Multiple Sclerosis - Causes, Symptoms and Treatment. MF.

Causes of Multiple Sclerosis
Symptoms and Signs
Diagnosis
Treatment
Complications and Prevention
Case Histories

Multiple sclerosis or, more correctly, disseminated encephalomyelitis is a chronic progressive demyelinating disease of the central nervous system. For the first time the disease was described in 1868 by the French neurologist Jean Martin Charcot. Earlier it was thought that women are more often sick, and the critical age is 20-40 years, but now the diseases of multiple sclerosis among men and people of the second half of life, people of the white race, inhabitants of the northern regions( Scandinavia, Belarus, St. Petersburg, Karelia).

Causes of Multiple Sclerosis

The main causes of the disease are viruses( measles, mumps, herpes, rabies, rubella. ..) that live for years in nerve cells, destroy the cellular structure, destroy myelin sheaths and replace them with a formed alien prion protein. Prion is manifested as an antigen and the body responds to it with autoaggression - it produces antibodies. Thus, a severe autoimmune reaction is formed.

The own immune system with multiple sclerosis gradually destroys the nervous system - a white substance, perceiving it as "alien."The macrophages and T-helpers are activated, the permeability of the hemato-encephalic barrier increases, the migration of T-lymphocytes, which synthesize anti-myelin antibodies, is formed - the focus of chronic inflammatory demyelination( destruction or sclerosis) is formed. Such lesions of sclerosis are scattered spatially in the brain and spinal cord, hence the name of the disease is multiple sclerosis. In one patient at different stages of the disease, it is possible to detect foci different in terms of formation time-acute( active process), old( inactive process), chronic with signs of activation, shade of plaques( possible remyelination).

In addition to white matter, other tissues are affected: gray matter( the body of nerve cells) and nerve fibers( inside myelin).Their defeat occurs by a different mechanism: tissues gradually fade, rapidly aging. And this process is constant, occurs not only during an exacerbation.

Risk factors for multiple sclerosis

Risk factors include white race, northern country of residence, impaired psychoemotional state, autoimmune diseases, infectious allergic diseases, vascular diseases, hereditary predisposition( insufficiency of T suppressors, change in enzyme parameters).

Symptoms of Multiple Sclerosis

The process of transmission of the nerve impulse is disrupted when the myelin sheath of the nerve is lost.
Arrays of demyelination with axial cylinder damage and the formation of pink-gray sclerotic plaques, foci of proliferation and necrosis are determined. It is the damage to the axial cylinders that ensures the irreversibility of the neurological defect. There can be demyelination anywhere, the nerve impulse is disturbed and a variety of neurological disorders occur.

With multiple sclerosis, exacerbations are followed by periods of remission. In the initial stages of remyelination, neurological symptoms may disappear or diminish, with exacerbation, that is, a new demyelination - to aggravate or to appear new depending on the functional significance of the affected part of the nervous system. The centers of demyelination are "scattered" throughout the nervous system, are of a multiple nature.

And the same many-sided symptoms of the disease. Depending on the zone of localization of the lesion, an appropriate neurological defect arises.

The range of symptoms of multiple sclerosis is wide enough: from slight numbness in the arm or staggering when walking to enuresis, paralysis, blindness and difficulty breathing. It happens that after the first exacerbation the disease does not manifest itself in the next 10 or even 20 years, a person feels completely healthy. But the disease eventually takes its toll, again there is an exacerbation.

Most common symptoms are motor disorders - paresis, paralysis, increased muscle tone, hyperkinesia, visual disturbances. Infringements can at first be transitory in nature, that is, appear and disappear.

The neurologist at the examination can detect nystagmus, double vision, increase of tendon reflexes, anisoreflexia, abdominal reflexes, abnormal signs, coordination disorders - statics and dynamics, dysfunction of the pelvic organs - delay and incontinence, violation of cranial nerves, symptoms of vegetative-vasculardystonia, mental disorders - neurosis-like symptoms, asthenia, euphoria, uncriticality, depression, sensitive disorders, decreased vibration sensitivity. And all of the above can be in any combination and as a mono symptom.

The degree of severity is isolated: a light course of multiple sclerosis - remittent( with rare exacerbations and prolonged remissions), of moderate severity - remitting progressive, heavy - progressive course( primary, secondary).The forms of multiple sclerosis depending on the prevailing symptoms - cerebral, spinal, cerebrospinal, eye, hyperkinetic, atypical.

Any disease, even SARS, hypothermia and overheating, insolation, neuro-emotional overload can provoke an exacerbation.

Symptoms of multiple sclerosis

Depending on the location of the foci of demyelination, the symptoms of multiple sclerosis are individual for each patient. Should be alarmed:

• Sensitivity disorders: tingling( "lying asleep") or numbness in the fingers, hands, legs or half of the body;disturbance of the feeling of hard ground underfoot( "I walk like a mattress", "like a cotton pad under my feet", "I often lose slippers and do not notice it").
• Movement disorders: marked tension in the legs or in the hands( due to increased muscle tone), paralysis is possible( "reduction of muscle strength in the hands and feet").
• Violation of coordination in the body, staggering when walking, awkwardness and trembling in the hands and feet( "the extremities do not obey") speaks of the defeat of the cerebellum.
• Visual impairment: decreased vision for one eye until complete blindness;black dot in the center of the field of view;sensation of a cloudy glass, shrouds before the eye. These are manifestations of retrobulbar neuritis( damage to the optic nerve on the site behind the eyeball as a result of the defeat of its myelin sheath).
• Impaired movement of the eyeballs( "objects are doubled") - nystagmus.
• Violation of urination: urinary incontinence( "I do not reach the toilet").
• Weakness of the muscles of one half of the face( "the face is twisted", "the eye does not close completely," "the mouth moves to the side");decrease in taste sensitivity( "chew the grass").They talk about the defeat of the facial nerve.
• Emotional disorders quite often develop on the background of multiple sclerosis: excessive anxiety, bad mood, depression or, conversely, underestimation of their condition, inappropriate gaiety( euphoria).
• Constant fatigue and fatigue even after mild physical and mental stress;feeling of "passing an electric current" down the spinal column when the head is tilted;exacerbation of already existing symptoms after a cup of hot tea, a bowl of soup, after taking a bath( a symptom of a "hot bath").

It is impossible to predict in advance how severe the manifestations of the disease will be in a particular patient, how often there will be exacerbations, and how long remissions will last.

Diagnosis of multiple sclerosis

Because there are no specific symptoms for multiple sclerosis, the diagnosis is only instrumental.

The diagnosis is confirmed by the detection of plaques demyelination in magnetic resonance imaging. The most reliable study on devices from 1.5 T with the introduction of contrast. The absence of plaques does not disprove the diagnosis. It requires dynamic observation at the neurologist, examinations of the oculist with examination of the fields of vision and the fundus. Leading is the clinical picture.

Magnetic resonance imaging - indicated plaques - foci of demyelination

Marburg disease - atypical malignant form of multiple sclerosis, rare cases are described. Characterized by acute onset in young people, rapid progressive course without remission. Primarily affects the brain stem. Movement disorders - gemi or tetraplegia, bulbar syndrome - speech, swallowing, breathing, violation of the oculomotor nerves, cognitive functions, aphasia, impaired consciousness up to coma are expressed. The centers of demyelination have a massive and multiple nature. The prognosis is usually unfavorable.

Differential diagnosis is carried out with almost everything, again because of the multifaceted symptoms.

Progression of neurological symptoms leads to disability of the patient. There are special scales for determining the degree of severity, severity of motor disorders, paresis, disability rating scale - EDSS.

Treatment of multiple sclerosis

A good prognostic sign of multiple sclerosis is the onset of the disease and monosymptomicity.

Patients with a debut of multiple sclerosis are to be admitted to specialized centers for the treatment of multiple sclerosis. There are selected treatment schemes, in most centers there are treatment programs for randomized trials. All patients should be on a dispensary record with a neurologist. The state of the patient's psyche, his social adaptation is important.

Treatment is administered individually, depending on the stage and severity of the disease.

• Hormonotherapy - pulse therapy with large doses of hormones( corticosteroids).Use large doses of hormones for 5 days. It is important as soon as possible to start to make droppers with these anti-inflammatory and immunosuppressant drugs, then they accelerate the recovery processes and reduce the duration of exacerbation. Hormones are introduced in a short course, so the severity of their side effects is minimal, but to protect them, they take drugs that protect the stomach mucosa( ranitidine, omez), potassium and magnesium preparations( asparks, panangin), vitamin-mineral complexes;
• plasmapheresis;
• cytostatics;
• β-interferons( reebi, avonex).Β-interferons are prevention of exacerbations of the disease, reduction in the severity of exacerbations, inhibition of the activity of the process, prolongation of active social adaptation and work capacity;
• symptomatic therapy - antioxidants, nootropics, amino acids, vitamin E and group B, anticholinesterase drugs, vascular therapy, muscle relaxants, enterosorbents.
• For the treatment of rapidly progressing forms of multiple sclerosis, the immunosuppressant mitoxantrone is used.
• Immunomodulators: copaxone - prevents the destruction of myelin, softens the course of the disease, reduces the frequency and severity of exacerbations.
• During the remission period, sanatorium treatment, physiotherapy exercises and massage are possible, but with the exception of all thermal procedures and insolation.

Unfortunately, the fullness of multiple sclerosis is not curable, we can only reduce the manifestations of this disease. With adequate treatment, it is possible to improve the quality of life with multiple sclerosis and prolong the periods of remission.

Symptomatic treatment of multiple sclerosis

For mild exacerbations with isolated sensory or emotional disorders, use: restorative means, agents that improve blood flow to tissues, vitamins, antioxidants, sedatives, antidepressants if necessary.

To remove the increased muscle tone( spasticity) apply muscle relaxants( baclosan).Trembling, awkwardness in the extremities is removed with clonazepam, finlepsin. With increased fatigue, neuromidine is used. With violations of urination - detrusitol, amitriptyline, proserin. With chronic pain - antiepileptic drugs( finlepsin, gabapentin, lyric), antidepressants( amitriptyline, ixel).Depression, anxiety, vegetative dystonia syndrome are removed by sedatives, tranquilizers( phenazepam), antidepressants( amitriptyline, cipramil, paxil, fluoxetine)

Often, with multiple sclerosis, it is necessary to take drugs that protect the nerve tissue from harmful effects( neuroprotectors) - cerebrolysin, cortexin,mexidol, actovegin, etc.

Multiple sclerosis in pregnancy

Despite the insidiousness of the disease, the pregnancy of exacerbation of multiple sclerosis occurs much less often. This is due to the fact that the immune system of the mother is suppressed in order to avoid an aggressive effect on the fetus, autoimmune reactions also subside. If the exacerbation during pregnancy still occurred, then, as far as possible, try to avoid the appointment of corticosteroids, and the treatment is performed with the help of plasmapheresis. From the prevention of copaxone and interferon beta during pregnancy, it is worth noting. In the first six months after delivery, on the contrary, the risk of recurrence is very high and you need to worry about preventive treatment in advance.

Complications of Multiple Sclerosis

Multiple sclerosis leads to disability. More often it occurs in the late stages of the disease, when the symptoms no longer pass after the aggravation subsides. But sometimes from the very beginning there is a very serious course of the disease with a violation of self-breathing and heart activity, in which case a fatal outcome is possible.

Prevention of Multiple Sclerosis

Primary prevention( directly aimed at preventing disease) does not exist. You can save yourself a little from multiple sclerosis or its relapses, if you exclude any infection, stress, trauma, surgery, smoking.

Smoking destroys the nerves

Smoking increases the likelihood of developing multiple sclerosis several times, shows a joint study of American and Norwegian scientists. Scientists from the University of Bergen( Norway) and Gardvard University( USA) have shown that cigarette smoke contains chemicals that are strong neurotoxins. As a consequence, active smokers develop more often nervous system diseases, including incurable ones( the latter includes multiple sclerosis)."We found that out of 87 patients with multiple sclerosis examined, 76 percent were active smokers with at least 15 years of experience in the past," said Dr. Alberto Ashero, the head of the study, in an interview with BBC.this terrible disease does not cause any doubt. "

But often there is a need for drug prevention of exacerbation if the disease occurs with severe symptoms and if the exacerbation happens very often. Use immunomodulators - drugs that make the immune system work correctly: beta-interferon( betaferon, rebeef, avinex) and copaxone. These drugs are used in injections every day, a day or less - for many years. Taking these drugs increases the duration of remission, reduces the symptoms of exacerbations and helps slow the progression of multiple sclerosis.

The doctor neurologist Kobzeva S.V.