Sclerosis en plaques, disseminated sclerosis
What is it?
It is a slowly progressive disease of the Central Nervous System characterized by disseminated patches of demyelinization (loss of the substance – myelin- that insulates the nerves) in the brain and spinal cord, prompting multiple, varied symptoms and neurological signs, with periods of remissions and exacerbations, making controversial the diagnosis, the prognosis and the effectiveness of the medications.
What is the cause?
The causes are unknown; however, studies focus on causes such as immunologica abnormalities, including infection produced by a slow or latent virus, and myelinolysis by enzymes.
Family incidence observations suggest genetic susceptibility, and women are somewhat more affected than men.
Currently, there is a larger number of cases than in the 50s, and onset of symptoms occurs between the ages of 20 and 40, the disease being less prevalent and incident in warm climates, occurring more commonly in mild climates.
What does one feel?
Patients report visual problems, speech, walking, balance and strength disorders, transient weakness at the onset of the disease, in one or more extremities, numbness, with periods of remissions and exarcebations. When the spinal cord is involved, the motor, sensitive and sphincter manifestations are generally present, while pain is rare.
The evolution is unpredictable and highly varied. At the beginning, there may be long periods of months or years elapsing between two episodes, but the intervals tend to diminish and, occasionally, occurs the progressive and permanent incapacitation. Some patients become rapidly incapacited. In patients with middle-age onset the progression is rapid, without remission and, sometimes, fatal – within one year only.
How is the diagnosis made?
The likely and possible diagnosis will depend on the experience of the neurologist who, aided by paraclinical pertinent tests, such as: magnetic resonance imaging, cerebrospinal fluid, evoked potentials, among others, will get to the diagnosis without virtually requiring the anatomopathologic test.
What is the treatment?
As to the treatment, in addition to general healthcare, physiotherapy and psychotherapy are recommended.