Multiple sclerosis
The most common autoimmune disease of the central nervous system is multiple sclerosis, also known as encephalomyelitis disseminata. There are many autoimmune diseases that can affect the central nervous system (CNS). The disease begins in young adults and is somewhat more common in women. Multiple sclerosis is a chronic disease with a variable course; it affects the brain and spinal cord – that is, the CNS – which is precisely why both regions have to be scanned when making the diagnosis.
Multiple sclerosis leads to the loss of neurons and their myelin sheaths. Without treatment, it leads to severe disability. The autoimmune process involves numerous reactive cells of the immune system that play a significant role in its pathogenesis. The clinical picture is episodic: neurological deficits develop over hours, days and weeks and then lessen or disappear – this pattern is known as relapsing-remitting. In time, some of the deficits do not recover and the condition becomes increasingly severe. Over time, the disease often turns into progressive multiple sclerosis.
Another typical clinical pattern is primary progressive MS, which is characterised by marked spasticity and paresis or paralysis; it is somewhat less common.
The symptoms are many and varied, because of the different regions of the central nervous system that the disease affects and its course over time. Early diagnosis, treatment and rehabilitation are key to curbing an unfavourable course of the disease. Neurorehabilitation techniques, rehabilitation aids, new medicines and good cooperation between the neurologist and the physiatrist are key to a better outcome. Disturbances of visual acuity and colour vision, often in one eye, with pain and flashes of light, are often the first symptom and usually settle spontaneously; sensory deficits, oculomotor deficits and other clinical disorders that the doctor will notice are also common. Changes can be found in the cerebrospinal fluid, and lesions in different parts of the brain on magnetic resonance imaging; the variation in the clinical presentation depends on where they are. Motor and sensory disorders and abnormal reflexes occur, walking becomes spastic-ataxic and uncontrolled, and bladder dysfunction significantly disrupts everyday life.
Rehabilitation, physical modalities such as ultrasound using the Seltzer method, walking and mobility aids, robotic rehabilitation, orthoses and regular exercise are an integral part of treatment. The medicines now in use have significantly improved the outcome. There are many unproven and partly proven methods that are ineffective and harmful, yet capture the interest, imagination and hope of seriously ill patients. Always consult a doctor about diagnosis, treatment and rehabilitation. Autoimmune diseases of the CNS that are somewhat rarer than multiple sclerosis include neuromyelitis optica, acute disseminated encephalomyelitis and some others that can affect the brain and other organs, such as Behçet's disease, sarcoidosis, giant cell arteritis, systemic lupus erythematosus, ANCA-associated vasculitides (e.g. Wegener's granulomatosis), Churg–Strauss syndrome, polyarteritis nodosa and granulomatous angiitis.
Faktor Zdravlje Polyclinic has leading experts in rehabilitation and the physical medicine treatment of multiple sclerosis, and an excellent team of physiotherapists skilled in the Bobath technique and other techniques aimed at CNS recovery. Robotic rehabilitation, or neurorobotics, is included in the rehabilitation process if the specialist physiatrist considers it appropriate.
