What is Multiple Sclerosis (MS)?
MS is a disease thought to be autoimmune in origin, caused by a disorder in the immune system where the body’s own cells attack the brain and spinal cord.

MS is an autoimmune central nervous system disease characterized by inflammation, damage to the myelin sheath, and axonal injury. MS is a chronic disease and occurs twice as frequently in women compared to men. The disease can present with relapses and remissions or may follow a progressive course.

In multiple sclerosis, various symptoms such as movement restrictions, weakness, partial paralysis, imbalance, speech and vision impairments are observed.

MS affects the central nervous system, that is, the brain, spinal cord, and the nerve fibers related to vision. In MS, the white matter—nerve fibers within the brain and spinal cord—is affected. White matter consists of fibers that enable communication within the central nervous system and between the CNS and other parts of the body.

What Causes MS?
According to current knowledge, the exact cause of the disease is unknown. Although there are several theories about the development of MS, none can fully explain it.

Genetic factors play an important role in the development of MS. However, studies have not identified a single gene responsible for the disease.

MS has been associated with other diseases such as thyroid/ goiter disorders, SLE (systemic lupus erythematosus), myasthenia gravis, diabetes, ankylosing spondylitis, inflammatory bowel diseases, scleroderma, and Behçet’s disease. This is interesting because most of these diseases have autoimmune origins.

Environmental factors include exposure to insecticides, herbicides, mercury, organic solvents, and other environmental toxins yet unknown.
Ethnicity plays a role; the prevalence is lower in yellow and black races compared to the white race. It is more common in Northern Europe, America, and Northern Canada, and less common near the equator.
Viruses, especially herpes group viruses, are suspected but never conclusively proven to be involved.
Genetics; the risk of MS in children of parents with MS is 7 to 10 times higher compared to the general population of the same age group. However, genes alone are not the sole factor in disease development.
Inheritance also plays a role.

What are the Symptoms of MS?
MS is a disease with highly variable symptoms that differ from patient to patient. The timing of symptoms, the location of lesions in the brain and/or spinal cord, and the severity of symptoms vary, which is characteristic of MS.

Symptoms tend to come in attacks followed by partial recovery. Over time, symptoms worsen and progress. Depending on the affected area and the individual’s immune response, MS presents with a variety of symptoms, generally including:

• Numbness, tingling, prickling sensations
• Muscle weakness
• Muscle spasms, stiffness, cramps, and pain (weakness can affect one side of the body’s arm and leg or both legs)
• Fatigue and exhaustion
• Vision loss, double vision
• Urinary incontinence, constipation
• Swallowing difficulties
• Depression
• Speech difficulties, fatigue
• Sexual dysfunction
• Loss of balance, nausea
• Short-term memory loss

The first symptoms in MS patients usually start with varying degrees of vision loss.

How is MS Diagnosed?
Diagnosing MS is not easy because there is no single special test or method specific to this disease. Diagnosis is made based on a good neurological history, clinical examination findings, and tests. MRI, cerebrospinal fluid (CSF) analysis, and evoked potential tests (which measure nerve conduction speeds) may be used. When myelin sheath is damaged, nerve conduction speed slows down.

How is MS Treated?
Currently, MS treatment focuses on managing the disease, fatigue, and exhaustion.

Particularly, walking difficulties and balance problems significantly limit daily life activities. Activity restrictions cause immobility, increasing the risk of obesity, diabetes, osteoporosis, and cardiovascular diseases. Therefore, regular exercise is very important at all stages of life, including for MS patients, to prevent complications, improve quality of life, and help patients feel better. Exercise programs should be individually tailored for each patient.

Rehabilitation plays a very important role in MS. After acute attacks, exercises and walking aids should be provided to improve function. For advanced patients who have lost walking ability, attention should be given to positioning in bed. Detailed programs should also include respiratory and trunk control, transfers, and upper limb strengthening.

In rehabilitation:

• The patient’s body awareness should be improved
• Abnormal muscle tone should be reduced
• Exercises should begin with positioning or stretching
• Sensory losses should be helped to reduce
• Exercise intensity should progress from simple to difficult
• Functional skills and daily living activities should be practiced extensively
• Walking, preparatory walking exercises, and assistive devices should be used to improve mobility
• A multidisciplinary approach should be applied

Exercises used in MS are effective in treating and alleviating symptoms caused by the disease. These include:

• Stretching exercises (to reduce muscle stiffness and prevent joint contractures)
• Postural exercises (to activate deep muscles important for balance and walking)
• Aerobic exercises (work large muscle groups, support heart and lung function)
• Strengthening exercises
• Endurance exercises (to increase muscle and respiratory system stamina)
• Balance, walking, and aquatic exercises

Home exercise programs should be planned specifically for each MS patient.

If patients have swallowing difficulties, these should be treated, and balanced nutrition ensured. If bladder dysfunction exists (urinary incontinence or incomplete emptying), medications should be given, and intermittent catheterization should be performed to empty the bladder.