believe that a combination of both environmental and also genetic factors lead to the development of multiple sclerosis. Understanding what these elements are can help us come up with some preventions measure and also with more effective treatment. There are many studies who try to explore the possibility of preventing the pathology. Some of them pointed out that maintaining an optimal level of vitamin D can be efficient. In a 2015 study, intermitted fasting periods seem to reduce the frequently relapsing effect. A study conducted in 2017 showed that higher amounts of resveratrol (which can be found in red wine) have anti-inflammatory effects and might even restore the damaged area of the brain. (Omerhoca,Akkas,2018)
Even though there are no clear prevention measures, there still exist some risk factors. For example, people between 30 to 33 years old, especially women tend to be at a higher risk. If the patient has a case of MS in his family, he is also at a higher risk. In terms of race, while people especially the ones who have descents from Northern Europe are at the highest risk. It was also pointed out that people who live in tropical areas have a lower risk for MS which leads to the affirmation that vitamin D levels can be efficient in preventing the onset of MS. Nevertheless, previous infections with viruses such as Epstein Bar can be linked to this disease.
As was proven in this paper, Multiple Sclerosis is a pathology that is not currently fully understand. We expect in the upcoming years to gain more knowledge in regard to what causes it and if we will be able to do this we might come up with a more efficient treatment. Until that point is reached, the patients can only get supportive treatment.
References
Huang, W. J., Chen, W. W., & Zhang, X. (2017). Multiple sclerosis: Pathology, diagnosis and treatments. Experimental and therapeutic medicine, 13(6), 3163–3166. https://doi.org/10.3892/etm.2017.4410
Dargahi, N., Katsara, M., Tselios, T., Androutsou, M. E., de Courten, M., Matsoukas, J., & Apostolopoulos, V. (2017). Multiple Sclerosis: Immunopathology and Treatment Update. Brain sciences, 7(7), 78. https://doi.org/10.3390/brainsci7070078
Ömerhoca, S., Akkaş, S. Y., & İçen, N. K. (2018). Multiple Sclerosis: Diagnosis and Differential Diagnosis. Noro psikiyatri arsivi, 55(Suppl 1), S1–S9. https://doi.org/10.29399/npa.23418
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