Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a chronic disease of the central nervous system (the brain and spinal cord). It occurs when the immune system mistakenly attacks myelin, a substance that surrounds and protects nerve fibres. This damage disrupts the transmission of nerve signals, causing various neurological symptoms. MS is described as an “autoimmune disease” because it results from an inappropriate immune response against the body’s own tissues.

Common symptoms

The symptoms of Multiple Sclerosis (MS) vary depending on the areas of the nervous system affected. They may include:

• Severe fatigue: often disproportionate to the level of activity.
• Visual disturbances: blurred or double vision, or partial loss of vision.
• Numbness or tingling: particularly in the limbs.
• Motor difficulties: muscle weakness, coordination or balance problems.
• Cognitive problems: memory or concentration difficulties.
• Pain: particularly neuropathic pain (burning sensations, electric shocks).
• Spasticity: involuntary muscle stiffness.
• Urinary problems: frequent or urgent need to urinate, or difficulty emptying the bladder.
• Bowel dysfunction
• Sexual dysfunction

These symptoms may occur in relapses (periods of worsening) followed by remissions (partial or complete improvements), or may progress slowly over time.

Prevalence in Belgium

In Belgium, it is estimated that approximately 15,000 people live with MS, corresponding to a prevalence of 127 cases per 100,000 inhabitants. The disease mainly affects young adults, with an average age at diagnosis of between 20 and 40 years, and predominantly affects women (approximately 73% of cases). 

Diseases associated with anti-MOG antibodies (Myelin Oligodendrocyte Glycoprotein) are a rare condition closely related to multiple sclerosis (MS) that also affects the myelin. In this disease, the immune system produces antibodies against a protein called MOG, which is present in myelin. This can cause symptoms similar to those of MS, but the mechanism is different, and the treatment must be different as well.

Neuromyelitis optica (or NMO) is a rare inflammatory disease of the nervous system in which the immune system primarily attacks the nerves of the eyes (optic nerves) and the spinal cord. This can lead to vision loss, eye pain, limb weakness or sensory disturbances. Early diagnosis and appropriate management can often help limit relapses and their after-effects.

Medical management of Multiple Sclerosis

Diagnosis

The diagnosis of MS is based on a set of examinations:

• Assessment of symptoms and clinical examination
• Blood tests: used to distinguish MS from other diseases that may “mimic” it
• Magnetic resonance imaging (MRI) : used to visualise lesions (or “plaques”) in the brain and spinal cord.
• Lumbar puncture: analysis of the cerebrospinal fluid (CSF) to detect signs of inflammation.
• Ophthalmological examination: used to detect damage to the optic nerve or paresis of the cranial nerves, which may manifest as double vision.  
• Evoked potentials : tests measuring the conduction speed of the nerve signals involved in strength and sensation in the arms and legs (motor and somatosensory evoked potentials), vision (visual evoked potentials), and hearing (auditory and brainstem evoked potentials).
   

Treatments

There is currently no cure for multiple sclerosis, but several treatments can slow the progression of the disease, reduce the frequency of relapses (episodes of symptoms), and relieve symptoms in daily life. 

These treatments fall into three main categories:

1. Treatment of relapses
   When a relapse occurs (sudden onset or worsening of symptoms), the doctor may prescribe:
   •    Corticosteroids (powerful anti-inflammatory medicines), administered by infusion or sometimes as tablets.
   Their role is to rapidly reduce inflammation in the nervous system and accelerate recovery.
    
2. Disease-modifying treatments
   These treatments are taken over the long term, even between relapses. Their aims are to:
   •    Reduce the number of relapses,
   •    Limit the progression of disability,
   •    Slow the progression of lesions in the brain and spinal cord (visible on MRI).
   There are several types of disease-modifying medicines, administered as tablets, injections or infusions. The choice depends on the type of MS, the level of disease activity, possible side effects and the patient’s lifestyle.
   
    
3. Symptomatic treatments
   MS can cause various symptoms over time, which can be relieved with appropriate treatments:
   •    Fatigue: management through rehabilitation, lifestyle and activity pacing, and sometimes medicines.
   •    Spasticity (muscle stiffness): management through rehabilitation and medicines such as baclofen or Sativex® (oral spray).
   •    Neuropathic pain: specific medicines (antiepileptic medicines or antidepressants used for pain relief).
   •    Urinary, sexual or digestive problems: depending on the case, medicinal or rehabilitation options are available.
   •    Anxiety and depressive disorders: psychological support and appropriate treatments.
   •    Cognitive disorders: neuropsychological support and, sometimes, cognitive rehabilitation.
   Regular physical activity is particularly important. If necessary, the patient may benefit from physiotherapy support.
   These treatments help improve quality of life on a daily basis, even when the disease is present.

MS is a complex disease that can affect several aspects of health. This is why its management requires a multidisciplinary team tailored to each patient, including:

• Neurologists: coordinate treatment and monitor the progression of the disease.
• Specialist nurses: provide therapeutic education and day-to-day support.
• Physiotherapists and occupational therapists: help maintain mobility and prevent complications.
• Psychologists: support patients in managing the emotional impact of the disease.
• Neuropsychologists: assess cognitive abilities (memory, attention, language and executive functions), adapt follow-up and provide daily-life advice (work, studies and personal-life organisation), and sometimes implement cognitive rehabilitation.
• Social workers: assess the need for assistance at home.

In addition to these healthcare professionals, other specialists may be involved:

• Infectious disease specialists: Before initiating a disease-modifying treatment, the infectious disease specialist ensures that there is no active infection and that vaccinations are up to date.
• Ophthalmologists: MS can cause visual disorders such as a sudden decrease in vision in one or both eyes (optic neuritis) or double vision (diplopia). The ophthalmologist can detect these disorders using examinations such as a fundus examination, visual-field testing or optical coherence tomography (OCT), and can therefore offer appropriate care.
• Urologists. Approximately 70 to 80% of people with MS experience urinary problems at some point: an urgent or frequent need to urinate, difficulty completely emptying the bladder, or recurrent urinary tract infections. The urologist assesses bladder function, often using an examination called a urodynamic assessment, adapts treatments (medication, catheterisation techniques and nerve stimulation), and offers care that respects the patient’s quality of life.
• Gynaecologists. In women with MS, certain gynaecological issues require particular attention: the impact of MS or its treatments on the menstrual cycle, contraception suited to certain treatments, pregnancy (MS does not prevent women from having a child, but requires specific monitoring before, during and after pregnancy), and sexual disorders related to the disease. In liaison with the neurologist, the gynaecologist helps ensure comprehensive follow-up of women’s health.
• Dermatologists: The dermatologist checks for any possible skin-related side effects associated with certain disease-modifying treatments.
• Neurorehabilitation specialists: This team participates in the rehabilitation and functional readaptation of patients experiencing problems with motor function, manual dexterity, coordination, balance or walking.
• The Pain Clinic: The team assesses and treats pain with the support of a multidisciplinary team.
• Neuroradiologists: The radiologist plays an essential role in the initial diagnosis of MS and in monitoring disease progression. Using MRI (magnetic resonance imaging), the radiologist identifies “plaques” (inflammatory lesions in the brain and spinal cord), which are characteristic of MS.

The H.U.B MS Clinic offers integrated, personalised and innovative multidisciplinary care for all patients diagnosed with MS.

For patients under 18, specific paediatric care is provided. This care takes into account the specific features of the condition, particularly from a clinical perspective, as well as its therapeutic aspects and follow-up. It also addresses the specific needs of a developing child, with particular attention to schooling, sports and extracurricular activities, as well as emotional and psychological aspects. This essential care helps to better respect the child’s pace, maturity in relation to treatment, and the expectations of children and their families. Find out more.

For patients over 18 years of age

‘MS Expert’ neurologists

• Dr Sophie ELANDS (FR, NL, EN)
• Dr Serena BORRELLI (FR, EN, IT)

Rehabilitation

• Dr Pierre CABARAUX
• Dr Johanne GARBUSINSKI

Paramedical team

Ms Francesca LOSURDO – Physiotherapist
Ms Elsa DI FONTE – Physiotherapist
Mr Corentin LOISON – Physiotherapist
Ms Fabienne DEVEYLDER – Research coordinator
Ms Christiane KITOKO – Research coordinator
Ms Sarah EL HAJJ – Research coordinator

For patients under 18

• Dr Audrey Van Hecke – Paediatric neurologist HUDERF (coordinating physician)
• Baijot Simon – Neuropsychologist
• Dr Lhoir – Ophthalmologist
• Dr Slegers – Cardiologist
• Dr El Nemnom – Dermatologist
• Dr Preziosi – Radiologist
• Dr Lombardo – Physical medicine
• Ms El Khaldi – Reference nurse for hospitalisation