Neurological diseases are among the health problems that are frequently seen in the society and affect the quality of life of individuals negatively. Among these diseases, there are demyelinating diseases, which are a group of diseases in which various neurological symptoms occur in the form of attacks, due to the destruction of the material called myelin belonging to the nervous tissue over time. The most common demyelinating disease in the community is multiple sclerosis.
What is MS Disease (Multiple Sclerosis)?
Multiple sclerosis, MS or emes disease; It refers to neurological problems that develop as a result of damage to the nerve tissues along the brain, brain stem and spinal cord that make up the central nervous system, as a result of the body's immune system being perceived as a threat. As a result, a wide variety of neurological manifestations may develop depending on the damaged nerve tissue. The disease can be seen in the entire central nervous system and is characterized by the formation of sclerotic plaques in these tissues.
Long arms of nerve cells called axons are covered with a special oil-rich material called myelin sheath. Myelin basically acts as a kind of insulation material that enables the messages (impulses) transmitted from nerve cells to be transmitted more quickly and effectively. Myelin sheath is produced especially in the cells of the central nervous system, where impulse transmission is intense, such as the spinal cord. As a result of inflammatory reactions against the myelin sheath and the attack of immune cells over time, the sheath around the nerve tissue is damaged. As a result, various neurological symptoms occur, which can be seen as exacerbations from time to time. In the area where immune elements are damaged, formations called plaques develop over time. With MS attacks, plaques develop in the affected nerve area and these plaques can be detected during clinical studies. divided into various sub-forms. Patients seen in the clinic can show one of these subforms. ibi; MS disease, which starts with a single form, may transform into another form over time. Since the course of the disease varies in each form, the treatment that should be applied to the patients may differ. The following disease forms can be summarized as MS types:
1.Clinical Isolated Syndrome (CIS): This form is basically considered as the pre-MS period or the onset of MS. During this period when patients experience loss of myelin (demyelination), clinical symptoms lasting at least 24 hours occur. Although the symptoms are compatible with MS; The clinical picture set in this period is not sufficient for the diagnosis of MS.
2.Relapsing-remitting MS (RRMS): In this most common form of MS disease, clinical symptoms develop in attacks, but these symptoms regress in the period between attacks. Attacks that develop in this way are relapsed; Improvements are called remissions. Although the disease progresses with relapses and remissions, it does not exacerbate. 85% of the cases are observed in this form.
3.Primary progressive MS (PPMS): Neurological problems developing in this form show progressive features. Although stability is achieved in the symptoms for a short time; Over time, these stable periods are replaced by periods of progressive disease. (Active and non-active periods)
4.Secondary progressive MS (SPMS): This form is mentioned when the relapsing-remitting MS form becomes progressive. Although the patients experience relapse attacks, the symptoms of the disease progress over time. However, studies have revealed the development mechanism of the disease and defined certain risk factors for the etiology of multiple sclerosis. In this respect, people with a genetic basis for MS can develop under the influence of some environmental factors. In addition, the risk of MS is higher in ethnic groups living in countries with cold climates such as Scandinavia and Scotland. Similarly, people living in areas with reduced daily sunlight developed more MS than the general population� i is shown. In this sense, it is thought that vitamin D deficiency may be important in the development of the disease. It is also known that smoking habit is among the risk factors for MS.
Since MS disease basically has an auto-immune mechanism, the risk of developing MS is higher in people with auto-immune diseases such as type 1 diabetes, inflammatory bowel diseases or Hashimoto's thyroiditis.
The disease is basically not hereditary. In other words, it is not a disease that is passed from parent to child. However, if there is a family member with MS, the risk of developing MS in other individuals is increased. The reason for this is that the immune system becomes prone to react to the myelin sheath under the influence of environmental factors in people with some defined genes.
What are the Symptoms of MS Disease (Multiple Sclerosis)?
Multiple sclerosis of the central nervous system Since it can develop in any region, the clinical picture can vary considerably and differs from patient to patient. Clinical manifestations are directly related to the affected nervous system area. In this regard, the following clinical symptoms may be among MS symptoms or multiple sclerosis attack symptoms seen at different times throughout the course of the disease:
- Weakness – fatigue (the most common symptom) that seriously affects daily life may be.
- Difficulty walking may occur.
- Weakness in the muscles, loss of strength or spasticity due to contraction may be observed.
- MS eye attacks such as visual impairment, visual field loss, double vision or blurred vision may occur. .
- Loss of balance is among the observed symptoms.
- MS can cause numbness or loss of sensation in the limbs.
- Acute or chronic pain may develop.
- Tremors may occur in the hands.
- In addition to symptoms such as difficulty concentrating, difficulty speaking, and confusion, MS can cause forgetfulness.
- Speech disorders at various levels
- Numbness or tingling that can be felt as pins and needles in the arms or legs or one half of the face
- Loss of balance and weakness in the legs, especially when walking
- Double vision, blurred vision or partial loss of vision that may be accompanied by eye pain
How Does MS Attack Occur?
Especially MS attacks or exacerbations seen in the relapsing-remitting form of MS appear as periods in which the symptoms of the disease appear or intensify. According to studies, MS attacks continue for at least 24 hours and occur at least 30 days after the previous flare-up. However, the symptoms of attacks may persist for days or weeks. Symptoms that do not meet these criteria and occur for a short period of time are considered MS pseudo attacks.
Research has shown that certain conditions can trigger MS attacks. In this sense, MS attacks may occur in people who experience intense stress in daily life. Similarly, patients with upper respiratory tract infections such as flu and cold may experience an MS attack. In this direction, it may be beneficial for patients to exercise regularly, to have a healthy and balanced diet, to sleep adequately, to be vaccinated against infections and to pay attention to hygiene so that they can manage their daily stress.
Is MS Contagious?
No, since MS is not an infection-based disease, it cannot be transmitted from one patient to another in various ways. Although it is stated that various viruses may play a role in the development of MS; The majority of individuals infected by these viruses do not develop MS. The development of MS seems to be possible with a genetic background and the presence of certain environmental factors.
Is MS Genetics?
One of the questions asked in society is “Is MS hereditary?” is the question. No, MS does not show genetic inheritance. In other words, it is not expected that children will have MS as a result of some genes in the mother or father being passed on to their children. However, studies have shown that some genetic factors attack the immune system to nerve tissue for MS development. proved that it can make it prone to the river. In the presence of appropriate environmental conditions, the risk of developing MS is higher in people with certain genes compared to the general population.
How to Diagnose MS?
In the presence of clinical symptoms that will raise the suspicion of MS in the patient, a specialist must first be diagnosed with MS. Evaluation should be made in the light of a detailed disease history taken from the patient by a physician and a detailed physical examination. If the physician deems it necessary, he may refer to additional imaging and laboratory tests. These examinations include magnetic resonance (MR), lumbar puncture (LP), optical coherence tomography (OCT) and some blood tests. The presence of antibodies in the cerebrospinal fluid must be proven. Again, for the diagnosis of the disease, other diseases involving auto-immune mechanisms such as lupus, Lyme disease, and Sjögren's syndrome should be excluded. Presence of two attacks or one exacerbation symptom lasting at least 24 hours, provided that there are two attacks, development of one lesion, and demonstration of widespread lesions in different parts of the nervous system
What to Do in MS Treatment?
There is no definitive treatment for multiple sclerosis in the current clinical approach. In addition, various treatment methods are successfully applied, in which the symptoms of the disease are eliminated and the quality of life of the patients is increased. Apart from this, the aim of treatment with multiple sclerosis drugs is to stop or slow the progression of the disease.
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