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   Background of Multiple Sclerosis
Causations of MS

As for all autoimmune diseases for MS several factors come together which cause the immune system to affect the body-own tissue.

Congenital factors:
A genetic susceptibility is being inherited but not the disease itself.

Viral infections:
Studies with humans and animals have shown that after a long retention period in the organism viruses can in fact arouse chronic inflammations with a destruction of the myelin sheath in the central nervous system. Recently the role of the herpes viruses as well as bacterial infections with Chlamydia (microorganisms which are closely related to bacteria) is being pointed out.

Due to the fact that, among experts, it is clear that several factors need to be combined necessarily, the search for a single reason is going to be unsuccessful.

Self antigen and autoimmune mechanism
Finally the myelin sheath in the nerve fibers of the brain because of its after birth development is a self antigen for everybody, which means it may be the target of an attack of the immune system. The natural protection mechanisms, which prevent such reactions in the majority of cases, have not yet been adequately explored.

Special white corpuscles carry the immunological attack of MS (so called T-Lymphocytes). The according ailment hypothesis is conclusive but strictly scientific not yet proven. Nearly all therapies aim on a repression or modulation of the immune reactions. Unfortunately the therapy results give reason to criticize the hypothesis because so far only a slowdown of the natural course of disease has been achieved. .

Unspecific defense mechanism:
Without question is MS a chronic inflammation. With the destruction of the tissue not only specific immunological mechanisms are considered but all defense measures of the body. Particularly at the typical MS-destruction another group of white corpuscles (so called phagocytes), factors of the blood serum (so called complement system) as well as the controlled interaction between all components through messengers (so called cytokine) has to be considered. All therapies attempts which regard this factor adequately are at least reasonable.

Physiological factors:
First symptoms of MS usually appear at the age of 20 to 40. Women are affected more often.


               
The forms of progression

In the beginning the diagnosis MS sure is a devastating shock for everybody. But it has to be underlined that the disease does not need to take a dramatic progression. In contrast, the probability to have a quite normal live expectancy and sufficient physical capability is relatively high.

A “typical MS” does not exist. The symptoms of each single ailment progression vary pretty much. Today the clinical point of view differentiates four different progressions:

Progression with attacks:
We speak of an attack, if new symptoms appear and last longer than 24 hours or if former symptoms are distinctly aggravated after at least a month of calmness. A progression marked of attacks comprises on the other hand a complete or at least a large degeneration of the neurological symptoms.

Progression with progressive-attacks:
This form of MS-progression is defined of attacks in which the neurological symptoms are not completely being degenerated. Within the years of ailment a progressive rise of the rest symptomatic occurs.

Secondary chronic-progressive progression:
This stage of ailment contains a creeping chronic aggravation. Sometimes this creeping progression is accompanied by an aggravation of symptoms through progressive attacks.

Primary chronic-progressive progression:
This means a progression of MS during which the symptoms are progressing slowly but constantly without any accompanied attacks.

After the newest proposals there should be a so called transit form which describes the situation between the progression with attacks and the secondary-chronic progression.


               
Severity code of MS

The individual different occurrence of symptoms and ailment progression make it hard to categorize MS-patients and to compare the stage of disease.

However are such valuation scales absolutely important, e.g. for the observation of progresses as well as for the evaluation of therapy effects.

The internationally most common one is the extended valuation scale of Kurtzke (so called EDSS-Grades), which contains qualitative and quantitative correlations. According to this scale MS is classified in 10 severity codes:

0. No diagnostic findings

1. Inconsiderable abnormality of functions

2. Slight interferences like slight spasticity or slight palsy appearances

3. Semi-hard interferences like moderate antaxy, slight semi-side-symptoms

4. Malfunctions which disable clearly but allow working

5. Permanent work incapacity, walking distance restricted on 500 meters

6. Intensely restricted ability of walking and only with walker

7. Patient needs the wheelchair but can still control it without help

8. Patient is bed-ridden, but the function of the arms is still given

9. Patient is bed-ridden with full disability of doing anything

10. Death due to MS-disease

Even though the disability of the psycho-mental capacity has not been accounted optimally (neither do most of the other scales), this scale allows a sufficient classification of the individual disability.

Also subunits of 0,5 EDSS-grades are differentiated, which precise the classification. With a severity code of 4 EDSS and more the restricted ability to walk or the usage of utilities for walking dominates the classification of the clinical situation.


               
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