Chronic demyelination is the slow destruction of the protective tissue that normally covers the nerves. Several conditions cause demyelination. They may be progressive in nature, with increasingly severe neurological symptoms. Others may wax and wane over time, allowing patients to recover between episodes. Treatment depends on the cause of the disease and may include medications, physical therapy, and occupational therapy to learn how to perform some tasks with decreased motor coordination and muscle strength.
A neurologist may be involved in the management of the patient and the development of a treatment plan. Neurologists who specialize in the care of such conditions may be able to offer more treatment options, including therapies available through clinical trials. Patients recently diagnosed with a chronic demyelinating disease may want to consider several consultations to find a doctor who will meet their needs.
Some examples of chronic demyelination include multiple sclerosis (MS), optic neuritis, and leukodystrophy. In all cases, the body’s deposits of myelin thin and may develop plaques, large lesions in the tissue. This interferes with nerve conduction. Nerves are not able to transmit signals as effectively, which can cause muscle weakness, tremors, and poor motor coordination. These symptoms tend to onset gradually with chronic demyelinating diseases, because the damage is incremental.
Congenital conditions can sometimes lead to chronic demyelination. In other cases, patients may acquire a condition that causes myelin damage, most commonly through episodes of inflammation. The body’s immune system may mistakenly regard proteins found in myelin sheaths as foreign, and begin attacking them. Chronic inflammation can damage the myelin, exposing the underlying nerve and creating problems for the patient.
This can be seen in multiple sclerosis, an example of chronic demyelination that comes in several forms. Some MS patients have a relapsing-remitting type, where they experience episodes of neurological problems followed by periods of regular functioning. Others have a progressive form, where their neurological problems grow worse over time because the myelin keeps eroding. Anti-inflammatory medications can help suppress the episodes and keep the myelin intact longer.
If a doctor suspects a patient has chronic demyelination on the basis of symptoms, medical imaging studies can provide more information. Sometimes biopsies and blood chemistry tests are helpful as well. On the basis of this information, the doctor can determine what is happening and may be able to identify the cause. This may assist with the development of a treatment plan, which may include anti-inflammatory drugs to keep the immune system suppressed so it cannot damage myelin as quickly or effectively.
