Multiple Sclerosis (MS) is a chronic autoimmune disease primarily affecting the central nervous system. It causes the immune system to abnormally attack the myelin sheath surrounding peripheral nerves, leading to impaired nerve signal conduction and a variety of neurological symptoms. Approximately 2.5 million people worldwide are affected by this disease, with the peak age of onset between 20 and 50 years old. The prevalence in women is about twice that in men.
The disease course is highly variable; some patients experience temporary remission of symptoms, while others may have progressive deterioration. Currently, there is no cure, but early diagnosis and treatment can effectively delay disease progression and improve quality of life. Recent studies indicate that vitamin D intake and geographic factors are associated with disease risk, suggesting that the etiology involves complex interactions between genetics and environment.
The key pathogenesis of MS involves the immune system mistakenly recognizing nerve myelin as foreign, continuously attacking it and causing demyelination (called demyelinating lesions). This damage results in patchy lesions that can severely impair nerve fibers themselves. Scientists believe this abnormal response may be related to dysfunctional T lymphocyte recognition, but the exact trigger mechanism remains unclear.
Family history is a significant risk factor. If one monozygotic twin has the disease, the risk for the other twin is 20 to 30 times higher than in the general population. Certain human leukocyte antigen (HLA) gene variants are highly associated with disease development. Environmental factors such as vitamin D deficiency, specific viral infections (e.g., Epstein-Barr virus), and residence in high-latitude regions have been proven to increase the risk of MS.
The heterogeneity of symptoms is characteristic of MS. About 85% of patients initially present with unilateral blurred vision or diplopia, known as optic neuritis. Motor impairments such as limb weakness and coordination difficulties are common, with approximately 60% experiencing gait instability or ataxia. Sensory abnormalities like tingling or numbness usually occur in the extremities.
Based on disease course, MS can be classified into four types: relapsing-remitting (accounting for 85%), secondary progressive, primary progressive, and progressive-relapsing. During remission periods, symptoms may partially recover, but cumulative demyelination can lead to irreversible damage. About 15% of patients develop a progressive course, with cognitive decline or bladder control issues.
Diagnosis requires exclusion of other neurological diseases and typically involves detailed medical history and neurological examination. Magnetic resonance imaging (MRI) is a crucial tool, revealing multiple lesions in the brain and spinal cord. Cerebrospinal fluid analysis showing oligoclonal bands or abnormal IgG index can strengthen the diagnosis.
Differential diagnosis includes neuromyelitis optica, Lyme disease, and vitamin B12 deficiency. In subacute cases, follow-up over six months may be necessary for confirmation. The latest diagnostic criteria emphasize MRI features showing "dissemination in time and space," meaning different lesions at different time points and locations.
Disease-modifying therapies (DMTs) are central to treatment. First-line medications include interferon beta injections and glatiramer acetate. Second-line potent therapies such as natalizumab and ocrelizumab are suitable for highly active disease. New oral drugs like siponimod can penetrate the blood-brain barrier to reduce brain lesion formation.
Targeted treatments include 4-aminopyridine to improve nerve conduction, antidepressants to alleviate fatigue, and physical therapy to reduce muscle stiffness. Bladder issues may be managed with alpha-blockers, and severe spinal cord lesions might require epidural spinal cord stimulation.
Currently, there is no way to completely prevent MS, but risk can be reduced through the following measures:
Recent research suggests that early exposure to ultraviolet B (UVB) sunlight may modulate immune responses, but overexposure should be avoided to prevent skin cancer risk.
If you experience the following symptoms, seek medical attention immediately: unilateral vision loss lasting over 48 hours, unilateral limb weakness lasting over 72 hours, or sudden gait instability preventing walking. Early diagnosis can be confirmed with MRI to assess lesion number and location. It is recommended to undergo a comprehensive evaluation within two weeks of initial symptoms.
If diagnosed patients experience sudden worsening of symptoms or new neurological deficits, immediate medical evaluation is necessary to consider treatment adjustments. Pregnant women with worsening symptoms should be monitored jointly by obstetricians and neurologists to adjust medications safely.
Physical therapists can improve mobility through balance training and muscle strengthening. Home environments should be designed to prevent slips and falls, and assistive devices can be used. Patients can perform tasks in segments, use supportive tools, and regularly adjust rehabilitation plans with healthcare teams to adapt to disease progression.
What types of medications are available for MS, and how are they chosen?Modifying therapies include interferons and monoclonal antibodies to slow disease progression; symptom treatments target issues like spasticity and pain. Physicians select the most appropriate treatment combination based on disease type, progression, patient age, pregnancy considerations, and other personalized factors.
What are the benefits and precautions of regular exercise for MS patients?Moderate exercise can improve balance, delay muscle atrophy, and reduce anxiety and depression. Low-impact activities such as aquatic therapy or yoga are recommended. Patients should avoid high-temperature environments and overexertion, and exercise under the guidance of rehabilitation professionals to adjust intensity appropriately.
What psychological challenges do patients face after diagnosis, and how can they cope?Common emotional issues include anxiety about disease progression and feelings of loss related to social roles. Participating in support groups, cognitive-behavioral therapy, and discussing anxiolytic medication options with physicians are helpful. Building a stable social support network is crucial.
How can relapse risk be reduced? What should be paid attention to in daily life?Adherence to disease-modifying medications reduces relapse frequency. Avoid infections, manage stress, and maintain normal calcium and sodium levels. Monitoring symptom changes, maintaining regular routines, and increasing communication with healthcare providers during weather changes or signs of infection are important.
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