Multiple Sclerosis: What It Is, Symptoms and Treatments

Most people have heard of multiple sclerosis, but few know its meaning and could identify some of its symptoms.

Although often remembered as a rare disease, sclerosis is highly prevalent in some parts of the world. In Brazil, it is estimated that there are about 30 thousand cases. Large hospitals, such as Albert Einstein in Sao Paulo, have specialized staff to treat the disease.

Below, Rodrigo Barbosa Thomaz, neurologist at Catem (Multiple Sclerosis Care and Treatment Center) of Santa Casa de São Paulo and also the Multiple Sclerosis Treatment Center at Albert Einstein Hospital? Einstein Neurology Program explains what the disease is and what its treatments are.

What is multiple sclerosis?

Multiple sclerosis is a demyelinating neurological disease that mostly affects young people in their 20s and 40s and is more common in women. It is responsible for an attack by the immune system on the structure of the brain or spinal cord called myelin.

? Myelin is the? Hood? which covers the extensions of neurons, through which passes the nervous impulse that will command certain functions of our organism. Thus, the disease means the presence of multiple affected areas in the brain and spinal cord, inflammation of the myelin sheath ?, explains Rodrigo Barbosa Thomaz.

How does the disease manifest itself?

Neurologist Rodrigo Thomaz explains that the disease generally comes in the form of outbreaks, which vary from individual to individual. • A person may have a loss of sight, for example, or have blurred vision, have pain to move their eyes, etc. In this case, you should seek medical attention, and check to see if it is an inflammation of the optic nerve. If inflammation is proven, this is a very common symptom to start the disease ?, he says.

Sclerosis can also manifest itself by affecting the spinal cord, which controls body movements. • The person may have loss of strength in one or both legs, arms, or even all four limbs, with or without tingling; problems with sensitivity? not feeling the temperature, not feeling pain etc. Or, may you have difficulty urinating or urinary incontinence and bowel movement ?, explains neurologist Rodrigo Thomaz.

Keeping an eye on these symptoms, the practitioner should investigate whether they are really the result of a common inflammation of the disease and also pay attention to other brain points, making sure there are no more affected areas.

Diagnosis

Neurologist Rodrigo Thomaz points out that since symptoms may resemble other neurological problems, MRI scans are necessary to confirm multiple sclerosis. "Resonance should also be associated with tests of cerebrospinal fluid (liquid that bathes the brain) to assess if there is any autoimmune reaction, typical of the disease," he explains.

"Some people often say that the diagnosis of sclerosis is exclusionary, but I disagree: as I see it, it has very well defined criteria for clinical presentation, resonance and CSF," adds the doctor.

Incidence and prevalence of the disease

The overall incidence, ie the number of (expected) cases of multiple sclerosis per year is 0, 1 per 100,000 population, reports neurologist Rodrigo Thomaz.

However, the doctor points out, the number of cases in a given population is very variable in different regions of the world. It is much more frequent in the Northern Hemisphere, in colder regions, far from the Equator Line. In these places there is a high prevalence of the disease, around 200 to 300 cases per 100 thousand inhabitants ?, he says.

Brazil is in a medium and low prevalence zone. "There are practically no studies on the prevalence of multiple sclerosis in our country, but there are some older ones?" from the 90's, early 2000? with an estimate that there are about 15 cases per 100,000 inhabitants ?, explains the doctor.

"This is the account that the Ministry of Health uses to make an analysis of how many people have the disease in Brazil, so today it is estimated to be around 30 thousand," he adds.

The influence of external factors on disease

Neurologist Rodrigo Thomaz points out that multiple sclerosis only manifests itself in people who have a genetic predisposition to the disease. "And by combining environmental factors or some infectious agents with this feature, there is an abnormal recognition of myelin by the immune system, which is why the disease develops," he explains.

"Some environmental factors that may be connected are colder climates, low exposure to sunlight and lower vitamin D levels," he adds. However, the doctor points out that there are still controversies regarding vitamin D. This is only a hypothesis.

How is the disease treated?

As it is basically an inflammatory brain disease, sclerosis is treated with medications that will reduce inflammation. “But it would be no use using conventional anti-inflammatory drugs. They need to be medicines that balance the person's immunity response, which is meant to inflame the brain. So are drugs called immunomodulators needed ?, explains neurologist Rodrigo Thomaz. "Or drugs that lower the production of the defense cells that are attacking the person, called immunosuppressants," he adds.

These medications are intended to lessen the autoimmune attack on the brain and thereby decrease the inflammation that can happen. "Thus, new injuries, new outbreaks are avoided so that people, throughout their lives, do not accumulate neurological sequelae," says the doctor.

In the midst of an outbreak where the practitioner perceives it to be a very intense inflammation, medications that are corticosteroids may be used. "They are corticosteroids used in intravenous regimens, in very high doses, to decrease inflammation and the patient can regenerate faster," he adds.

Psychological counseling

One factor that greatly interferes after the disease has already manifested is the stress that people are subjected to in everyday life. ? There seems to be a lot of influence of stress with the severity of the disease, with the outbreaks. So, once the patient is undergoing treatment, one tip we give is that they have psychological support, can control their bouts of irritation or know how to better cope with certain situations ?, says neurologist Rodrigo Thomaz.

Is there prevention?

Neurologist Rodrigo Thomaz points out that there are no concrete ways to prevent multiple sclerosis. "Is there any speculation that smoking is one of the external factors that, combined with genetics and other factors, could aggravate the condition and make the disease appear," he says. "But avoiding smoking, in fact, is a general guideline for people's overall health, and not just for this case," he says.

Sunning often, maintaining more adequate vitamin D levels and engaging in physical activity are other recommendations. But that will not necessarily prevent the disease ?, adds the doctor.

In the case of pregnant women with multiple sclerosis, or people who have the disease in the family, there is a greater concern on the part of doctors to maintain high levels of vitamin D in their patients' blood and advise them to sunbathe. ? This seems to be a matter of change of habit that may decrease the incidence of the disease in the population, but is still a hypothesis ?, highlights.

To say that there is a definite cure for the disease could frustrate patients who do not achieve this result the way they imagined. “One day we hope to have such a potent treatment that will prevent the disease from continuing. Or, identify it early, before it can manifest ?, concludes neurologist Rodrigo Thomaz.

Meanwhile, much research and research on this and other neurological disorders is ongoing to ensure treatments that make patients regenerate as well as possible.

Update on Multiple Sclerosis | UCLA Neurology (April 2024)