The Multiple Sclerosis Companion : Answers to the Most Frequently Asked Questions From People with MS

The book provides competent assistance to all those affected by Multiple Sclerosis to better understand the disease and educates them about current diagnostic methods and treatment approaches. With independent information, the guidebook provides the key to a self-determined life with the disease. Complex medical facts such as the malfunctioning immune system or MRI findings are explained in understandable words and accompanying drawings. This companion also raises awareness beyond conventional medicine to take into account important influencing environmental factors.The author provides answers to the many questions that are asked again and again in the doctors'practices and cannot always be answered to this extent and with this clarity due to time restrictions. For this reason, it is a highly helpful tool to both MS practitioner and patient.The book is structured as follows:What is MS? - How the central nervous system is structured - What happens when the nervoussystem is misdirected - MS relapse and typical symptoms - The path to diagnosis - An excursion into our immune system - The MRI findings - Why lumbar puncture - What to do during an MS relapse - I'm fine, why therapy? - MS and the desire to have children - What can I do myself: Nutrition, Vitamin D, intestine and microbiome. Preface Acknowledgements Contents About the Author Part I: MS: Understanding the Disease 1: What Is MS? A First Overview 1.1 Jennifer’s Story 1.2 First Things First: A Few Facts and Figures About MS 1.3 How the Central Nervous System Is Structured: Anatomy 1.3.1 The Central Nervous System: Brain and Spinal Cord 1.3.2 Corpus Callosum and Spinal Cord 1.4 Immune System and its Influence on the Central Nervous System: The Consequences 1.4.1 When the Body Attacks Itself: Autoimmune Disease 1.4.2 Nerve Cell: Dendrites, Axon and its Sheath, the Myelin 1.4.3 Short Circuit in the Nervous System and Its Consequences 1.4.4 Iceberg Model: Disease Activity and Inflammatory Activity 1.5 How Multiple Sclerosis Manifests Itself: MS Relapse and Typical Symptoms 1.5.1 “Typical” MS Symptoms 1.5.2 MS Can Be Overlooked at First 1.6 How the Disease Can Run Its Course 2: Do I Really Have MS? 2.1 The Path to Diagnosis 2.1.1 Important Diagnostic Criteria: Spatial and Dissemination in Time 2.2 What Tests Are Used to Detect MS: Methods 2.2.1 Questions About Questions: What the Anamnesis Can Do 2.2.2 When Your Doctor Swings the Hammer: The Neurological Examination 2.2.3 Measuring the “Cable Run” Electrically: The “EPs” 2.2.4 For the Earliest Possible Detection: The MRI 2.2.5 More Than Just Water: CSF Examination and Oligoclonal Bands 2.2.6 CIS: The Clinically Isolated Syndrome 2.2.7 Changed Diagnostic Criteria Since 2017 3: A Trip into Our Immune System 3.1 The Players in Our Immune System: Lymphocytes, Antibodies and Others. 3.1.1 The Stem Cell in the Bone Marrow: The “Mother” of the Immune System 3.1.2 The Lymphoid and the Myeloid Progenitor Cell 3.1.3 The White Blood Cells: “The Police” in the Blood 3.1.4 The Innate Immune System: Granulocytes, Monocytes and Macrophages 3.1.5 The Acquired Immune System: T and B Lymphocytes 3.1.6 Friend or Foe: The Maturation Process of T Lymphocytes and Immunological Imprinting 3.1.7 The B Lymphocytes and the Perfect Defence 3.1.8 The Phagocytes: “Big Eaters” 3.1.9 T Lymphocyte Activation: Here We Go! 3.1.10 The Counterparts: The Regulatory T Lymphocytes 3.1.11 B Lymphocyte Activation, Plasma Cells and Custom-Made Antibodies 3.1.12 Reminder: The Memory Cell 3.2 The Inflammatory Attack Against the Nervous System 3.2.1 Activated T Lymphocytes Invade the Brain 3.2.2 T Lymphocytes in Imbalance: The T-Regulatory Cells Are Weakening 3.2.3 The Attack Against the Myelin: Common Cause with the B Lymphocytes 3.2.4 B-Cell Nests: A New Discovery 4: Why MRI? 4.1 My MRI Report: Not a Closed Book! 4.2 Anatomical Terms You Should Know 4.2.1 The Brain in Slices: The Axial Sectional Plane in MRI 4.2.2 Cortex, White Matter and Ventricles: Where Do I Find What? 4.2.3 The Brain in Longitudinal Section: The Corpus Callosum and the Roof of the Cerebellum in Focus 4.2.4 All Good Things Come in Threes: The Coronal Plane 4.3 Where MS Sits in the Body 4.4 How the MRI Works 4.4.1 Magnetic Field and Hydrogen Atoms 4.4.2 High-Frequency Pulse (HF Pulse) and Hydrogen Atoms 4.4.3 The Image Contrast: How the Different Images Are Created 4.5 How to Read the MRI: The Image Contrasts 4.5.1 The Image Contrast T1 and T2 4.5.2 T1-Weighted Images: MS Lesions Can Hide 4.5.3 T2-Weighted Images: Here You Can See More 4.5.4 The T2 Special Forms: T2-FLAIR, PD and DIR Sequence 4.5.5 T2-PD: Proton Weighted 4.5.6 T2-FLAIR: For a Good Overview 4.5.7 The DIR Sequence: Shows Lesions in the Cerebral Cortex 4.5.8 In a Nutshell 4.6 Why the Contrast Medium Is Important 4.6.1 The MRI Procedure 4.6.2 T1-Weighted Images: Fresh Acute MS Lesions Particularly Visible 4.6.3 Age Determination of MS Lesions Possible Thanks to Contrast Agent 4.6.4 Early Diagnosis Thanks to Contrast Agent 4.7 “Black Holes”, “Footprints”, Brain Atrophy: And What They Mean 4.7.1 The Healing Process After Acute Inflammation: Black Holes and Footprints 4.7.2 When the Brain Changes: Brain Atrophy 4.8 When an MRI Is Necessary: The “MRI for Diagnosis” and the “Follow-Up MRI” 4.8.1 The MRI for Diagnosis 4.8.2 The MRI for Follow-Up 4.9 Typical MRI Images in MS 4.9.1 Corpus Callosum Lesions 4.9.2 Brainstem Lesions 4.9.3 Cock’s Comb-Like White Matter Lesions, Also Called “Dawson Fingers” 4.9.4 Black Holes 4.9.5 New Contrast-Absorbing Lesions (Fig. 4.26) 4.9.6 Lesion in the Cervical Spinal Cord (Fig. 4.27) 4.9.7 Brain Atrophy (Fig. 4.28) 4.9.8 The MRI Report: Not a Closed Book! 5: The Most Important Things About the Cerebrospinal Fluid 5.1 Basics of the Cerebrospinal Fluid 5.1.1 Cerebrospinal Fluid: What It Is and Where It Comes From 5.1.2 Blood and Cerebrospinal Fluid: Two Separate Areas 5.2 How a Lumbar Puncture Works 5.2.1 Practical Procedure 5.2.2 After That ... 5.3 What the Lumbar Puncture Tells Us: The Evaluation 5.3.1 The CSF Examination: Cell Count, Total Protein, Sugar and Lactate 5.3.2 Blood–Brain Barrier Function: Albumin Shows What Is Going On 5.3.3 The Albumin Quotient 5.3.4 Antibodies Made in the CNS Itself: The IgG Quotient 5.3.5 The Reiber Diagram 5.3.6 Deviations Upwards on the Vertical: Too Much IgG in the CSF 5.3.7 Deviations to the Right on the Horizontal Axis: Too Much Albumin in the CSF 5.3.8 And Now a Few Examples: The Normal Finding 5.3.9 MS-Typical Findings: Intrathecal IgG Production 5.3.10 Another MS-Typical Constellation 5.3.11 Isoelectric Focusing and Oligoclonal Bands (OCBs) Part II: MS: Understanding the Therapy 6: How MS Is Treated 7: What To Do in an Acute MS Attack 7.1 Cortisone Pulse Therapy: How Is It Done? 7.2 Plasma Exchange Treatment: Plasmapheresis and Immunoadsorption 8: I’m Fine: Why Therapy? 9: MS Therapy Yesterday and Today 9.1 Development of the MS Therapy Landscape 9.2 Interferons and Glatiramer Acetate 9.3 Natalizumab and Fingolimod for Escalation 9.4 Alternative in Tablet Form: Teriflunomide and Dimethyl Fumarate 9.5 Long-Acting Interferon: PEG Interferon 9.6 Antibody Therapies: Alemtuzumab and Ocrelizumab 9.7 Cladribine: Oral Pulse Therapy 9.8 Siponimod Approved for SPMS 9.9 Ozanimod and Ponesimod 9.10 Ofatumumab 9.11 Natalizumab 9.12 Diroximel Fumarate 9.13 Therapy Goal Today: Individual Therapy—Something for Everyone 9.13.1 Therapy Concept: Basic and Escalation Therapy 9.13.2 New Therapy Concept: Therapy Decisions Based on Prognosis 9.13.3 Prognosis Assessment: There Are Risk Factors 9.13.4 Individual Therapy Decision 9.13.5 “Hit Hard and Early” and “Treat to Target” 9.13.6 Individual Therapy: Take Life Situation into Account 10: How the Progression of the Disease Can Be Influenced: The MS Drugs in Detail 10.1 The Approved Drugs in Detail 10.2 How What Works 10.2.1 Interferons and Glatiramer Acetate 10.2.2 Natalizumab 10.2.3 Fingolimod 10.2.4 Teriflunomide 10.2.5 Dimethyl Fumarate 10.2.6 Alemtuzumab 10.2.7 Cladribine 10.2.8 Ocrelizumab 10.2.9 Siponimod 10.2.10 Ozanimod 10.2.11 Ofatumumab 10.2.12 Natalizumab Subcutaneous (s.c.) 10.2.13 Ponesimod 10.2.14 Diroximel Fumarate 10.3 No Effect Without Side Effect 10.4 JCV and PML: What Is It? 10.5 Regulatory Studies, Expert Information and “Real-World Data” 11: The Therapy Goal Has a Name: NEDA 11.1 Paraclinical Course Parameters: MRI 11.2 Dreams of the Future: Neurofilaments 11.3 Clinical Course Parameters: Relapse Rate and Disability Progression 11.4 The EDSS Score Shows Disability Progression 11.5 The Hidden Symptoms: Fatigue and Cognition 11.6 In a Nutshell 12: MS and Vaccinations 12.1 Active and Passive Vaccination 12.2 Why Is the Vaccination Issue So Important in MS Now? 12.3 Distance Good: All Good 13: MS and the Desire to Have Children 13.1 The Importance of Pregnancy Registers and MS 13.2 MS Is Not a Hereditary Disease Part III: MS: And What You Can Do Yourself 14: Self-Initiative Helps 14.1 From Self-Experimentation to Case Reports 14.2 The Intestine in the Focus of Research 15: Forest Fire MS 15.1 The MS Numbers Are Increasing 15.2 Not Victims of Our Genes: Environmental Factors in Our Sights 16: Western Diet and Blue Zones 16.1 Our Diet Has Changed: “Western Diet” 16.2 Ready-Made Products: Chemistry Replaces Nature 16.3 Create Awareness 16.4 “Blue Zones”: Healthy Ageing 17: Nutrition Works 17.1 Dietary Fibre and Secondary Plant Compounds 17.2 Effects of the Plant-Based Diet 17.3 The “China Study” 17.4 China’s Shift to the “Western Diet” and Its Consequences 17.5 What Can a Plant-Based Mediterranean Diet Do? 18: The Intestine and Its Inhabitants 18.1 What Does the Gastrointestinal Tract Look Like? 18.2 Three Layers: Mucosa, Connective Tissue and Musculature 18.3 The Intestine Has Its Own Nervous System: The “Enteric Nervous System” 18.4 The Intestine and Its Own Immune System: The “GALT” 18.5 The Intestine Has Immense Possibilities for Interaction 19: Microbiota and Microbiome 19.1 Bacteria in the Majority 19.2 Our Intestine: A Giant “Bioreactor” 20: How the Microbiome Develops 20.1 A Healthy Intestine = Eubiosis, a Diseased Intestine = Dysbiosis 21: How Bacteria Can Be Identified 21.1 Microbiome Analysis by “Next-Generation Sequencing” (NGS) 21.2 Species Richness of the Microbiota 22: The Stool Transplant 22.1 FMT and Practical Implementation 22.2 FMT and Consequences 23: The Bowel and MS: What Does Scientific Research Say? 23.1 Animal MS Studies on Mice: “EAE” 23.2 Does MS Start in the Gut? 23.3 Gut Bacteria and MS 23.4 The Metabolic Products of the Bacteria and MS 23.5 High-Fibre Diet: Energy Source for the Intestinal Cells 23.6 Short-Chain Fatty Acids and Immune System 23.7 Nutrition and Microbiota 23.8 Back to the Western Diet 23.9 Many Studies, Many Pieces of the Puzzle 23.10 Just Give It a Try 23.11 Propionate: As a Food Supplement 24: Vitamin D: Sense and Nonsense 24.1 What Vitamin D Can Do 24.2 Where Vitamin D Comes from 24.3 In-House Production 24.4 Own Production Has a Hard Time in the Northern Climes 24.5 Let Us Start with the Sun 24.6 From the Sun to Vitamin D Administration (Vitamin D Substitution) 24.7 About Calcidiol Units and Standard Values 24.8 Which Vitamin D? 24.9 How Much Vitamin D3 for Which Target Value? 24.10 Effects of Vitamin D on the Immune System 24.11 Effect of the Sun 24.12 Current Vitamin D Study 25: Action Plan and Recipes to Follow 25.1 Plant-Based Does Not Mean: No More Meat! 25.2 Our Attitude Is Crucial 25.3 High-Fibre Plant-Based with Good Oils Is Key! 25.4 What You Should Eat 25.5 What You Should Avoid 25.6 No “Rush Jobs” 25.7 What If ... 25.8 Is There Anything Missing for the Start? 25.9 Recipes to Try Out: The Small “Starter Set” 26: The Most Important Recommendations Summarised 26.1 Nutritional Optimisation 26.2 Sun and Vitamin D3 26.3 Movement and Relaxation 26.4 In Conclusion Glossary Bibliography Index