Introduction to Multiple Sclerosis
Notably, diseases are the primary cause of disabilities and mortality among humans since their civilizations. Conditions and disorders present in various forms targeting various organ systems hence interfering with the normal physiology. Multiple sclerosis is one of the significant chronic inflammatory diseases. Ideally, the main characteristic of the disease is the presence of lesions on the central nervous system (CNS) and, in turn, results in cognitive as well as physical disabilities. The main cause and condition’s progress remain unclear. However, different studies have tried to map the disease’s pathogenesis, diagnosis, factors, and treatment plans.
Studies by Ghasemi, Razavi & Nikzad. (2017) have demonstrated the multiple factors in MS’s etiology and pathogenesis. Importantly, their studies highlighted the role of environmental factors and the genetic predisposition in the disease onset. There is a need to understand the etiology, pathogenesis, prevalence, and the various diagnostic approaches for the disease. The understanding would be relevant in enriching the existing body of knowledge and preventing and managing the disease.
Incidence of Multiple Sclerosis and Impacts it has on the Society
In line with its names, a multiple sclerosis is primarily a form of a demyelinating condition. The condition gained interest in the last two decades, where scientists focused on understanding the primary cause of disabilities in human beings’ lives. This has also been an approach to developing various pharmacological agents to targets certain conditions and alleviate suffering in the individual’s lives (Boru et al., 2018). Most cases present MS as an autoimmune disease and the most prevalent illness in neurological disabilities. People suffering from the condition have the low cognitive ability, physical incapacitation. The most devastating aspect is the emerge of the during the early adulthood phase; the disease lowers the quality of life and results in dependency to perform necessary daily activities.
MS appears as chronic inflammation and damage to the white matter in the CNS myelin. It is still unclear as to why the disease does no cause inflammation of the peripheral nervous system. In the united states, there are about 400,000 people affected by the condition (Boru et al., 2018). Gender, in most cases, influence the pathogenesis of a disease. The presence of defective chromosomes in males does not spare them from inheritable conditions.
On the other hand, the two XX chromosomes’ presence may exacerbate the genes’ translation resulting in the disease. For MS, more women than men suffer from the condition. Notably, some highlights indicate that the typical onset of the illness is between ages 30 and 40 (Boru et al., 2018). Studies by Boru et al. 2018 have highlighted the significant aspect of its prevalence in the world. Boru et al. (2018) noted that there had been a considerable increase in the number of cases globally, with about 2 million people living with the condition. Boru et al. 2018 points out that the disease is quite prevalent in the Mediterranean region in a country like Turkey. Boru et al. carried studies in turkey to understand the prevalence of the disease in the community. The result presented important information about the disease, with most cities having a prevalence of 41-101/100,000 (Boru et al., 2018). This helps us understand the distribution of the disease in these countries. Also, the condition is prevalent among people of northern European ancestry and less common among Asiatic groups (Norris & Lalchandani, 2018). Prevalence in these regions appears to align with the immigration of people with some defective genes.
Impacts on the Society
Multiple sclerosis is a long-life condition that interferes with the normal functions of the patient’s body. The disease increases the risk of cardiovascular diseases, coordination challenges, mental and emotional, sexual dysfunction. The condition improves the years of living with disability and predominantly increase dependency for daily life activities (DLA) (Eades et al., 2014). Patients living with mental and physical needs must have people take care of their well-being, such as feeding—the disease condition increases suffering in society; the disease causes economic struggle in families. Sometimes the disease affects a family’s breadwinners, resulting in some extents of poverty in the families.
Significantly, it interferes with the community’s overall wellness as people have to focus on understanding how to handle the condition in challenging times. The disease affects the well-being of the patients; most of the patients feel demoralized due to disabilities (Eades et al., 2014). The disease affects an individual’s sex life; therefore, getting a supportive partner is crucial in helping patients go through challenging conditions (Eades et al., 2014). Due to multiple sclerosis’s overall health implications, there is a shift in roles for partners, which sometimes calls for some understanding levels. If the relationship previously suffered from commotions, the disease presence can result in some people deserting their lovers.
Discussing the impacts of multiple sclerosis with parents and partners is crucial. This helps prepare them psychologically for the challenges that occur with the disease (Eades et al., 2014). These discussions are relevant as they help prepare parents and other family members for the presenting difficulties. Families are crucial in providing support in chronic disease conditions. Preparing the family for the ailment ensures that one has full support if they develop some forms of physical disabilities (Eades et al., 2014). This is crucial in improving patients’ well-being and boosting their morale to living with the condition. Multiple sclerosis impacts patients’ social life; for instance, some of the disease manifestations prevent them from engaging in specific activities such as running. The main challenge that would appear is maintaining an active life despite the disabilities that present. Patients may feel uncomfortable in various places if they have unique treatments. Such feelings increase anxiety and distress among patients; the family must stand with their ailing relative in the disease course.
Pathophysiology of Multiple Sclerosis
The chronic demyelinating condition occurs due to the damage and degradation of the myelin sheath. Multiple factors contribute to the deterioration of the myelin sheath, which increases the oligodendrocyte damage, particularly in the presence of type 1 steroid receptors. Studies highlight the role of steroid receptors in the development of the condition. The rising number of unbound Vitamin D receptors in the brain predispose people to develop multiple sclerosis (Lundsgaard, 2017). Regarding the receptor’s role, excess receptors lead to aggregates and which sometimes results in a massive release of zinc.
Zinc, on the other hand, plays a crucial role in the hyperphosphorylation proteins found in the neurons (Tau proteins). The presence of steroid receptors in the cytoplasm plays an essential role in the pathogenesis of the condition. These receptors are predominant in people with sex hormone problems attributed to multiple sclerosis. Such understanding provides a detailed picture of pharmacological agents’ role to disintegrate the steroid receptors in the brain (Lundsgaard, 2017). Some theories counteract MS is an autoimmune condition. However, there is a belief that oligodendrocytes’ internal changes and damage to myelin elicit immunological reaction within the central nervous system. Family history plays an essential role in predicting if one will get trapped by the condition. Notably, family history increases the chances of an individual developing MS by about 10 to 20 percent. Another factor that promotes an increase in the condition’ risk is the halotype for human leukocyte antigen HLA-DR2.
Multifocal inflammation in the CNS due to various immunological cells’ infiltration plays an essential role in the disease progression. Immunological cells affect the function of the oligodendrocytes (Norris & Lalchandani, 2018). These cells increase the inflammation in the CNS’ gray matter, causing nerve fibers’ demyelination. The inflammatory process results in the formation of plaques in the brain that interferes with impulses conduction, which increases neuronal dysfunction. The effects of the inflammatory process interfere with the conduction of impulses in the sensorimotor and the autonomic nervous system (Norris & Lalchandani, 2018). Development of neuropathies in these branches of the CNS results in manifestations such as sexual dysfunction, fatigue, irritability and instability of emotions, physical disabilities, and visual disturbances.
The role of immune cells and various cytokines is elaborate in the disease progression. The most predominant is the release of triggers of immune reactions, including interleukins and cytokine following the CD4+ cells’ infiltration and the T-helper cells (Ghasemi, Razavi & Nikzad, 2017). Constant reactions induce the building of an adaptive immune response. Cells in the gray matter present various receptors, such as type I steroid receptors (Ghasemi, Razavi & Nikzad, 2017). Immunological cells such as the T lymphocytes bind to these cells and release cytokines and interleukin, which attract other cell types into the target region.
Binding of antigen-presenting cells (APCs) by CD4 and the T lymphocyte promotes interleukin production (IL)-12, IL-4, and IL-23 (Ghasemi, Razavi & Nikzad, 2017). These interleukins promote the proliferation and the differentiation of the CD4+; this leads to Th1 and 2, respectively. T help cells formed can produce cytokines (Ghasemi, Razavi & Nikzad, 2017). On the other hand, these cells release interferon-gamma and other pro-inflammatory chemicals, promoting the inflammatory process. CD8+ is crucial in the roles in the formation of the MS lesion in the CNS.
The proposed model of action of these cells includes the formation of cytolytic cells upon binding APCs. The oligodendrocytes in patients with MS present various antigens, binding of the CD8+ increases apoptosis of these cells, implicated in the disease progress (Ghasemi, Razavi & Nikzad, 2017). Fas ligand secreted by the lymphocytes binds on the tumor necrotic factor receptors (TNF) appearing on the oligodendrocytes, thus initiating apoptosis (Ghasemi, Razavi & Nikzad, 2017). The high rates of apoptosis of the oligodendrocytes decrease the number of cells synthesizing myelin sheath and increase demyelination.
Exposure to various diseases and condition exacerbates the development of multiple sclerosis. People with a direction to viral agents such as the Epstein Barr Virus (EBV), the mycoplasma, herpes simplex virus 6, smoking, and deficiency of specific vitamins have elevated chances of developing MS (Ghasemi, Razavi & Nikzad, 2017). The intruding elements, in some cases, have proteins with structures homologous to the myelin sheath. The proteins elicit an immune response and latter increase the risk of an individual’s immune cells attacking the myelin cells, forming lesions. Nitric oxide and carbon monoxide from smoking are toxic to the oligodendrocytes, which interferes with myelin sheath synthesis (Ghasemi, Razavi & Nikzad, 2017). Genetic factors also play a crucial role in the etiology and progress of the disease.
MS results in the demyelination of essential nerve fibers in the gray matter and the CNS. Fiber demyelination decreases the impulse’s transmittance from various receptors or organs in the body with the brain (Norris & Lalchandani, 2018). Besides, demyelinated fibers reduced the velocity of impulse from different locations to the brain; this, in turn, results in various abnormalities. The manifestation of the disease depends on the nerve fibers affected (Koriem, 2016). If the lesion occurs in the region involved in controlling the limb’s movement, physical disabilities develop. Sometimes the damage of optical nerves by the inflammatory activities results in vision problems.
Lesions on the corticospinal tract interfere with the muscle activities while on the cerebellar lot increases gastrointestinal tract dysfunction. In the extremities, peripheral neuropathies develop with a burning sensation, tingling, numbness, among others—the symptom of MS range from asymptomatic to severe cases (Koriem, 2016). The interference of impulse’s conduction affects different regions and may present sexual and bladder dysfunction, corrupted gain (Norris & Lalchandani, 2018). There are occasional relapse of the disease symptoms and the deterioration of the sign as the disease progress. Continuous damage to the nervous fibers increases individuals’ vulnerability, affecting the different presentations of the condition.
Diagnosis for Multiple Sclerosis
The diagnosis of MS is crucial in enabling people to develop the best management program. Ideally, there is no single ideal diagnosis approach for the condition. A multitude of the test must be available to validate the presence of the disease in individuals (Norris & Lalchandani, 2018). The advanced cerebrospinal fluid analysis is a significant example of tests used to unmask the presence of MS. An MRI scan had made it possible for a pathologist to diagnose the condition. The evidence of specific symptoms such as those recorded in a clinical history with symptoms persisting for more than six months. MRI scans are crucial in identifying lesions on the brain, which may appear familiar with the use of computed tomography. Computed-MRI helps in the identification and establishment of the sizes of the lesions (Norris & Lalchandani, 2018). This is crucial in understanding the disease’s progress.
The documentation and analysis of the lesion is possible through the use of CT and electrophysiological evaluation (Norris & Lalchandani, 2018). These approaches should be supported by the laboratory analysis of the cerebrospinal fluid. Laboratory analysis should present and elevation of the immunoglobulin G (Koriem, 2016). Further evaluation should establish specific proteins in the CSF, markers of the inflammatory process within the cranium region.
Advancements in laboratory technologies have enhanced diagnosis of MS. The main role of using differential diagnosis is focus on the disease by ruling out other conditions that cause lesion in the brain. Relapse is crucial in establishing if a condition is MS (Ömerhoca, Akkaş & İçen, 2018). CT and MRI scan can be crucial in establishing these patterns. MRI that can capture inflammatory demyelinating data could be crucial for patients without relapse. MRI scan can help in analysis of lesions could be crucial in differentiating them from Schilder’s disease lesions (Ömerhoca, Akkaş & İçen, 2018). A combination of MRI and various laboratory analysis are crucial in differentiating MS from other conditions such as paraneoplastic neurological syndrome and Sjogren syndrome.
Collaborative Treatment/ Management of MS
The prominent approach in this disease condition involves managing the symptoms. Treatment of the state becomes difficult with the lack of a single diagnostic method and the tricky aspect of the disease. There is no need for promoting therapy in asymptomatic patients. These patients, however, should avoid factors that exacerbate the disease condition (Norris & Lalchandani, 2018). They should ensure that they lead a healthy lifestyle, such as observing the nutritional requirement. For instance, these patients should ensure that they have adequate vitamin D levels as it has a vital role in modulating the immune system.
Patients should adopt a relaxed mode to maintain a healthy lifestyle; however, they should engage in non-straining activities. Patients with muscle problems should engage in some physical exercises to enhance muscle relaxation and tone (Norris & Lalchandani, 2018). On the other hand, patients should seek family members and counselors support if they have psychological problems such as emotional stress. Moreover, they should make an effort to lead a stress-free life and avoiding extreme environmental factors.
Pharmacological agents also play an essential role in the management of MS. The physician should focus on agents that restore the myelin sheath and also decrease incidences of pain. Most of the treatment plans use corticosteroids as the first-line agent in the treatment of MS. The use of these agents should be short-term to avoid the harmful effects of the disease. Intravenous immunoglobulin may also decrease symptoms of the condition (Norris & Lalchandani, 2018). A physician may also promote the use of disease course modifying agents, including glatiramer acetate and beta interferons. Products with immunomodulatory effects may also be relevant in patients; these include products such as Mitoxantrone. Caregivers may also recommend using an agent that reduces constipation, such a diet rich in fibers.
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