12.2 Nutrition and Long-Term Cardiovascular Illnesses

Multiple sclerosis is a complex autoimmune disorder that attacks the central nervous system. It causes demyelination, inflammation, and axonal damage, leading to a range of neurological symptoms that can significantly impact daily life.

Diagnosis involves a combination of clinical evaluation, MRI scans, and cerebrospinal fluid analysis. Treatment focuses on managing symptoms and slowing disease progression through immunomodulatory therapies, which aim to reduce relapses and disability.

Overview of Multiple Sclerosis

Mechanisms of multiple sclerosis

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• Autoimmune disorder involves the immune system mistakenly attacking the central nervous system (CNS)
  • T-cells, a type of white blood cell, cross the blood-brain barrier and enter the CNS causing damage
• Demyelination occurs when T-cells attack and damage the myelin sheath, the protective covering around nerve fibers
  • Damage to myelin disrupts the transmission of electrical signals along nerve fibers leading to impaired function
  • Scarring (sclerosis) occurs in multiple areas where myelin is damaged resulting in hardened, scar-like tissue
• Axonal damage can occur as the disease progresses, where the nerve fibers (axons) themselves become damaged
  • Axonal damage leads to permanent neurological deficits and disability due to irreversible nerve damage
• Inflammation in the CNS is caused by immune system activation
  • Inflammatory chemicals contribute to further damage of myelin and nerve fibers exacerbating the condition
• Neuroplasticity, the brain's ability to form new neural connections, can help compensate for some damage

Signs and symptoms of multiple sclerosis

• Visual disturbances such as optic neuritis, an inflammation of the optic nerve
  • Blurred vision, double vision, or complete loss of vision in one eye can occur
• Sensory symptoms include numbness, tingling, or burning sensations in the face, body, or extremities
  • Paresthesia, abnormal sensations such as pins and needles, may be experienced
• Motor symptoms involve muscle weakness, especially in the legs
  • Difficulty with coordination and balance can be present
  • Spasticity, stiffness and involuntary muscle spasms, may occur
• Fatigue is an overwhelming tiredness that worsens as the day progresses
  • May be exacerbated by heat exposure (Uhthoff's phenomenon)
• Cognitive changes such as difficulty with attention, concentration, and memory
  • Slowed information processing speed can be observed
• Bowel and bladder dysfunction including urgency, frequency, or incontinence
  • Constipation may also be experienced
• Sexual dysfunction such as decreased libido, erectile dysfunction, or reduced vaginal lubrication
• Other symptoms can include vertigo and dizziness
  • Pain, including trigeminal neuralgia and dysesthetic pain, may be present
  • Emotional changes, such as depression or mood swings, can occur

Factors and diagnosis of multiple sclerosis

• Risk factors for developing MS include genetic susceptibility, where certain genes increase the risk
  • Environmental factors such as low vitamin D levels, smoking, and Epstein-Barr virus infection may play a role
  • Geographic location, with higher prevalence in regions farther from the equator, is a contributing factor
  • Age and gender, typically diagnosed between 20-40 years old and more common in women, are risk factors
• Diagnostic methods involve a neurological examination to assess signs and symptoms
  • Magnetic Resonance Imaging (MRI) detects lesions in the brain and spinal cord and helps rule out other conditions
  • Cerebrospinal fluid (CSF) analysis, obtained through a lumbar puncture, may show oligoclonal bands and elevated IgG index suggesting MS
  • Evoked potential tests measure the electrical activity of the brain in response to stimuli and can detect subtle changes in nerve conduction
  • McDonald Criteria are diagnostic guidelines that combine clinical presentation, MRI findings, and CSF analysis to confirm MS diagnosis and rule out other possible causes
• The Expanded Disability Status Scale (EDSS) is used to quantify disability in MS patients and monitor disease progression

Types and Treatment of Multiple Sclerosis

• Relapsing-remitting MS is characterized by periods of symptom flare-ups followed by periods of remission
• Progressive MS involves steady worsening of neurologic function over time without distinct relapses
• Immunomodulatory therapy is a primary treatment approach, using medications to modify the immune system's response
  • These treatments aim to reduce the frequency and severity of relapses and slow disease progression