Multiple sclerosis is a neurological disease characterized by a progressive course.
With this pathology there are multiple lesions in the central nervous system, and single lesions in the ANS. In neurological practice, this disease can still be called "multiple sclerosis", "plaque sclerosis", "spotted sclerosis", etc. However, this does not change the essence: all these terms mean the same disease.
The disease is characterized by a wave-like chronic course. It is more often diagnosed in women than in men, although a third of cases of its development is recorded in the stronger sex. Pathology is usually manifested at a young age - from 20 to 45 years, and, moreover, people are most affected by it, whose main field of activity is associated with mental exertion.
In addition, age limits for the incidence of multiple sclerosis are being actively reviewed. In medicine, there are known cases of diagnosing this pathology in children 10-15 years old. In addition, the risk group included patients over 50 years of age.
Multiple sclerosis has its own classification, according to which, it happens:
- Primary-progressive. For this form of the disease is characterized by a constant, steadily progressive deterioration of the patient. Symptomatology of the disease is weak, and is mainly accompanied by a violation of gait, vision, speech, urination, bowel movements.
- Relapsing-remitting. Usually diagnosed in people 20 years of age. Attacks are periodic, and are accompanied by pain in the eyes, lower limbs, dizziness, imbalance, coordination of movements. Also, this type of multiple sclerosis is characterized by depression and mental impairment.
- Secondary progressive. This phase of the disease occurs after relapsing-remitting, which can last for years. For this type of multiple sclerosis is characteristic manifestation of ailments without alternating relapses and remissions. Patients have severe weakness, unsteadiness of gait, impaired coordination. Patients complain of stiffening and "stiffness" of the leg muscles, digestive disorders, worsening of depression, problems with thinking.
- Progressive recurrent. This type of multiple sclerosis is much less common than previously discussed. In this form of the disease, seizures occur periodically, accompanied by the persistence of symptoms even in the period of remission. The clinical picture of progressive recurrent multiple sclerosis is similar to the types described above. Patients complain of mental, motor, visual and auditory disorders. The process of emptying the bladder and intestines is impaired, problems with sensitivity and coordination of movements are manifested. Depression is aggravated.
Causes of development
The exact causes of the disease until the end has not yet been established. This question today is the subject of discussion between many scientists, including world-famous researchers. But in one they are in solidarity: the disease is caused by autoimmune disorders occurring in the body.
In addition to them, the possible provocateurs of multiple sclerosis include:
- prolonged toxic effects on the body;
- UV radiation (especially for people with white skin);
- long-term effects of radiation on the body;
- living in a cold climate;
- constant psycho-emotional stress, stress, mental fatigue;
- transferred operations;
- severe injuries (mental and physical);
- frequent allergies;
- genetic predisposition.
As for heredity, this is a relative reason. Therefore, it is not at all necessary that if the mother or father has symptoms of this pathology, it will develop in the child.
However, it is reliably known that the histocompatibility system influences the possibility of the pathology in question. First of all, it concerns the antigens of locus A (HLA-A3) and B (HLA-B7). Scientists came to such conclusions during the study of the phenotype of a person suffering from multiple sclerosis. Researchers managed to establish that it is the antigens of these loci that are scattered twice as often as others. Pathological changes are also subject to the antigen DR-2.
Based on the foregoing, it can be concluded that these antigens carry information about the resistance of an individual’s organism to various etiological factors that contribute to the development of multiple sclerosis. The presence of histocompatibility antigens cause a decrease in T-suppressors - specific cells whose action is aimed at preventing unnecessary immunological reactions.
Indicators of interferon are also subject to changes - under the influence of these antigens, it also decreases significantly. Scientists associate such processes with each other, since it is the HLA system that is responsible for producing antigens at the genetic level.
Symptoms and first signs
In adults, the symptoms and the first signs of multiple sclerosis depend on how much of the nervous system is affected, so the clinical picture of the disease appears differently in all patients. Initially, many patients may complain about the occurrence:
- numbness and tingling in the hands and feet;
- weakness in the limbs;
- increased fatigue, chronic fatigue;
- neuritis of the facial nerve;
- horizontal nystagmus;
- wobbling gait, etc.
In multiple sclerosis, symptoms occur in most patients. It:
- Visual disorders. The patient may note a decrease in visual acuity and double vision. In addition, the appearance of a veil before the eyes is possible, or even blindness of one or both organs of vision. Symptoms in the form of strabismus, vertical nystagmus, diplopia, internuclear ophthalmoplegia, etc. are also characteristic of multiple sclerosis.
- Urinary problems. Bladder emptying disorders are one of the very first symptoms of multiple sclerosis. Moreover, in 15% of patients, this deviation is the only clinical manifestation of this neurological disease. In multiple sclerosis, patients may complain of incomplete emptying of the bladder, nocturia (night urge to urinate), involuntary discharge of urine, intermittent urination.
These are the symptoms that need special attention. Multiple sclerosis is a progressive neurological disease, if left untreated, the clinical picture will expand. Over time, in the absence of medical intervention, the main symptoms will join:
- Sensitivity problems. Patients begin to complain of tingling, numbness, burning in the hands and feet. Over time, tingling develops into pain. Unpleasant sensations occur first in the lower part of the body, and then gradually spread to the upper. At first, tingling or pain affects only one side, but then it can move to the second limb. At first, such weakness can be mistaken for ordinary fatigue, but as the pathological process progresses, motor disturbances will worsen. Thus, the patient will be difficult to perform even the most simple movements.
- Tremor of the hands and feet. This symptom significantly impairs the quality of life of a patient with multiple sclerosis. Sometimes the patient may complain of trembling not only in the arms and legs, but also in the whole body. Such a violation is due to a malfunction in the muscular system of a person with multiple sclerosis.
- Visual disorders. With the progression of multiple sclerosis, patients notice a deterioration in color perception. In addition, the development of optic neuritis is possible. Typically, these disorders are one-sided, but sometimes both eyes are affected at once.
- Cephalgia Attacks of headaches are another common symptom of a disease like multiple sclerosis. Doctors suggest that this malaise is associated with impaired muscle functioning, as well as with depressive states.
In addition to the previously considered symptoms, multiple sclerosis is often accompanied by:
- violation of swallowing function;
- change of gait, its shakiness and uncertainty;
- speech motor disorder;
- muscle spasms;
- cognitive impairment;
- sleep disorders;
- violation of intellectual activity;
- hypersensitivity to heat;
- chronic fatigue;
- decreased libido;
- vegetative disorders;
- depressive or anxiety states;
- hearing impairment.
Diagnosis of multiple sclerosis is based on a survey and examination of the patient. But this is not enough. To clarify the diagnosis, it is necessary to conduct more informative instrumental diagnostic procedures - MRI or CT of the brain and spinal cord.
Among laboratory studies, lumbar puncture is preferred. In case of MS, oligoclonal immunoglobulins are detected in the CSF of a sick person. Also important is the so-called immunological blood monitoring. Its essence lies in comparing the immune parameters of a sick person with such in healthy people.
The therapeutic approach depends directly on the form of the course of multiple sclerosis.
- With remitting MS, special attention is paid to treatment aimed at preventing the recurrence of pathology. Equally important is the symptomatic therapy, which involves the elimination of urination problems, depression, pain, chronic fatigue.
- In the secondary progressive form of multiple sclerosis, the main goal of the therapy is to prevent relapse and slow the progression of the pathological process.
- Primary progressive multiple sclerosis requires only symptomatic therapy.
The main rule is a purely individual approach to the issue of treatment. This can be achieved only if there is a precise determination of the degree to which phase the disease is currently in. There are several stages:
- stabilization phase;
- transition stage.
To control the situation, it is necessary to regularly conduct MRI and immunological blood tests. Based on these data, you can assess the degree of progression of the pathology, as well as monitor the effectiveness of the treatment. Due to this, the neurologist is able to:
- decide on what drugs and additional therapeutic measures to appoint a specific patient;
- set the duration of the therapeutic course;
- decide on the abolition of the use of active immunosuppressants or, conversely, to prolong therapy with their use.
Additional diagnostic measures to control treatment are also important. It:
- determination of visual acuity;
- hearing evaluation;
- study of somatosensory brain potentials.
Using electrophysiological methods, it is possible to determine the degree and level of the conductive nerve pathways. In addition, the results of such studies help to fully confirm or refute the diagnosis of MS.
At deterioration in sight observation by the ophthalmologist is obligatory. Also important is the consultation of a neuropsychologist. After it, psychotherapy is prescribed, both for the patient himself and for his family members.
Thus, in order to successfully advance the treatment, in multiple sclerosis, the patient must be under special control of the following specialists:
- an immunologist;
- a neuropsychologist;
The main essence of the treatment is:
- prevention of exacerbation of pathology;
- effects on the foci of the autoimmune process;
- stimulation of development or enhancement of compensatory-adaptive mechanisms;
- relief of exacerbated disease;
- elimination of symptoms that reduce the quality of life of the patient;
- the choice of measures aimed at adapting the patient to the complications of the disease. This will help the patient in the future, as far as possible, to achieve a quality of life, if not at the highest level, then at least at the current level.
No bacterial, viral, or fungal pathogen has been identified, which is why there is no need for etiotropic therapy. Pathogenetic treatment is aimed primarily at the elimination of the immune-inflammatory process, leading to demyelination.
To eliminate the worsening disease and its further prevention, corticosteroids are used, as well as ACTH or its analogues: Prednisolone, Methylprednisolone, Dexamethasone, etc. These drugs stop inflammation, but they also inhibit the immune system.
Multiple sclerosis is a chronic, slowly but steadily progressive neurological disease. Alas, today it was not possible to develop therapies that would help to completely get rid of the pathology. It can only be transferred to the remission phase, the duration of which depends on the treatment carried out, and patient compliance with all recommendations of the attending physician during the stabilization period.
However, at the end of the twentieth century, scientists still managed to develop drugs that help slow the progression of the pathological process, somewhat improve the quality of life of the patient. These drugs are indicated in different ways: drugs that change the course of the disease (PITS), or drugs modifying therapy (PIM). All these tools have a direct effect on the patient's body, and are used for pathogenetic therapy. However, they can not completely cure or prevent the development of the disease.
Symptomatic treatment of multiple sclerosis is carried out with the aim of improving the quality of life of the patient. In particular, hormone therapy is carried out with parallel prescription of immunostimulants or immunomodulators. Sanatorium treatment shows very good results.
With the help of such therapeutic measures can significantly increase the duration of remission. We make a brief overview of the basic principles of symptomatic treatment of multiple sclerosis.
Treatment with corticosteroids is carried out according to the scheme of pulse therapy. This means that within 5 days the patient will have to take high, practically “shock” doses of hormonal drugs prescribed by the doctor.
It is very important during the period of treatment with hormones to supply the body with vitamins, micro-and macronutrients. He especially needs potassium and magnesium, which is why patients taking a course of hormone therapy are prescribed drugs Asparkam, Panangin and similar products.
To protect the gastrointestinal tract from the negative effects of hormones, patients are prescribed anti-ulcer drugs. They possess not only therapeutic, but also protective properties.Preference is given to Omez, Omeprazole, Losec, Ultop, Orthanol, etc.
Prescription medications that suppress immunity are advisable in cases of frequently recurrent MS. In this case, the drug Mitoxantrone is often used.
They are used in depressive episodes or deep depressions. Paxil, Tsipramil, Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, etc., have good efficacy.
In symptomatic therapy also apply:
- Drugs that eliminate pelvic disorders: Amitriptyline, Detruzitol, etc.
- Nootropic drugs: Glycine, Phenibut, Piracetam, Fenotropil, etc.
- Vitamins B and E.
- Enterosorbents: Atoxyl, white coal, Sorbex, activated carbon.
- Immunomodulators: afalaza, Bation, Immunal.
- Painkillers: Lyrics, Gabapentin, Gabagamma.
How many people live with multiple sclerosis?
The prognosis for life depends on the form, severity of the course of the disease and the treatment received by the patient. In the absence of such, the patient is unlikely to live 20 years from the time of diagnosis.
With the exclusion of the impact of negative factors, the survival rate increases, but it still decreases by 7 years in comparison with that in healthy people. Equally important for the prognosis for life is the age at which the patient was diagnosed with MS. In older people, pathology is prone to rapid progression.
Typically, death occurs 5 years after the identification of a neurological disease.