“The disease is multidimensional, affects many scattered areas of the brain and causes a variety of symptoms. In the modern era, with the progress of science in the fields of neurology, immunology and genetics, significant advances have been made in the therapeutic approach to the disease,” emphasizes Mr. Konstantinos Vumvourakis, Director – Head of the Multiple Sclerosis Department at Metropolitan Hospital, Emeritus Professor of Neurology, EKPAwho then explains what it is, what the symptoms are, what the causes are and how the disease is treated.

What does Multiple Sclerosis do to the body?

In Multiple Sclerosis (MS), the patient’s immune system is dysregulated, and by various mechanisms it “attacks” destroying the myelin. This is the lipid substance that protects the nerves and allows them to function properly and transmit the nerve signals that control movement, speech and other functions. As the myelin is destroyed, a scar tissue is created on the nerve cells, as a result of which the corresponding function cannot be performed. That is, nerve signals are not transmitted correctly.

At what ages does it occur?

It usually appears during the reproductive age, i.e. between 20-40 years, but it can appear earlier or later than the specific ages.

Is it a hereditary disease?

The disease is not considered hereditary, but a genetic burden has been found. Specifically, people who have a parent or sibling with the disease have a probability of approximately 1 – 3% of manifesting it, while in twin brothers this percentage increases to approximately 30%, i.e. a multifactorial aetiological substrate is attributed to its pathogenesis.
It is more common in women (women/men: 3/2)

What are the causes of the disease?

The causes that lead to its appearance remain unknown, but, as already mentioned, it is considered a multifactorial disease. In particular, genetic predisposition contributes to its occurrence, as there are many genes that seem to be susceptible to its manifestation. In addition, exposure to pathogens and the development of pathological immune mechanisms against the central nervous system from unspecified causes affect its appearance and development.

How does it manifest itself?

Multiple Sclerosis has the following symptoms:

• Weakness in arms or legs
• Numbness
• Diplopia
• Loss of vision in one (each) eye, accompanied by pain when moving the eye (optic neuritis)
• Sensation of electricity in the back
• Difficulty walking
• Difficulty speaking
• Dizziness
• Fatigue
• Itching
• Disturbances from urination, defecation or sexual function
• Progressive mental decline

In what forms is the disease distinguished?

MS is characterized by the presence of four main clinical forms:

• the relapser
• the secondary development
• the primary producer
• the progressive-relapsing form

In recent years, they have also been identified two new “informal” forms associated with the initial onset of the disease. The first of them is the radiologically localized demyelination syndromewhere through a random MRI scan of the brain, changes similar to those of the disease are detected, but without clinical symptoms or other tell-tale signs. The second form concerns the clinically identified syndromewhich initially presents with one or more clinical symptoms.

How is the diagnosis made?

The initial clinical examination is essential for every patient. Usually, imaging tests are required, such as CT and especially MRI, blood tests and ophthalmological examination with evoked potentials and/or visual fields.

In many cases, the final diagnosis and confirmation of the disease requires lumbar puncture (LUP)which takes place in a hospital, with the patient staying for one day. This procedure is performed exclusively by a neurologist and is done under local anesthesia. The fluid obtained is sent for special analyses.

How is it treated?

The approach to the disease is personalized with a human-centered character, so it is focused and adapted to the needs of each patient, who is invited to actively participate in decision-making, a fact supported by many scientific researches.

In the past, treatments focused on immunosuppression. Today, however, the majority of treatments are aimed at disease modification with less emphasis on immunosuppression and with the goal of maximally reducing relapses and the impact of the disease on the person’s daily life, while maintaining their quality of life and without negatively affecting the pregnancy (when the affected person is female) and the patient’s fertility.

Treatment approaches include:

• Injectable subcutaneous or intramuscular treatments.
• Oral therapies.
• Treatments with monoclonal antibody biologic agents, which are usually delivered through intravenous infusions.
• In many cases, they are combined with sessions of specialized physical medical rehabilitation, in order to improve the condition of the patients and prevent possible complications of the disease.

How good a quality of life can people with MS have?

Quality of life will depend on symptoms and how well the patient responds to treatment. This rare but unpredictable disease can change course without any warning. Most people with MS do not experience severe disability and continue to live normal lives.

*In Metropolitan Hospitaloperates the Center for Multiple Sclerosis & Special Neurological Diseases, a specialized unit that focuses on the care of patients with the above diseases. The Center uses the most modern treatments that have been approved internationally, including disease-modifying and symptomatic treatments. The staff of the Center consists of specialized doctors with many years of experience in the care of patients with MS, while they are informed about the latest developments in the field through their participation in international and national scientific conferences.