Introduction of Disease
Multiple sclerosis, as a specific example of the disease, is a chronic condition that affects the central nervous system. The destruction of the myelin sheath that surrounds the nerves and the subsequent formation of plaques are prominent (Witt et al., 2007). Accordingly, the latter disrupts the normal transmission of nerve impulses, leading to symptoms of blurred vision, numbness, fatigue, spasticity, cognitive problems, and more.
Separately, it is worth noting that, given the disease’s ambiguous and incomplete etiology, there is currently no cure (Hauser, 2021). Thus, the unpredictable nature of MS poses challenges and negative consequences for both patients, requiring lifelong adaptation to symptoms, and for health care providers focused on patient care.
Etiology and Risk Factors
In terms of common causes, the exact factors remain unknown, but they may be tied to autoimmune problems, as the immune system destroys the nerve sheath. Triggers can be variations or combinations of genetic, internal, and external factors (Wens et al., 2014). Risk factors include age between 20 and 40, female biological sex, climate, geographic location away from the equator, and vitamin D deficiency. In addition, there is a genetic predisposition, and bad habits such as smoking and alcohol consumption have a discouraging effect.
Pathophysiological Processes
The disease involves complex changes at the cellular, tissue, and organ levels: an aberrant immune response triggers an inflammatory response in the CNS driven by inflammatory cytokines. Tissue damage results in denuding nerve fibers and disrupting impulse transmission, concomitant with the formation of plaques in the white matter of the brain and spinal cord. At the organ level, problems of interaction and functional impairment are manifested as further axonal damage progresses.
Cellular adaptation occurs through the process of remyelination, that is, attempts to repair the damaged substance; however, in multiple sclerosis, this process is ineffective or incomplete, and the nervous system demonstrates neuroplasticity to compensate, but rarely sufficient to restore function. The link to the previously mentioned symptoms is obvious and direct, depending on the specific areas affected; for example, blurred vision is a consequence of damaged visual pathways or nerves.
Clinical Manifestations and Complications
- Physical signs: spasticity, double or foggy vision, numbness, speech distortion, loss of coordination, bladder and bowel problems, fatigue.
- Diagnostic signs and symptoms: neurologic examination for abnormal reflexes, weakness, and sensory deficits; visual disturbances; MRI.
- Complications: muscle atrophy, secondary progressive multiple sclerosis, depression, contractures, pressure sores, cognitive decline.
- Consequences: likelihood of disability, decline in quality of life, impact on mental state.
- Understanding and addressing all of the factors and complications outlined above is essential in a comprehensive approach, without which the patient’s condition can deteriorate very severely.
Diagnostics
MRI is used to reverse plaques and CNS problems, especially in the brain. Cerebrospinal fluid analysis is also useful in understanding the disease process by monitoring immunoglobulin levels and the presence of oligoclonal bands, which can signify an abnormal immune response (Mahler et al., 2020). Visual evoked potentials measure the electrical activity of the optic nerve to detect abnormalities, which may also indicate a disease process. Blood tests will rule out other diseases with similar symptoms, such as vitamin deficiencies or infection. A combination of these methods and many others, such as somatosensory evoked potentials, optical coherence tomography, and lumbar puncture, is crucial in the diagnosis.
Interview
My distant acquaintance John (name changed) is 45 years old and has been living with the disease for seven years. Clinical manifestations include numbness, fatigue on walking, and tingling in the limbs, according to the patient, which are consistent with the symptoms reported in the resources. Further, due to weakness, John is at risk for muscle atrophy and possible joint contractures, and the extent depends on the variability of disease progression.
John is also diagnosed with hypertension, complicating treatment due to the ambiguous cross-compatibility of medications, which requires clarification and close monitoring. Daily life suffers because my acquaintance complains of forced restrictions, regular spending on medications, and controlling fatigue with activity adjustments in parallel with neurologist visits and regular MRIs. At the same time, he maintains an optimistic outlook on life because he feels his family’s support. From the interview, it became clear that the daily impact of the chosen disease on the person and the criticality of a strong support system are.
References
Hauser, S. L. (2021). Curing multiple sclerosis: How to know when we’re there. Annals of Neurology, 90(4), 539–541.
Mahler, M. R., Søndergaard, H. B., Buhelt, S., von Essen, M. R., Romme Christensen, J., Enevold, C., & Sellebjerg, F. (2020). Multiplex assessment of cerebrospinal fluid biomarkers in multiple sclerosis. Multiple Sclerosis and Related Disorders, 45(102391).
Wens, I., Dalgas, U., Vandenabeele, F., Krekels, M., Grevendonk, L., & Eijnde, B. O. (2014). Multiple sclerosis affects skeletal muscle characteristics. PloS One, 9(9).
Witt, E., Kessel, L., Van, K., & Moss-Morris, R. (2007). Multiple sclerosis. In S. Ayers, A. Baum, & C. McManus (Eds.), Cambridge handbook of psychology, health and medicine. Cambridge University Press.