Multiple Sclerosis Treatment

Specialists of the Neurology department Israel’s leading private hospital Herzliya Medical Center diagnosis and effectively treat multiple sclerosis (MS). Innovative techniques prevent the progression and development of complications of this disease and maintain and manage motor and sensory function.

What is MS?

Multiple sclerosis (MS) is the result of an abnormal immune-mediated process whereby the immune system directs an attack against the central nervous system (CNS), which includes the brain and spinal cord. The protective coating (myelin sheath) insulates core nerve fibers (neurons) and facilitates the normal transmission of nerve impulses from the brain to other parts of the body [depicted on the adjacent top illustration]. MS primarily targets and degrades the myelin sheath [depicted on the adjacent bottom illustration], ultimately destroying the underlying nerve fiber causing a disruption of communication between the brain and the rest of the body. Multiple sclerosis is a chronic, progressive disease, which results in irreversible damage to the central nervous system.

Causes of Multiple Sclerosis

The main cause of multiple sclerosis is an autoimmune process, in which the immune system produces antibodies against the cells of the myelin sheath, the most common type of demyelinating disorder of the CNS. This mechanism of the autoimmune reaction is not fully understood, and it is impossible to determine the initial pathological process that caused the destruction of its own tissues. Despite the fact that the causes of MS are unclear, scientists have established a number of risk factors, including:

• Demographics – the disease is more common in women aged 15 to 60 years living in temperate countries
• Hereditary predisposition
• Infectious diseases, such as infectious mononucleosis
• The presence of other autoimmune diseases such as type 1 diabetes, autoimmune thyroid inflammation or intestine
• Symptoms of multiple sclerosis [discussed below]

MS Symptoms

Symptoms of multiple sclerosis vary considerably depending on which of the nerves are damaged. The progressive nature of the disease occurs with periods of exacerbation and remission, new symptoms overlap with existing disorders. The main signs of multiple sclerosis are:

• Numbness in one or more limbs
• Muscle weakness in one or more limbs (usually on one side of the body)
• Blurred vision – diplopia (double vision), blurred vision, discomfort, and pain during movement of the eyeballs. In severe cases, as well as frequent recurrent exacerbations of multiple sclerosis can lead to complete and irreversible loss of vision
• Pins and needles sensation – tingling and pain in various parts of the body
• Incoordination, staggering gait, tremors (shaking) limbs
• Violation of speech (slurred speech) and swallowing
• Dizziness, progressive weakness, and fatigue
• Abnormal functioning of the bladder and intestines, including involuntary urination and constipation, bowel incontinence
• Muscle spasms (progressive MS)

Forms of Multiple Sclerosis

Depending on the clinical course, there are four main types of MS:

• Relapsing-remitting MS – is the most common type of disease. Neurologic function progressively worsens with attacks (relapses), following remission the symptoms show no real progression
• Primary-progressive MS – Since the onset of the disease a steady progression of MS symptoms, such as bladder problems, affected vision, and tingling
• Secondary-progressive MS type of multiple sclerosis. After the remitting-relapsing course of the disease, a worsening of neurological (and other) symptoms occurs, resulting in secondary issues like bladder infection (following bladder problems)
• Progressive-relapsing MS – a rare form of the disease characterized by periodic abrupt deterioration, without remission

Diagnosis of Multiple Sclerosis

There is no definitive (single) diagnostic test for MS, and the symptoms many patients experience are because of other disorders. In addition, patients will have at least two separate attacks before a confirmatory diagnosis of MS is made. Thus, MS requires a highly skilled neurologist in MS and a set of criteria to determine the presence of MS this is based on:

• The characteristic symptoms and the type of clinical manifestations
• Evoked potentials test – to determine if MS has affected nerve pathways
• Magnetic resonance imaging (MRI) – the presence of foci of demyelination of the nerve fibers
• Differential diagnosis – involving laboratory tests of blood and spinal fluid (lumbar puncture/ spinal tap)

Once MS is diagnosed, a neurologist can then determine the type of MS based on symptoms and disease progression (relapses, for example)

Treatment of multiple sclerosis

Modern methods of treatment of multiple sclerosis depend on the clinical form and phase of the disease (exacerbation or remission). The Neuropathology Clinic at Herzliya Medical Center offers the following types of treatment:

• Treatment of acute-phase – therapy is aimed at preventing the (irreversible) destruction of the myelin layer. The clinic uses intravenous corticosteroids and plasmapheresis (plasma exchange transfusion, in order to reduce the concentration of autoantibodies)
• Relapse prevention and treatment of progressive forms of multiple cases of sclerosis, such as Beta interferon, Glatiramer acetate (Copaxone), Natalizumab (Tysabri), Dimethyl fumarate (Tecfidera), Mitoxantrone (Novantrone), Fingolimod (Gilenya), Teriflunomide (Aubagio)
• Symptomatic therapy to reduce pain, restore the function of the intestines and bladder, as well as to reduce the side effects of the primary treatment.
• Physiotherapy and complex rehabilitation procedures to restore lost functions

Most procedures are performed on an outpatient basis or as part of a day hospital in the Centre of Neurology. Regular monitoring and preventive treatment can prevent relapses and delaying the development of the disease.