The Demyelinating diseases Are a broad group of medical pathologies characterized by an involvement of the myelin that covers the nerve cells (Bermejo Velasco et al., 2011).
There is a wide variety of medical alterations that can occur with myelin involvement, including Multiple sclerosis Is the most frequent and known, however, there are also others that are common or frequent in the population General: disseminated acute encephalomyelitis, Baló conc. Sclerosis, optic neuromyelitis, persistent transverse myelitis, etc. (Bermejo Velasco et al., 2011).
What is a demyelinating disease?
A Demyelinating disease Is any condition that results in damage or injury to the protective cover or sheath of Myelin that turns nerve fibers in the brain and spinal cord (Mayo Clinic, 2014).
When the covering of the nerve cells is damaged, the nerve impulses begin to circulate in a slow way, even stopping and Resulting in a wide variety of Neurological signs and symptoms (Mayo Clinic, 2014).
What is myelin?
Nerve cells send and receive messages constantly from different body areas to the brain centers responsible for the Processing and processing responses (HealthLine, 2016).
In much of the nerve cells, different areas are covered with myelin (HealthLine, 2016).
The Myelin Is a membrane or protective layer containing large amounts of lipids and its essential function is to isolate the axons of the Nerve cells from the extracellular environment (Clark et al., 2010).
This sheath or sheath allows impulses and nerve signals to be transmitted rapidly between different cells (National Institutes of Health, 2016).
There are several diseases that can damage the myelin. Demyelinating processes can slow down the flow of information and cause damage Structures in Axons of Nerve Cells (HealthLine, 2016).
Depending on the area where myelin involvement and axonal damage occur, the different demyelinating alterations may cause problems such as Sensory deficits, motor, cognitive, etc. . (HealthLine, 2016).
What is the difference between a demyelinating disease and a dysmyelinating disease ?
The diseases Des Myelinating conditions are those conditions in which there is a pathological medical process that is affecting myelin
(Bermejo Velasco et al., 2011).
On the other hand, diseases Dis Myelinating Leukodystrophies Are those conditions in which there is a
Inadequate or abnormal formation of myelin (Bermejo Velasco et al., 2011).
What are the most common demyelinating diseases?
The most frequent demyelinating disease is multiple sclerosis , However there are others such as Encephalomyelitis , the Optic neuromyelitis , Optic neuropathy wave transverse myelitis Which also have representation Clinic in the general population.
1. Multiple sclerosis
The Multiple sclerosis (MS) is a chronic, inflammatory and demyelinating disease affecting the central nervous system (CNS) (Neurodidacta, 2016)
Specifically, in multiple sclerosis there is a progressive deterioration of the myelin cover of the nerve cells of different areas (National Multiple Sclerosis Society, 2016).
How often is it given?
This is one of the Neurological diseases More frequent among the young adult population that is between the ages of 20 and 30 years (Multiple Sclerosis Spain, 2016).
It is estimated that approximately 2,500,000 people suffer from multiple sclerosis worldwide, while the estimated number for Europe is 600,000 Cases and for Spain of 47,000 cases (Multiple Sclerosis Spain, 2016).
What are the Signs and Symptoms of Multiple Sclerosis?
The signs and symptoms of multiple sclerosis are widely heterogeneous between the different cases and vary fundamentally depending on the areas And severity (Mayo Clinic, 2015).
The most characteristic physical symptoms of MS include ataxia , Spasticity, pain, fatigue, fatigue, optic neuritis, hemiparesis, etc. (Junqué and Barroso, 2001).
In addition, among the varied physical involvement of MS, we can also observe different cognitive alterations: deficit in attention, memory, function Execution, reduction of processing speed, etc. (Chiaravalloti and DeLuca, 2008).
What is the cause of multiple sclerosis?
As we have pointed out above, multiple sclerosis is classified within the group of inflammatory and demyelinating diseases.
The specific causes of multiple sclerosis are not known with exactness, however it is thought that it can have an autoimmune origin, that is to say, that is The patient's own immune system that attacks the myelin covers of nerve cells (Neurodidacta, 2016)
Despite this, the most accepted hypothesis is that multiple sclerosis is the result of different variables such as genetic predisposition and factors The same person, would give rise to a wide spectrum of alterations in the immune response, which in turn would be the cause of the Inflammation present in MS lesions (Fernández, 2000).
How is multiple sclerosis diagnosed?
The diagnosis of multiple sclerosis is made through the consideration of different clinical criteria (presence of signs and symptoms), Neurological examination and different complementary tests such as magnetic resonance imaging (Fernández, 2000; Demyelinating diseases, 2007).
Is there treatment for multiple sclerosis?
Although there is treatment for multiple sclerosis, mainly symptomatic, there is currently no cure for this pathology Demyelinating.
Therapeutic interventions are fundamentally oriented to (Mayo Clinic, 2015):
- Control relapses and outbreaks of symptoms.
- Treatment of symptoms and medical complications.
- Modify the clinical course of the disease.
2. Acute disseminated encephalitis
What is acute disseminated encephalomyelitis?
Acute disseminated encephalomyelitis (EAD) is a neurological pathology in which different inflammatory episodes at the brain and spinal cord Cause severe damage to the myelin cover of nerve fibers (National Institute of Neurological Disorders and Stroke, 2016).
Is disseminated acute encephalomyelitis a frequent pathology?
The Encephalomyelitis Acute disseminated disease is a pathology that can affect anyone, however, it is much more prevalent in the population (National Organization for Rare Disorders, 2013).
The most frequent age of presentation ranges from 5 to 8 years and equally affects both sexes (National Organization for Rare Disorders, 2013).
What are the signs and symptoms of acute disseminated encephalomyelitis?
The clinical course is rapid onset and characterized by the presentation of symptoms similar to those of encephalitis: fever, headache, fatigue, Nausea, convulsive episodes and in some cases severe coma (National Institute of Neurological Disorders and Stroke, 2016).
On the other hand, lesions in nerve tissues can also cause a wide variety of neurological symptoms: muscle weakness, paralysis, Visual deficits, etc. (National Institute of Neurological Disorders and Stroke, 2016)
What is the cause of disseminated acute encephalomyelitis?
Generally, acute disseminated encephalomyelitis is the result of an infectious process. Approximately between 50-75% of cases the disease is Preceded by a viral or bacterial infection (Cleveland Clinic, 2015).
Acute transverse encephalomyelitis usually appears about 7-14 days after an infection affecting the upper respiratory tract and courses with Cough or sore throat (Cleveland Clinic, 2015).
On other occasions, this pathology occurs after vaccination (mumps, measles or rubella) or after an autoimmune reaction, although it is less Frequent (Cleveland Clinic, 2015).
How is acute disseminated encephalomyelitis diagnosed?
The diagnosis of acute disseminated encephalomyelitis is based on the identification of the characteristic clinical symptoms, the analysis Detailed clinical history and the use of some diagnostic techniques such as magnetic resonance , Immunological exams and metabolic tests (National Organization for Rare Disorders, 2013).
Is there treatment for disseminated acute encephalomyelitis?
For the treatment of acute disseminated encephalomyelitis, anti-inflammatory drugs are usually used to reduce inflammation of the areas (National Institute of Neurological Disorders and Stroke, 2016).
Generally, those affected usually respond well to Corticosteroids Such as meltiprednisolone (National Institute of Neurological Disorders and Stroke, 2016).
3. Optic neuromyelitis
What is neuromyelitis optica?
The Optic neuromyelitis (NMO) or Devic's disease, it is a demyelinating disease affecting the central nervous system (Cleveland Clinic, 2015).
Specifically, optic neuromyelitis causes a loss of myelin in the optic nerves and spinal cord (Cleveland Clinic, 2015).
Is optic neuromyelitis a frequent pathology?
Optic neuromyelitis is a rare medical condition, its prevalence estimated to be around 1-2 cases per 100,000 inhabitants (Institut D'Investigacions Biomèdiques August Pi I Sunyer, 2016).
As for its distribution by sex and age, it is more frequent in women than in men with a ratio of 9: 1 and the age characteristic presentation round The 39 years (Institut d'Investigacions Biomèdiques August Pi I Sunyer, 2016).
What are the characteristic signs and symptoms of optic neuromyelitis?
People with optic neuromyelitis often have some or all of the following signs and symptoms: eye pain, loss of vision, Muscle weakness, numbness, paralysis in the extremities, sensory disturbances, etc. (National Institute of Neurological Disorders and Stroke, 2016).
In addition, symptoms related to muscle spasticity and loss of sphincter control may also appear (Cleveland Clinic, 2015).
What is the cause of optic neuromyelitis?
The cause of optic neuromyelitis is unknown, however, there are cases in which the clinical course arises after the suffering of some Infection or autoimmune disease (Mayo Clinic, 2015).
In many cases it is diagnosed as part of the clinical symptomatology characteristic of multiple sclerosis (MS) (Mayo Clinic, 2015).
How is neuromyelitis diagnosed?
In addition to the clinical examination, the use of magnetic resonance imaging for the detection of nerve damage or cerebrospinal fluid , Test of oligoclonal bands or blood tests (Cleveland Clinic, 2015).
Is there treatment for optic neuromyelitis?
There is no cure for optic neuromyelitis, however there are pharmacological therapies for the treatment of outbreaks or symptomatic attacks (National Institute of Neurological Disorders and Stroke, 2016).
Generally, patients are treated with immunosuppressive drugs (Institut d'Investigacions Biomèdiques Agust Pi I Sunyer, 2016). It is also possible Plasma exchange or plasma exchange in people who do not respond to usual treatment (National Institute of Neurological Disorders and Stroke, 2016).
In cases where physical disabilities are significant, the use of combined therapeutic strategies will be essential: physiotherapy, Occupational therapy , Neuropsychological rehabilitation , etc. (National Institute of Neurological Disorders and Stroke, 2016).
4. Transverse myelitis
What is transverse myelitis?
The transverse myelitis Is a pathology caused by an inflammation of different areas of the spinal cord (Johns Hopkins Medicine, 2016).
Inflammatory outbreaks or attacks can cause significant damage to the myelin of the spinal nerve fibers, injuring or even destroying it (National Institute of Neurological Disorders and Stroke, 2012).
Is transverse myelitis a frequent disease?
Transverse myelitis is a disease that can be suffered by any person in the general population; however, there is a peak prevalence among 10 and 19 years and between 30 and 39 years (National Institute of Neurological Disorders and Stroke, 2012).
Although there is little data on the prevalence and incidence rates of transverse myelitis, some studies Produces approximately 1,400 new cases in the United States (National Institute of Neurological Disorders and Stroke, 2012).
What are the signs and symptoms characteristic of transverse myelitis?
The most common symptoms of transverse myelitis include (Mayo Clinic, 2014):
- Pain : Symptoms often begin with localized pain in the neck or spine depending on the affected spinal area.
- Abnormal sensations : Many people may suffer from numbness, tingling, burning or cold sensation, tenderness of the Clothing or changes in temperature in different body areas.
- Weak extremities : It is possible that the muscular weakness begins to appear with stumbles, falls or drag of some Lower extremity. Weakness in the extremities can develop into the development of paralysis.
- Urination and bowel problems : Increased urinary need or incontinence, difficulty urinating, constipation, others.
What is the cause of transverse myelitis?
The specific causes of transverse myelitis are not yet known with exactness. Clinical reports indicate that in many cases spinal inflammation Is the product of primary infectious processes, immunological reactions, or reduced marrow blood flow (Christopher and Dana Revee Foundation, 2016).
In addition, transverse myelitis may also appear secondary to other pathological processes such as syphilis , mumps , Lyme disease wave Varicella vaccination and / or rabies (Christopher and Dana Revee Foundation, 2016).
How is transverse myelitis diagnosed?
The diagnosis of transverse myelitis is similar to that of other demyelinating diseases (National Institute of Neurological Disorders and Stroke, 2012).
In addition to clinical observation and examination of medical history, neurological examination and the use of various diagnostic tests are essential (Magnetic resonance, computed tomography, myelography, blood analysis, lumbar puncture, etc.) (National Institute of Neurological Disorders and Stroke, 2012).
Is there treatment for transverse myelitis?
The treatment of transverse myelitis is fundamentally pharmacological. Some of the more usual interventions include (Mayo Clinic, 2014; Hopkins Medicine, 2016): intravenous steroids, Plasmapheresis , Antiviral medication, etc.
On the other hand, non-pharmacological interventions include physical therapy, occupational therapy and psychotherapy (Jhons Hopkins Medicine, 2016).
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