Does menopause aggravate MS

Multiple sclerosis is individual. Nevertheless, over the years, many MS patients have developed their limitations. Science has been researching this aspect more intensively for a few years. The first results of these new approaches give cause for hope.

The disease of the 1000 faces does not allow any prediction about the individual course. The most important lesson, however, is that MS doesn't have to be severe.1 Research also gives hope: While the effectiveness of a therapy has so far mainly been measured by how much the relapse frequency can be reduced, the progression of the disability is now also receiving more attention.2 And that gives hope! What exactly does disability progression mean? Progression means progressive development and disability progression in MS accordingly the progressive disability in the course of the disease. Although MS presents itself with a wide variety of symptoms in various forms and can lead to limitations over time, the disease leads to severe disability in only a few cases (in less than five percent of all patients) within a few years.1

The forms of MS and their effects

A distinction is made between the relapsing and the progressive (chronically progressive) form.3 In the majority of all patients, the disease begins relapsing:1 The symptoms set in suddenly - usually without any discernible cause - and last for a few days or weeks. Several weeks, months or even years lie between the attacks.3 The initially relapsing course can change into a progressive course of the disease (secondary chronic-progressive). After 10 to 15 years, this is the case for around 30 to 40 percent. After more than 20 years, up to 90 percent of patients are affected.1 This means that the disabilities no longer recede completely and continue to increase regardless of any relapses. It is not possible to predict whether and when the disease will change into a chronically progressive course.3

In about every tenth MS patient, MS is progressive from the start (primarily chronically progressive). The handicap is constantly increasing without any clear delineation of relapses. This form occurs mainly in people with a later onset of the disease from the age of 40.3 This is probably due to the reduced ability of the brain from this age to repair the nerve damage that has occurred.4

Disability progression as a criterion for MS research

In every MS study, the effectiveness of a therapy is also measured by the progression of disability. The basis for this is the EDSS value (Expanded Disability Status Scale), which is based on a scale system for the systematic recording of the disability of MS patients.5 Since this value remains stable for years with today's medication and therapy progress is difficult to record, findings that can be detected in the MRI are also taken into account. At best, no disease activity can be detected: If the EDSS value remains stable, there are no relapses and no new inflammation foci in the MRI, the scientists speak of NEDA (No Evidence of Disease Activity).6

Smoking and MS

It is known that smoking promotes inflammation in the body and should therefore be avoided in MS. Studies also show that cigarettes not only increase the risk of developing MS, but can also affect its progression. You still haven't been able to let go of the glowing sticks? Here comes an insight that will surely give you the final boost of motivation to finally become smoke-free. A study carried out at Nottingham University Hospital shows that quitting smoking can significantly reduce the likelihood of progression. For every year that passes after quitting smoking, the researchers report a five percent decrease in progression!7

MS and menopause (menopause)

In a long-term study of 391 patients, researchers in Boston found that there was a faster accumulation of disabilities at or around the beginning of menopause. Research is still going on. If the hormonal changes in the body are responsible, this could be an approach to find an effective therapeutic approach for women in menopause.7

Vaccinate

In Boston, scientists investigated a therapy similar to vaccination. This stimulates those cells that can counteract the specific immune activities during a progressive MS phase. In animal experiments, this enabled the symptoms to be reduced after the onset of progression. The study is in a very early phase and further investigations into the potential of this therapy must be awaited.7

Early therapy delays disability progression - can it also prevent it?

The latest research gives hope. The long-term evaluation of more than 500 patient data from an MS center in San Francisco (USA) shows that early therapy with medication can curb disease activity: After 17 years of illness, only every tenth patient who uses basic therapy today needs one Walking aid, before the introduction of basic therapies, it was every second. And: In the meantime, more effective medication is available to patients who repeatedly have relapses despite basic therapy - this development is likely to have advanced even further in ten to twenty years. Research is continuing to open up therapy options that may slow the progression of disability even further in the years to come.8 The researchers were surprised to find that only 18.1 percent of the patients who initially suffered from relapsing MS switched to a progressive (chronically progressive) course of the disease. Previous experience shows that without drug treatment, at least twice as many (36 to 50 percent) would develop a progressive form of the disease.9

This means: early therapy with the drugs available today not only affects the current disease situation and reduces, for example, the frequency, duration and severity of the attack, but can also influence the course of the disease.

There is constant further research with the aim of enabling MS patients to live as free as possible from restrictions such as wheelchairs and co.

Technical support: Dr. med. univ. Philipp Bloching

Jan. 09, 2017