Multiple Sclerosis (MS) — Definition, Symptoms and Treatment

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Definition

The name of this disease describes the multiple presence of indurations (= scleroses) in the central nervous system. This is a chronic, immune mediated progressive inflammatory CNS disease that harms the myelin sheath and the nerve cells in variable degrees leading to physical disabilities.

Epidemiology

MS is the most common inflammatory disease of the brain and spinal cord. It has a frequency of approximately 1:1000 in the EU and the U.S. For example, about 2,500 patients in Germany are diagnosed with this disease every year. Most of these patients are very young (20 to 30 years old) and are in a phase of their lives in which chronic diseases are far removed from daily life.
MS is one of the most common causes of long-term disability in young patients, with women being affected 2 to 3 times more frequently. It is an extreme burden for many previously healthy patients to be faced with a MS diagnosis. The conversation with the patient should therefore be both empathetic and informative.

Etiological and Histopathological Traits of MS

The exact etiology of MS is unknown, but the disease is thought to be a multifactorial disease with causative factors including:
  • Genetic factors
  • Environmental influences
  • Auto-immunity
Genetic Factors of Multiple Sclerosis
There is not yet any specific inherited gene that can be deemed the cause of MS, but there are likely polygenetic influences. Especially changes of the MHC class II can be associated with 2 to 4 times the risk of acquiring the disease. Interleukin receptor polymorphism also appears to increase the risk (Compston & Coles, 2002). For instance, the genetic component can be seen in the increased risk of the disease appearing in children of afflicted parents. These children are 20 times more likely to be affected.
Environmental Factors of Multiple Sclerosis
When observing an epidemiological map of the world, the distribution of the disease makes it apparent that prevalence of MS increases with the distance from the Equator. The U.S., Central Europe, and New Zealand have a prominently high prevalence. Given this information, the different level of sun exposure, smoking, EBV infection, and humane herpes virus 6 have been often discussed.
Interestingly, studies of migratory patterns have revealed that migration from a low-risk area of MS to a high-risk area gave rise to an age-dependent risk adjustment: Migrants under the age of 15 exhibited a higher risk, whereas older migrants did not experience any change in their risk of acquiring MS.

Risk multiple sclerosis
Image: “ This slide shows the global prevalence of multiple sclerosis.” by Dekoder. License: Public Domain

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