Multiple Sclerosis – Clinical Types, Prognosis And Treatment

Multiple Sclerosis

Multiple sclerosis is a chronic and degenerative disease of the central nervous system which is characterized by axonal myelin destruction and progressive neurological dysfunction. Multiple sclerosis represents the most frequent cause of chronic neurological disability in the young adult.

Clinical Types Of Multiple Sclerosis

1. Relapsing-Remitting form. In this form after a period of stable symptoms appear episodes of worsening called  relapses, attacks, exacerbation or flare-up. These episodes may be followed by parietal or complete periods of recovery free of symptomatic progression. Approximately 85% of affected people have this form of multiple sclerosis at the time of their diagnosis. It is to mention that this new relapse is defined as new symptoms onset or aggravation of old ones that last more than 48 hours and are separated from other symptoms by at least one month.
2. Primary-Progressive form.In this form there is a slow but nearly continuous worsening of symptoms from the onset, with no distinct relapses or remissions. This is the pattern for about 10% of patients and there may be occasional plateaus or temporary minor improvement.
3. Secondary-Progressive form. In this form the initial periods of relapsing-remitting multiple sclerosis are followed by steady worsening of symptoms with or without occasional flare-up, remissions or plateaus. About 50% of those with relapsing-remitting multiple sclerosis develop this form within 10 years of their initial diagnosis.
4. Progressive-Relapsing form. In this form there is a steady worsening of symptoms that occur from the time of onset with clear acute attacks, with or without recovery. Approximately 5% of patients have or develop this form of disease.

Multiple Sclerosis

There are many tests aimed to qualify the neurological deficit in multiple sclerosis. EDSS (Expanded Disability Status Scale) is one of the most used means to evaluate the disease.

The EDSS scale extends from 0 (normal neurological examination) to 10 (death from multiple sclerosis complications) in 0.5 unit increments. EDSS 1.0 to 4.5 refers to patients with unaffected amublation capacity. The precise step are denoted by functional scores which are graded from normal (0) to maximal impairment (5 or 6) for pyramidal, cerebellar, brein stem, sensory, bowel, bladder, visual, cerebral, mental and other functions. EDSS 5.0 to 9.5 are defined by impairment to ambulation.

Multiple sclerosis prognosis is variable and individual but generally it is associated with a 5 to 10 years of life expectancy and is influenced by the burden of accumulated handicaps that may significantly influence the quality of life.

Multiple Sclerosis Outcome Predicting Factors

• Factors associated with a relatively good outcome:

1. Female gender.
2. Onset with optic nevritis.
3. Predominantly sensory signs.
4. Neurological examination without objective findings.
5. Low relapse rate over the first year.
6. Lack of coordination and walking involvement.
7. No evidence of progression.

• Factors associated with a relatively worse outcome:

1. Male gender.
2. Onset with major pyramidal symptoms (walking), balance and coordination.
3. High relapse rate over the firs year.
4. Progressive disease.

Multiple Sclerosis Treatment

Multiple sclerosis dose not benefits from etiological treatment, only pathogenical according to the presumtion that there is an autoimmune side of the disease. According to clinical trials evidences exist ” disease modifying therapies” that allows relapse reduction by slowing the disease progression and for this reason treatment is staged.

Multiple Sclerosis Treatment

Relapse treatment consists in corticotherapy with Methil-predinsolone intravenously for 3 to 5 days, followed by oral therapy with a progressive dose reduction. In sever forms of multiple sclerosis, treatment consists in plasma exchange.

Because is an autoimmune disease of central nervous system, multiple sclerosis also benefit from:

• Immunmodulatory treatment with beta 1-b interferon (betaferon) or beta 1-a interferon (avonex) and capxone (glatiramer acetat).
• Immunosupressive treatment with mithotaxone, azathioprine and methotrexate.
• Lymphocytotoxic medication, cladribine an analogue of purinic nucleoside with lymphocytotoxic effect.
• Monoclonal antibodies against some surface antigens of lymphocytes and monocytes (alemtuzumab) or against the adhesion molecules needed for lymphocytes to penetrate blood brain barrier (natalizumab).

Symptomatic treatment consists of muscle relaxants, neurotrophic medication, vitamins, analgetic medication, antidepressive medication and fatigue medication.

General care, physical rehabilitation, psychotherapy and social reintegration of multiple sclerosis patients are very important.