It always really annoys me – when even renowned magazines or television stations translate MS as muscle atrophy. Despite intense public relations work by organizations (like the AMSEL), the misconception that MS has “…something to do with muscle atrophy” persists quite stubbornly. It is not uncommon for this misconception to occur among MS patients as well, especially if they have recently fallen ill and are poorly informed about the disease.Therefore, it should be clearly stated here once again – MS is not muscle atrophy. MS is not a disease of the muscles or the musculoskeletal system. MS stands for Multiple Sclerosis – which literally translated means “multiple hardening” and describes the condition in which one finds in the brain of MS patients – as a result of chronic inflammation – a multitude of scars that have a harder consistency than the surrounding (unaffected) brain tissue. Multiple sclerosis is therefore based on a chronic inflammation of the brain and spinal cord, which we also collectively refer to as the central nervous system – abbreviated as CNS. In neurology, there is also the alternative term “Encephalomyelitis disseminata (abbreviated by doctors as E.d.)” – which translates as “scattered inflammation of the brain and spinal cord” and thus precisely describes what constitutes the disease.
The motor problems that MS patients exhibit and that lead to a limitation of mobility are often evaluated by medical laymen as a disorder of the muscles; after all, according to popular opinion, muscles are responsible for movement. But the musculature of MS patients is usually completely healthy, the problem is rather with the control of the muscles. This can be compared to a modern car (even if the comparison is somewhat flawed): Even if the engine is completely fine, one can still break down on the road if any complex electronic component is defective. The central nervous system is like a complex electronic control. If there is an inflammatory defect here, this can affect the power (motor), tension and coordination of the limbs, among other things, and thus impair mobility.
Now, it is not uncommon to see that in MS patients the muscle mass in the affected limbs is actually somewhat reduced. So one can indeed detect a slight “wasting” of the musculature. However, this is more likely due to the fact that the muscles are used less due to the dysfunction of the limb. And if you don’t use your muscles, then it happens quite quickly that the muscle mass decreases significantly. But this is not a sign that the muscle is becoming ill, it is merely becoming thinner because it has to do less. In theory, MS patients can therefore train a muscle on a paralyzed limb again if they are specifically rehabilitated.
This may also make it easier to understand why it is so important to specifically exercise and use a paralyzed limb whenever possible. Otherwise, a vicious circle is initiated: the reduced control capacity due to the inflammation in the CNS leads to a decrease in mobility, the limb is therefore moved less, muscle mass is lost and this in turn leads to a further intensification of the motor disorder, etc.
So what is “muscle atrophy”? This is ultimately an old, lay medical term for (relatively) rare diseases of the muscles or the nerve strands that supply the muscles (the so-called Peripheral Nervous System, PNS). With such diseases, there is a very rapid and very pronounced loss of muscle mass, which is much more dramatic than the slight reduction of muscle mass due to inactivity in MS patients. In very severe cases, the muscles completely disappear, leaving the patient truly only “skin and bones”. Unlike MS, physical training does little to help these diseases because the muscles or the associated nerves are sick. A disease that has become somewhat better known and leads to “muscle atrophy” is Amyotrophic Lateral Sclerosis (ALS) – the disease for which many celebrities had ice buckets dumped over their heads last year.
