Neurology Specialist Prof. Dr. Ayşe Sağduyu Kocaman explained 30 well-known mistakes about MS disease and made important warnings and suggestions as part of the World MS Day on May 10th.
The epidemic disease of the century, the Covid-19 pandemic, has been adversely affecting MS patients, which have become increasingly widespread both in the world and in our country in recent years. Acıbadem Maslak Hospital Neurology Specialist Prof. Dr. Ayşe Sağduyu Kocaman, stating that there are approximately 3 million MS patients in the world and 50 thousand in our country, said, “MS (Multiple Sclerosis) is a chronic disease caused by a disorder in the immune system that occurs with the effect of environmental factors on the basis of genetic predisposition and shows its effect in the central nervous system. The Covid-19 pandemic, which has been deeply affecting the whole world for about one and a half years, causes delays in the diagnosis of MS patients who experience their first clinical findings, and many wrong ideas in the society, such as the need for MS patients to stop MS drugs during the pandemic, can cause disruptions in treatment.
MS patients have a very high risk of getting Covid-19! False!
It is not true that MS is a disease that occurs as a result of insufficient functioning of the immune system, and therefore MS patients have a very high risk of contracting Covid-19, on the contrary, MS occurs as a result of excessive and irregular functioning of the immune system. The immune system, whose normal function is to protect our body against external pests, damages the nerve fibers we call 'axons' in the brain and spinal cord, which are defined as the central nervous system for various reasons, and the sheath called 'myelin' surrounding them. As a result of damage to the axon and myelin, nerve conduction slows down, zaman zamThe moment can stop completely, so that the stimuli transmitted by the nerves cannot be perceived in the tissues where these stimuli will turn into activity and cause neurological dysfunctions. For this reason, to treat MS, we first give immunomodulatory treatments, if we do not get the response we want from these treatments, we can switch to immunosuppressive treatments. The risk of catching Covid-19 in individuals with MS is not different from the society as long as they pay attention to the mask, hygiene and distance rules, only on the days when they take high-dose cortisone due to the attack and in the treatment areas that suppress the immune system, these rules should be paid more attention.
It is harmful for people with MS to get Covid-19 vaccine! False!
We recommend the Covid vaccine to all MS patients. Live virus vaccination in MS can trigger attacks, but the Covid vaccines in our country are not live virus vaccines. Therefore, whatever vaccine they access, they must be vaccinated. Covid vaccines have not yet reported any adverse effects on individuals with MS, but for the vaccine to be effective, application zamthe moment matters; Vaccination is appropriate in individuals receiving immunosuppressive therapies. zamIt may not be effective if not done immediately. Therefore, our patients zamIt is useful to consult their doctor about vaccination with understanding.
MS patients should stop taking MS medications during the pandemic! False!
Continuous treatment of MS, especially in the early stages of the disease, is very important in terms of preventing disability that may occur in the future. During the pandemic, drug reports were extended so that the treatment could be continued without interruption, and our patients took their medications without any problems, only the application intervals of some treatments that were administered through the vascular access in the hospital and suppress the immune system were opened, and the patients were tried not to be adversely affected by the pandemic. We observed that our patients who regularly use MS medications do not experience any special problems due to their illnesses or medications, as long as they do not have obesity, diabetes, hypertension and other similar chronic diseases, even if they get Covid-19.
It is not possible to diagnose MS at an early stage! False!
MS can begin with signs and symptoms that vary from person to person. Since these symptoms can usually resolve spontaneously in the early stages of the disease, it may be delayed for patients to consult a physician and get a diagnosis, whereas early diagnosis and appropriate treatment may be delayed as soon as possible. zamIt prevents the attack on the central nervous system and causes the protection of nerve cells and conduction extensions. This means clinically preventing disability. The classic symptoms of MS include decreased vision, loss of vision, double vision, instability, weakness in an arm or leg or both legs, numbness, and changes in sensation in the trunk. Individuals experiencing any of these symptoms as soon as possible zamThe diagnosis process begins with the application to a neurologist at the same time. A neurologist experienced in MS can make a clinical diagnosis of MS with a detailed history and examination. Another important rule in confirming the diagnosis is the exclusion of other diseases that can be confused with MS. Therefore, it is very important to evaluate the brain and spinal cord with Magnetic Resonance (MR) imaging. In some cases, examination of the cerebrospinal fluid (CSF), electrophysiological tests and blood tests may also be required for a definitive diagnosis.
There is no cure for MS! False!
Neurology Specialist Prof. Dr. Ayşe Sağduyu Kocaman “MS has become a curable disease today, but it should be kept in mind that it is a chronic disease and therefore the treatment will be long-lasting. The aim of MS treatment is to control the disease activity as early as possible, to prevent attacks and to prevent disability. A very important progress has been made in this regard in the past 15 years. We have the chance to diagnose the patient who presented to us with his first attack and to treat the attack with cortisone treatment, and then give anti-attack treatment. Therapies that change the course of MS have the greatest effect mainly in MS patients with an aggressive course and in the early stages of the disease. Therefore, patients' compliance with the treatment is very important. For each patient, we start the treatment that should be used in the long-term by making a patient-specific decision and we receive close monitoring of our patients. The first 10 years after the diagnosis is very important, it is usually clear how the disease will progress in this period. Of course, depending on environmental factors, there is a possibility of changes in the course of the disease in the second or even the third 10 years, but with close physician follow-up, we can evaluate the disease activity and make drug changes when necessary, ”he said.
It is inconvenient for women with MS to get pregnant! False!
MS, which is seen 2,5 times more frequently in women than in men, occurs especially in young adulthood between the ages of 20-40, that is, in the childbearing age. MS certainly does not prevent conception and childbirth. With appropriate treatments that control disease activity, appropriate zamBy understanding, our patients can of course give birth and breastfeed. The increase in our treatment options in recent years has made us physicians as comfortable as our patients. By planning the appropriate treatment before pregnancy, it is possible to interrupt the immunomodulating treatments during pregnancy and to continue with the same or other treatments after the breastfeeding period is over with the appropriate treatments according to the disease activity after the birth. The important thing is that our patients plan their pregnancy together with their physicians after their disease activities have subsided.
MS patients should not go out in the sun! False!
Neurology Specialist Prof. Dr. Ayşe Sağduyu Kocaman “I can say that this is the wrong belief I hear most often. Studies have revealed the importance of vitamin D deficiency as well as genetic characteristics in the formation process of the disease. In our age, especially the living conditions in big cities cause people to see less of the sun and therefore vitamin D deficiencies that we frequently encounter. The healthiest source of vitamin D is the sun. The sun does not adversely affect MS patients. In the summer, when the sun rays are steep, taking 20-30 minutes of sunlight without applying sunscreen on the arms and legs is a situation we recommend in terms of filling the vitamin D stores. Of course, those with skin cancer in their family should be more careful in this regard. "People with MS may feel more tired as nerve conduction slows down in hot environments, but this is a temporary situation and has no negative effect on the course of the disease," he says.
MS patients should avoid exercise, shouldn't get too tired! False!
People with MS may feel more tired than anyone else, but the only way to cope with this fatigue is to exercise and be active as much as possible. Inactivity affects people with MS more than anyone else. In particular, we recommend our patients with walking difficulties to stay still, walk and exercise regularly. An increase in pre-existing disability findings is inevitable in our patients who are immobile. For this reason, it is very important for individuals with MS to use the medications recommended by their physicians to prevent disability, as well as to exercise regularly, eat healthy, not gain weight and not smoke.
Every patient with MS becomes addicted to the wheelchair one day! False!
MS progresses with attacks and improvements in 85 percent of patients. In 15 percent of the cases, we see the primary progressive form of the disease, which manifests itself with gradually increasing gait and balance impairment without an attack. There have been really rapid advances in the diagnosis and treatment of MS in recent years. We can diagnose patients who consult a doctor when their complaint first appears, at the very beginning of the disease. We can control the inflammation that causes myelin destruction and axon damage in the early period in MS patients with an attack, thus there has been a serious decrease in the rate of disability compared to the past, and our wheelchair-dependent patients are really very few in our polyclinics. We see that disability can be prevented in patients whose treatment process is well managed. Unfortunately, our treatment options are still limited in progressive MS, which is a small proportion of all MS individuals. While there is a chance for new treatment options in patients who have entered the progressive phase in which clinical or radiological activity continues, we are not yet at the point where we want to be in patients with a progressive course from the beginning and without clinical or radiological activity, but many studies are continuing in this area.
MS treatment lasts a lifetime, it is not possible to interrupt the treatment! False!
MS occurs in 85% of patients in young adulthood, between the ages of 20 and 40. These are the ages when immune responses are highest. As people age, the activity of the disease slows down or may even disappear. Generally, after the age of 50-55, we stop the treatment and follow up in patients who do not show any signs of disease activity for a long time, in other words, in patients who have stabilized. Sometimes the disease can reactivate, it zamIt may be necessary to start the medication again. In a group of patients, disease activity may disappear completely and a secondary progressive process may begin. In these patients, we need to go to a drug change. When we observe that the drug no longer provides any benefit in patients whose treatment window is closed, we terminate the drugs that are effective on the immune system.