Multiple Sclerosis: Understanding the Disease and Living Better with it Daily

Multiple sclerosis (MS) is a chronic disease of the central nervous system, primarily affecting the brain and spinal cord. It is characterized by the formation of demyelinating plaques, i.e. the destruction of the myelin sheath that protects nerve fibers. This damage slows down the conduction of nerve signals, and can cause a wide variety of motor, sensory, visual and cognitive symptoms.

In Belgium, the prevalence of MS is estimated at around 13,500 people. The disease mainly affects young adults, between the ages of 20 and 40, and affects around three times as many women as men. Although the course of the disease varies from one individual to another, multidisciplinary care combining medical monitoring, rehabilitation and psychological support helps to preserve autonomy and improve patients’ quality of life.

What is multiple sclerosis (MS)?

Multiple sclerosis is an autoimmune disease in which the immune system mistakenly attacks myelin, the protective sheath that surrounds the nerve fibers of the central nervous system. This destruction, known as demyelination, causes plaques to form in the brain and spinal cord. These lesions disrupt nerve conduction and explain the characteristic symptoms of the disease.

MS is considered a chronic disease because it develops over the long term. There is no cure, but its effects can be mitigated with appropriate treatment. The term “sclerosis” refers to the scar tissue that forms where myelin has been destroyed, while “plaques” designates the areas of lesion scattered throughout the brain and spinal cord.

Biological mechanisms of demyelination

In terms of biological mechanisms, immune cells – notably T lymphocytes and macrophages – cross the blood-brain barrier and attack myelin through inflammation. This autoimmune reaction triggers a cascade of phenomena that progressively damage nerve axons. The loss of myelin slows, or even blocks, the transmission of signals between the brain and the rest of the body, explaining the diversity of symptoms depending on the area affected.

The different forms of MS and their progression

Multiple sclerosis does not present itself in the same way in all patients. There are several forms of MS, each with a different evolutionary profile:

• Relapsing-remitting form (RRMS): the most common (85% of cases). It is characterized by relapses followed by periods of partial or total remission. Between attacks, the disease does not progress.
• Secondary progressive form (SPMS): follows a relapsing-remitting form. Symptoms worsen progressively, with or without additional attacks.
• Primary progressive form (PPMS): progressive from the outset, with no distinct relapses. It more often affects men, and generally has a later onset.
• Progressive relapsing-remitting form (PRMS): progressive from onset, with occasional acute attacks.

Disease progression and evolution

The progression of MS is unpredictable and highly variable from person to person. Some patients experience a slow progression with little disability over several decades, while others may experience a more rapid worsening. Regular medical follow-up and early initiation of disease-modifying therapy can significantly slow the progression of disability.

What are the first signs and symptoms of MS?

Recognizing the first signs of multiple sclerosis is crucial for early diagnosis. The most frequently reported initial symptoms are :

• Visual disorders: decreased vision in one eye, blurred or double vision (optic neuritis)
• Numbness or tingling in the limbs or face
• Weakness or clumsiness of an arm or leg
• Balance disorders and walking difficulties
• Unusual and persistent fatigue
• Lhermitte’s sign: sensation of electric discharge in the back when the neck is flexed

Frequent symptoms over time

As the disease progresses, MS symptoms may broaden to include :

• Disabling chronic fatigue
• Motor disorders: weakness, spasticity, gait disorders, imbalance
• Neuropathic pain and muscle aches
• Cognitive disorders: memory, concentration, processing speed
• Urinary and digestive disorders
• Emotional disorders: depression, anxiety
• Speech and swallowing disorders (in advanced forms)

Early diagnosis enables us to adapt treatment, limit the consequences of disability and significantly improve patients’ quality of life.

Biological causes and mechanisms of the disease

The exact cause of multiple sclerosis is still poorly understood, but scientific research has identified several risk factors that appear to contribute to its onset. MS is considered a multifactorial disease, at the crossroads of genetic, immune and environmental factors.

Genetic and hereditary factors

MS is not strictly speaking a hereditary disease, but there is a genetic predisposition. The risk is multiplied by 20 to 40 in people with a first-degree relative affected. Certain genes in the HLA (Human Leukocyte Antigen) system are associated with an increased risk. However, genes alone are not sufficient to trigger the disease.

Environmental factors and triggers

Several environmental factors are suspected of playing a role in the onset of MS:

• Vitamin D deficiency (insufficient exposure to sunlight)
• Certain viral infections, notably the Epstein-Barr virus (EBV)
• Smoking, which increases risk and worsens progression
• Obesity in childhood
• Geographical factors: MS is more common in countries far from the equator

In terms of biological mechanisms, the chronic inflammation triggered by the autoimmune attack leads to progressive demyelination and, ultimately, axonal degeneration. This process explains the transition from a relapsing-remitting form to a progressive form with accumulating disability. Diseases associated with MS, such as other autoimmune diseases (thyroiditis, psoriasis), may also occur in some patients.

How is multiple sclerosis diagnosed?

The diagnosis of multiple sclerosis is based on a series of clinical and paraclinical examinations. There is no single test to confirm the diagnosis; it is established according to the McDonald criteria, revised in 2017.

• Neurological examination: assessment of reflexes, coordination, vision and cognitive functions
• Brain and spinal cord MRI: magnetic resonance imaging to visualize demyelinating plaques in the brain and spinal cord
• Lumbar puncture: analysis of cerebrospinal fluid for oligoclonal bands
• Visual evoked potentials: measuring nerve conduction velocity
• Biological work-up: to rule out other pathologies (differential diagnosis)

Differential diagnosis

Differential diagnosis is essential, as several conditions can mimic MS: neuromyelitis optica (NMOSD), acute disseminated encephalomyelitis (ADEM), neurological lupus, vitamin B12 deficiency and certain vasculitides. A full work-up is needed to rule out these pathologies and make a precise diagnosis.

Current treatments and management

There is no cure for multiple sclerosis, but several therapeutic strategies can slow the progression of disability and relieve symptoms on a daily basis.

Medications and background treatments

Disease-modifying therapies aim to reduce the frequency and severity of attacks, limit the formation of new plaques and slow disease progression:

• Immunomodulators: beta interferons, glatiramer acetate, dimethyl fumarate – used as first-line agents
• Immunosuppressants: natalizumab, fingolimod, alemtuzumab – for more active forms
• Symptomatic treatments: to manage spasticity (baclofen), fatigue (amantadine), neuropathic pain (antiepileptics, antidepressants), urinary disorders.
• Corticosteroids: short courses during flare-ups to speed recovery

Rehabilitation and multidisciplinary support

Rehabilitation is essential to maintain mobility, autonomy and quality of life for people with MS. A multidisciplinary team is usually involved:

• Physiotherapy: to maintain muscle strength, coordination and gait fluidity
• Occupational therapy: adapting daily activities and the living environment
• Speech therapy: for speech and swallowing disorders
• Neuropsychology: for cognitive disorders and mental fatigue
• Psychological support: to help patients manage the emotional impact of illness

Regular medical follow-up, including neurological consultations and periodic MRI scans, is essential to monitor disease progression and adapt treatments if necessary.

Living with MS: tips and resources

Despite the challenges posed by multiple sclerosis, it is possible to maintain a good quality of life thanks to practical adaptations and the use of available aids.

Adapting your environment to prevent falls

To limit fatigue and prevent falls on a daily basis, we recommend a number of improvements:

• Install grab bars in bathrooms and toilets
• Opt for non-slip floor coverings
• Optimize traffic flow to make getting around easier
• Organizing the home to reduce distance and effort
• Use adapted seats and booster seats

Innovations in Walking Aids

Technological advances have led to the emergence of innovative walking aids, specifically adapted for people with MS. The Wheeleo®, for example, is a one-handed walker designed to facilitate movement while reducing fatigue and the risk of falling.

Thanks to its stability and maneuverability, Wheeleo® helps maintain natural posture and fluid walking, promoting functional recovery and self-confidence. It integrates perfectly into a rehabilitation program, complementing physiotherapy and motor stimulation exercises. In Belgium, health networks specializing in MS recommend the use of this type of walking aid to limit the progression of disability and improve patients’ quality of life.

To find out more about the innovative aids available for people with multiple sclerosis, explore the resources offered by Wheeleo® and Belgian MS patient associations.

Frequently asked questions about multiple sclerosis

What are the first signs of multiple sclerosis?

The first signs of multiple sclerosis are often visual disturbances (reduced vision, blurred vision), numbness or tingling in the limbs, unusual muscle weakness, balance problems or unexplained intense fatigue. These symptoms may be transient during an initial attack. Any unexplained neurological episode should lead to consultation of a neurologist for appropriate assessment.

How long can you expect to live with multiple sclerosis?

Life expectancy for people with MS is close to normal thanks to medical advances. Most patients live for several decades after diagnosis. MS is generally not fatal in itself, but certain complications (repeated urinary tract infections, respiratory problems in very advanced forms) can reduce life expectancy in severe cases. Appropriate medical monitoring and early treatment can help preserve quality of life over the long term.

What triggers multiple sclerosis?

Multiple sclerosis is triggered by a combination of genetic (hereditary predisposition), immune and environmental factors. Identified triggers include vitamin D deficiency, Epstein-Barr virus infection, smoking, and certain geographical conditions (more common in countries far from the equator). Autoimmune disease is triggered when the immune system mistakenly begins to attack the myelin of the central nervous system.

Is there a cure for multiple sclerosis?

To date, there is no cure for multiple sclerosis. However, current treatments are effective in controlling the disease, reducing relapses and considerably slowing the progression of disability. Research is advancing rapidly: remyelinating therapies (to repair myelin) and regenerative medicine approaches are currently undergoing clinical evaluation.

What is the differential diagnosis of multiple sclerosis?

Several diseases can present with symptoms similar to MS and should be ruled out: neuromyelitis optica (NMOSD), acute disseminated encephalomyelitis, neurological lupus, sarcoidosis, certain cerebral vasculitides or vitamin B12 deficiency. Differential diagnosis is based on MRI, cerebrospinal fluid analysis and full laboratory tests.