Multiple sclerosis (MS): causes, diagnosis and course

Multiple sclerosis (MS): causes, diagnosis and course

Multiple sclerosis is an inflammatory disease of the nervous system that affects more than 200,000 people in Germany and can take very different courses. Despite intensive research, the exact mechanisms by which MS develops are still unclear—all information about the causes, symptoms, diagnosis, therapy and course of this disease.

What is multiple sclerosis?

It is not known how long multiple sclerosis (MS) – a chronic inflammatory disease of the nervous system – has existed. What is believed to be the first appropriate description of the symptoms of MS dates from 1395? The German poet Heinrich Heine also suffered from ailments that could be attributed to MS.

Multiple sclerosis, also known as encephalomyelitis disseminata (ED), is often equated with rapid disability and disability in a wheelchair. Fortunately, multiple sclerosis is often less dramatic. The course is very different, so multiple sclerosis is also called the disease with 1,000 faces. Initially, only a few symptoms can occur that hardly get worse; the disease can progress continuously or get worse again and again in the form of individual flare-ups.

The prevalence of MS increases with distance from the equator, so the disease is most prevalent in temperate climates. Around 2.5 million people are affected worldwide. Women fall ill about twice as often as men; the first signs usually appear between the ages of 20 and 40.


Causes of Multiple Sclerosis

In MS, the fatty coverings of the nerve cells in the brain and spinal cord (the so-called myelin sheaths) are damaged and destroyed by inflammatory processes (demyelination). The myelin sheaths form an insulating layer around the long extensions of the nerve cells; their task is the rapid conduction of stimuli within the brain. If the myelin sheaths are destroyed, motor and sensory failures are the result – depending on where the infectious focus is located in the brain. As a result, the transmission of information there suffers, and there are failures of the areas otherwise supplied with information by these nerves – for example, the eyes or the skin.

According to current knowledge, multiple sclerosis is based on several factors that interact with this disease. At the heart of the MS disease is the immune system, in which some of the immune cells mistakenly attack the body’s tissue – the protective sheaths (myelin sheaths) of the nerve fibres – and trigger an inflammatory reaction there. However, what causes this misguided immune reaction ( autoimmune disease ) is still being determined.

MS caused by viral infection?

As early as the late 19th century, scientists suspected an infection could cause inflammation in multiple sclerosis. Even today, infections with viruses in childhood are suspected to be the trigger, such as the pathogens that cause rubella and measlesherpes or the Epstein-Barr virus (EBV).

A study from 2022 provides clear evidence that the Epstein-Barr virus, in particular, could play an essential role in the development of MS. Although not every infection with the virus leads to multiple sclerosis, it could be a possible late consequence of the EBV infection. The Epstein-Barr virus is widespread and is the cause of glandular fever.

Other environmental influences, such as a lack of sunlight and vitamin D, are also possible causes. In addition, there is probably a genetic component with which at least a predisposition to multiple sclerosis is inherited.


Symptoms of MS

The symptoms of multiple sclerosis are very different and range from minor signs to a pronounced MS attack. The symptoms that occur depend on which areas of the nervous system are affected by the inflammation. Possible signs include visual disturbances such as double vision, bladder weakness, and tingling in fingers and toes; Dizziness also occurs frequently.

You can read more information about symptoms and signs of MS here.

Diagnosis and progression of MS

Die Häufigkeit und Schwere eines Schubs bei MS ist sehr unterschiedlich, der Verlauf nur schwer vorhersagbar, da die Krankheit sehr unterschiedlich in Erscheinung treten kann. Bei manchen Betroffenen tritt nur selten ein Schub auf, bei rund zwei Dritteln der Betroffenen verschlechtern sich die Körperfunktionen über die Jahre, bei fünf Prozent resultieren aus der Multiplen Sklerose dauerhaft schwere Behinderungen.

Die Diagnose der Multiplen Sklerose ist aufgrund der vielfältigen Symptome nicht einfach. Berücksichtigt werden hierbei die Krankengeschichte (Anamnese) sowie die Ergebnisse der körperlichen und der technischen Untersuchungen. Typischerweise werden folgende Untersuchungen vorgenommen:

  • Kernspintomographie (MRT)
  • evozierte Potentiale (zur Prüfung von Funktion und Leitfähigkeit der Nerven)
  • Untersuchung des Nervenwassers (Liquorpunktion)
  • Blut- und Urinuntersuchungen

Damit kann die Diagnose Multiple Sklerose gestellt und andere Ursachen der Symptome ausgeschlossen werden.

Wie erfolgt die Therapie bei Multipler Sklerose?

Multiple Sklerose ist noch nicht heilbar, deshalb werden bei der Therapie vor allem die Symptome behandelt. Ziel der Therapie ist es, die Beschwerden der Betroffenen zu lindern. Dies beinhaltet, Anzeichen eines Schubs zum Verschwinden zu bringen, das Fortschreiten der Krankheit zu verlangsamen und Komplikationen und langfristige Einschränkungen zu vermeiden. Verschiedene medikamentöse Therapien stehen zur Auswahl.

Lesen Sie hier mehr zu den Therapien bei MS.


Kann man Multipler Sklerose vorbeugen?

Da Ursachen nicht bekannt sind, lässt sich Multipler Sklerose nicht vorbeugen. Allerdings weiß man, dass manche Faktoren den Verlauf negativ beeinflussen oder einen Schub auslösen können. Zu diesen Faktoren gehören größere körperliche und seelische Belastungen wie beispielsweise eine Operation (OP), eine fieberhafte Erkrankung oder Infektion. Auch der Aufenthalt in warmen Klimazonen scheint Multiple Sklerose ungünstig zu beeinflussen. Hormonelle Umstellungen wie nach einer Schwangerschaft können ebenfalls einen Schub auslösen.

Immunsystem und MS

Für Betroffene ist wichtig zu wissen: Maßnahmen, die das Immunsystem beeinflussen, können Multiple Sklerose verschlechtern. Dazu gehören Hyposensibilisierung bei einer Allergie, Impfungen sowie Wirkstoffe, die das Immunsystem stimulieren (auch pflanzliche Medikamente). Das Robert Koch-Institut empfiehlt Menschen mit MS die vorgesehen Impfungen, da es keinen wissenschaftlichen Beleg dagegen gibt, aber ein viraler Infekt die Erkrankung nachweislich verschlimmern könnte.

Leben mit MS

Living with multiple sclerosis initially means coming to terms with the fact that you have a chronic illness. Even if there is a rule of thumb that says that the severity of the disability five years after the onset of multiple sclerosis corresponds to about three-quarters of the disability that will be achieved after 10 to 15 years, the individual MS progression cannot be predicted. The MS course is more favourable for:

  • Women
  • First illness under 40 years of age and initially with only one MS symptom
  • complete resolution of symptoms after the first MS attack

It is essential to recognize and avoid the individual flare-up triggers, look for a competent doctor, and be in close contact with him. The extent to which multiple sclerosis influences the practice of work or restricts physical performance varies. Working with MS is possible but varies from person to person. Self-help groups, for example, from the German Multiple Sclerosis Society, offer support and an exchange of experiences in the case of multiple sclerosis.

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