The diagnosis of multiple sclerosis (MS) is a hard blow for many affected people, because this disease is not curable yet, its course is difficult to estimate and the symptoms are manifold and often stressful. But one thing is for sure: Not every MS is so severe that it leads to complete immobility. Life with MS is possible! care.de explains how an MS disease can progress and what treatment options people with multiple sclerosis have.
Table of Contents
Multiple sclerosis (MS): course of the disease
In multiple sclerosis, there is no single progression that applies to every patient. For example, it is not possible to predict how long a relapse will last, when the next relapse will occur and whether the disabilities will disappear again. In many cases, the inflammatory lesions in the brain and spinal cord, which characterize the clinical picture of multiple sclerosis, completely disappear. However, scars (lesions) often remain, which show up in X-ray or MRI images.
Basically, the following three MS courses can be distinguished:
- Relapsing course (relapsing remitting MS):
Symptoms start suddenly over days or weeks, can be treated with cortisone therapy. Then again symptom-free intervals follow for months and even years.
- Primary chronic-progressive (creeping-progressive) course:
Restrictions increase without clearly delineable episodes.
Gradual MS is more common in first-time MS sufferers over the age of 40. onset in the first year of life. (1)
- Secondary chronic-progressive course:
The limitations do not completely disappear, but continue to increase from relapse to relapse.
A typical Multiple sclerosis end stage There is no such thing as a "one-size-fits-all" approach to MS, because the course of MS is highly individual, and thus the stages of MS differ as well. However, there are a number of so-called prognostic factors that indicate a rather favorable (mild) or rather unfavorable (severe) course of multiple sclerosis:
Prognostic factors that tend to favor a favorable course of MS include:
- Only one symptom at the beginning (either tingling or numbness or visual disturbances) of the MS disease course
- Short duration of symptom and good regression after MS relapse
- Long intervals between relapses
- Low degree of disability after five years of disease duration
- No paralysis or balance disorders
- Onset of the disease before the age of 35. Year of life
Prognostic factors that speak for a rather unfavorable course are, for example:
- Several symptoms at the onset of MS (including when they indicate inflammation in the cerebellum or spinal cord, such as gait disturbances, tremors of the arms or legs, movement and speech disorders, muscle cramps or stiffness)
- Long-lasting relapses with poor regression of the symptoms
- Recognizable inflammation and scars (lesions) in the MRI image
Often the onset of the disease is characterized by a so-called relapse. MS relapses occur in about 70 percent of people with the disease and are characterized by many symptoms. (1) Depending on where the inflammation occurs, the signs of an attack are very different.
Recognizing a relapse of MS is not easy at all. Therefore, it is helpful to look at the possible manifestations or symptoms of an MS relapse. Sometimes the ability to move certain parts of the body (for example arms or legs) is impaired, sometimes bladder or bowel functions (incontinence), vision or speech are restricted. Sometimes the limitations develop quite suddenly, sometimes they start insidiously and then gradually increase in severity.
An MS relapse occurs when new or known symptoms appear more than 24 hours and more than 30 days after the start of the last relapse. The symptoms can neither be explained by a change in body temperature nor by infectious disease.
MS relapse: duration
The duration of a multiple sclerosis attack varies between a few hours, days or weeks. After that, the symptoms subside slowly. Sometimes the relapsing symptoms disappear on their own, sometimes only with the help of medication.
MS without relapses
A large number of people with MS have no more relapses after about ten to 15 years. There is no relapsing (more precisely "relapsing-remitting") MS anymore, but the disease takes on a so-called secondary chronic-progressive course, in which the relapses become less as the disease progresses. According to the most comprehensive global study to date, the Atlas of MS, about 12 percent of people with MS have a slowly progressive deterioration from the beginning (primary chronic progressive), so MS progresses without relapses. (2)
Progression of multiple sclerosis © care.de
Multiple sclerosis: Life expectancy
A study from Norway showed that MS patients live on average from about 72 years (men) to 77 years (women). This is only slightly less than the life expectancy of healthy people, which is between about 78 years (men) and 84 years (women). (3) In addition, all these are statistical values; they have only a limited significance for the individual person.
Cure: Is MS curable?
Multiple sclerosis is currently not curable. Since the cause of the inflammation is not yet clear, the only option is to treat the symptoms – but treating MS symptoms can achieve good results and often lead to patients living as symptom-free as possible.
MS: Therapy& Treatment
MS is not curable even with therapies. Treatment is used to limit the symptoms of the disease as much as possible. MS treatment focuses on four major goals:
- Inhibition of the acute inflammatory reaction (relapse therapy)
- Prolongation of the relapse-free/poor time (course-modifying therapy)
- Alleviation of symptoms (symptomatic therapy)
- Prevention of possible complications (symptomatic therapy)
These therapeutic goals are usually combined with each other, individually tailored to the patient and constantly modified – depending on the clinical picture.
- Occupational therapy
- Speech therapy
- neuropsychological therapy
- Rehab measures
Several treatment methods have been shown to alleviate symptoms in MS treatment:
For the relapse therapy, mainly cortisone preparations are available, which are supposed to contain the inflammations. In an acute attack, it is administered as an infusion over three to five days (High-dose relapse therapy). They are considered to be well tolerated. Nevertheless, stomach problems, sleep disturbances or an increase in blood sugar and blood pressure can occur in individual cases.
If symptoms persist after several days, therapy can be repeated (with a higher dose).
Blood washing (plasmapharesis)
In many cases, a so-called blood wash is used (plasmapharesis), in which blood is extracted, purified and returned to the body. In about half of the cases, blood washing has proven to be helpful as a therapy for MS.
Plasmapharesis is only possible in special centers and is also called only for severe acute episodes carried out. This blood washing removes proteins from the blood, which in turn increases the patient’s susceptibility to infections.
Blood washing (immunoadsorption)
A special form of blood washing with fewer side effects is known as immunoadsorption, in which the blood is separated into plasma (blood fluid) and blood cells. Only the plasma is purified, reunited with the blood cells and returned to the body.
This form of treatment opens up new perspectives, for example, in severe relapses that do not respond to cortisone therapy. The therapy takes place on an inpatient basis and lasts about one to two weeks . For example every second day a treatment of about three hours duration carried out. As a rule, a total of five to six treatments are given.
There are a number of drugs that are designed to strengthen the immune system and prevent inflammation. However, some of these have severe side effects. They can increase susceptibility to infection, cause pain in the head and/or back, damage the liver, and alter blood counts.
Many medications originate from cancer therapy and their Use requires a skilled expert and close monitoring of the patient.
Cost absorption of MS therapy
The costs for plasmapheresis or immunoadsorption are usually covered by health insurance. These medical treatments are carried out in clinics.
MS& natural medicine
Many MS sufferers turn to natural remedies to relieve their symptoms and discomfort. These include medicinal plants such as St. John’s wort or the herbal remedies made from them. St. John’s wort, for example, is a popular and important medicinal plant for depressive moods. Mistletoe preparations act on the nervous system.
Use of homeopathic remedies in MS
Many symptoms that occur in the course of multiple sclerosis can also accompanying can be treated with homeopathic remedies. Depending on MS symptoms and complaints, there are different homeopathic remedies available to sufferers, which need to be individually selected and matched for a successful treatment process. To find the right homeopathic remedy, patients should always discuss its use with their doctor and a therapist.
Research into the causes and treatment of MS has kept experts busy for a long time. Although a cure has not yet been found, doctors can now diagnose multiple sclerosis much earlier and also treat it more effectively thanks to the latest diagnostic techniques.
Competence Network MS
In the meantime, science has discovered the disease multiple sclerosis for itself. A large competence network for multiple sclerosis developed from the research interest. Multiple sclerosis research is now looking at the disease from many angles. All aspects of the disease are being heavily researched, from causation to diagnostic procedures to optimal therapies and the possibility of curbing inflammatory forms of MS.
Not only neurologists and immunologists deal with MS, but also occupational therapists and physiotherapists are involved and new professions such as the MS nurse or the MS caregiver have emerged.
MS research balance
Prof. Dr. Heinz Wiendl, a representative of neuroimmunology and MS research, affirms in a 2018 article from the German Society of Neurology "that a disease that was de facto untreatable more than 20 years ago has become a diagnosis with which patients can often lead an almost normal life". (4)
Living with MS
Multiple sclerosis is scary. It is unsettling because no sufferer can ever be truly sure that relapses will no longer occur or that the disease has even come to a halt. The longer the disease remains stable – i.e. does not worsen – the more favorable is the prognosis.
But all this is statistics and what may be true in general does not have to be true in individual cases. All people with MS have to live with this uncertainty. You all know that you can go to bed at night with a good general feeling, but you have to expect that you can wake up the next morning and have visual disturbances or paralysis.
The disease is a life companion, which nobody wishes for, but which 2.8 million people all over the world have to live with. (2)
Life with MS can be worth living. Provided that people accept their disease and live with MS instead of against it. This is part of it:
- Accepting impairments
Accept impairments, but do not make them the main content of life: If walking is difficult, cycling may be easier. If it is difficult to change gears when driving a car because the arms are weak, an automatic car can be a good alternative.
- Acknowledge stress limits
Acknowledge the physical stress limits and, for example, dose the sports program in such a way that you do not exceed your capacity. In general, there are no limits to your preferences when it comes to sports. Whether you prefer water gymnastics or climbing in the high mountains. You may also learn new sports during a rehab measure, for example equipment or balance training, which can be a lot of fun for you.
- Adapt diet
You can adjust your diet to your disease: While there is no specific MS diet, there are plenty of recommendations, for example a vegan diet, an anti-inflammatory diet, or even a diet that is as low in carbohydrates (low carb) as possible, but high in proteins. Vitamin D – experts say – should always be part of your diet, possibly as a supplement if your doctor thinks it’s appropriate.
High doses of vitamin D can reduce MS attacks, i.e. slow down MS activity somewhat. (5) Vitamin D is produced by the body as soon as it receives sunlight. So exercise in the fresh air has more than one health-promoting aspect!
MS: Help& Self-help
There are now many MS support groups for people with MS. The MS self-help group gives support to those affected and enables them to exchange information with each other. This increases the quality of life immensely. Relatives can also get help in MS support groups.