- 1 Multiple sclerosis
- 2 The reasons
- 3 Symptoms
- 4 Diagnostics
- 5 Treatment
- 6 Exacerbation prevention
- 7 How many live with multiple sclerosis
A wide group of people aged 10 to 40 years under the influence of various factors, often against the background of a violation of several genes, show signs of multiple sclerosis. The disease is chronic, slowly progressive. Characterized by the occurrence of demyelination sites. According to statistics, about 2 million people around the world suffer from multiple sclerosis.
For multiple sclerosis is characterized by a wave-like course – exacerbations are replaced by remissions, but in general there is a gradual development. To understand whether there is an exacerbation in a given period of time, the patient’s condition is evaluated on an EDSS scale and the results obtained are compared with the previous ones. An increase in performance even by one point indicates an exacerbation. At such times, an MRI scan is shown.
It is customary to speak about the development of an exacerbation if new symptoms or intensification of old ones appear no earlier than a month after the last episode. The duration of the manifestation of new signs – not less than a day.
Talked about the four forms of the disease. The most common is remittent-recurrent, for periods of remission are not peculiar to exacerbation. With secondary progressive sclerosis, it progresses with and without exacerbations. The primary progressive form is characterized by changes that occur at the onset of the disease, sometimes associated with a decrease in the severity of symptoms. The rarest – progressing with aggravations. Symptoms develop as soon as a person falls ill, the process changes slowly.
Nerve impulses are transmitted from one neuron to another through long processes – axons. Many of them are covered by a protein-lipid myelin sheath. That it provides fast transmission of nerve impulses.
It is believed that the causative agent of multiple sclerosis is NTU-1 virus or a type close to it. It leads to the development of inflammation. Another factor is genetic predisposition. T-lymphocytes and immunoglobulin are activated, they penetrate the blood-brain barrier, promote the formation of antigens that act against the myelin sheath covering the axons of the spinal cord and brain neurons. As a result, single plaques are formed, which, as the disease develops, merge and form large areas of damage.
The process also affects oligodendrocytes. This type of cell is responsible for creating myelin.
As a result of demyanization, there is a violation of the transmission of nerve impulses to other neurons and organs of the body. There are disorders of movement, sensitivity, there are chaotic involuntary actions.
Based on recent data, axon damage is important. Damage occurs from the beginning of the development of the disease, but in the early stages it does not affect what is happening in the body due to the compensatory mechanism of the central nervous system. However, after a few years, it is their damage that leads to irreversible neurological processes associated with damage to the white matter of the brain.
The following causes cause multiple sclerosis:
- head injuries;
- spinal injury;
- infectious diseases;
- hepatitis B vaccine;
Researchers have noted the negative impact of metabolic disorders due to malnutrition and place of residence.
The main signs of multiple sclerosis include visual impairment, coordination, sensitivity. There is a dysfunction of the sensory nerves, organs of the pelvic region. High fatigue, attention and memory disorders attract attention.
At the same time, in the initial stages of development, violations related to movements, sensitivity, and divergence of the eyes are noted to a greater degree. Pelvic organs are less affected.
A disease severity test is performed on a ten-point EDSS scale J. Kurtzke. An indicator of up to 4.5 indicates that a person is independent, above 7 – about severe disability.
As the disease progresses, a person raises limbs, rotates them, but if necessary, to keep them in a certain position experiences difficulties, the feeling of an additional obstacle. Reduced muscle mass. Subsequently, tension builds up in the muscles of the arms and legs. The patient can not lift his leg from the floor, his hand from another plane. Any active movements in the area of the joints are possible only on the plane.
Coordination of movements
When the primary signs revealed instability, the inability to stand on one leg. The patient can not go straight with his eyes closed.
The staggering gait is already developing with eyes open. The patient spreads his legs wide to hold them. In the later stages can not move independently. Muscles weaken, they mark the trembling of the head, hands, the inability to perform intentional movements. Observed changes in speech. She loses smoothness.
Involuntary eye movements are noted. At first, only when they are retracted to the sides, later with a direct gaze, in the later stages, the spasm appears when the eyes move slowly. Strabismus develops.
There is a darkening in the eyes. They get tired quickly even without much stress. Gradually, vision decreases. The development of blindness is possible.
The outline of the vessels of the eyes is broken. Arteries narrow, and veins, on the contrary, dilate. Over time, the death of the optic nerve occurs.
The defeat of the myelin sheath in multiple sclerosis occurs on the sensory nerves. At first there is a feeling of numbness, burning. In the future, the sensitivity either increases or decreases, reaching its complete absence.
Symptoms of abnormal pelvic organs do not appear immediately. Over time, the patient notes that he can not restrain urine for a long time, at the same time he has difficulty urinating. There is a feeling of incomplete emptying. Over time, incontinence develops.
Difficulties with defecation. The patient begins to suffer from persistent constipation.
In women and men, sexual activity is reduced. In men, impotence develops, in women, the menstrual cycle is upset.
Damage to the trigeminal nerve leads to complete loss of sensation. The patient loses the ability to chew normally.
With the defeat of the facial nerve, the patient cannot close his eyes, facial asymmetry becomes pronounced, in the later stages all muscles involved in facial expressions are paralyzed.
If the pathology affects the bulbar nerves, the person loses the ability to swallow, chew food. The speech is broken, it becomes blurred, slurred.
With the development of multiple sclerosis, a gradual decrease in intelligence to its complete disintegration is noted. Lost ability to be critical of their condition. Memory deteriorates.
Lability of mood is noted. There is euphoria, turning into depression. Fatigue increases, apathy appears.
Signs of multiple sclerosis are evidenced by various laboratory tests. Symptoms and treatment are confirmed by a doctor.
An important part of the examination is the study of cerebrospinal fluid. Analysis of the liquor shows oligoclonal immunoglobulins. However, the results of this study may also indicate other diseases. Puncture in multiple sclerosis can be performed several times.
For the diagnosis of multiple sclerosis at an early stage, information is analyzed from the anamnesis, objective and subjective symptoms of nerve tissue damage. Magnetic resonance therapy is prescribed. Today, this diagnostic method is considered the most informative. MRI can detect lesions, trace the dynamics of their appearance, distribution.
With the introduction of a contrast agent in the new foci, its accumulation occurs. If there is an increase in the old, the contrast accumulates around the perimeter.
The appearance of one or two typical foci within two years in people from 10 to 40 years is considered to be a reliable sign of multiple sclerosis. Confirm the presence of foci of accumulation of contrast.
Alternative diagnostic methods are currently under consideration. So, the American researchers consider the objective method of determining multiple sclerosis, based on the reaction of the pupil to light.
A blood test for antibodies to myelin is associated with the use of a particular RNA molecule. It is capable of reacting with antibodies and attaching obelin to them. At the same time, the attached protein begins to glow.
In multiple sclerosis, therapy includes means that prevent the occurrence of exacerbations, ensure a long period of remission, and reduce the rate of development of the disease. Symptomatic treatment is carried out.
Preparations that change the course of multiple sclerosis help prevent the occurrence of exacerbations and reduce the severity of the disease:
- Interferons. Drugs in this group reduce the activity of lymphocytes, prevent their spread in the central nervous system, and reduce immune cells in the affected area. The group includes Betaferon, Gilenia, Exceia, Avonex.
- Glatiramer acetate. With prolonged use, the number of complications and their frequency decreases, and reactions leading to the destruction of myelin are blocked.
- Immunosuppressants. The drugs of the group are aimed at suppressing the immune response. This is Prednisolone from the glucorticosteroid series, Cyclosporine, Sirolimus.
- Monoclonal antibodies. Aimed at removing antigens that are not peculiar to humans. Used Tisabri.
During exacerbation, glucocorticosteroid drugs are used. This is Dexamethasone, Prednisolone. Methylprednisolone can be administered intravenously.
Ascorbic acid is simultaneously administered – it participates in the synthesis of glucocorticosteroids. Ethisisol leads to activation of the pituitary gland and an increase in the content of the hormone in the blood.
Alternatively, intravenous immunoglobulins are administered, or plasmapheresis is performed. The latter method is aimed at cleaning the blood from antibodies and toxins.
To reduce the brightness of symptoms prescribed antidepressants. This group includes Amitriptyline, Fluoxetine. Their purpose is to regulate the content and balance of neurotransmitters, in particular, dopamine, serotonin and norepinephrine.
Anticonvulsant drugs are used. They reduce cramping and pain. Some of them also have a sedative effect. Phenobarbital, Atsediprol, Amizepine is used.
Muscle relaxants reduce muscle tension, eliminate cramps. Used Mydocalm, Baclofen.
Nootropic drugs contribute to the improvement of mental activity, memory, attention. At the same time, they have a calming effect. Preparations: Nootropil, Pantogam, Glycine.
Additionally prescribed medication to relieve dizziness, incontinence, constipation.
Recently used alternative methods of treatment. These include the use of stem cells, immunosorption.
In multiple sclerosis, the pathological manifestations usually grow slowly. For the prevention of multiple sclerosis exacerbations, it is recommended:
- Take all prescribed medications. If there are side effects, it is recommended to consult a doctor. He will pick up an alternative.
- Avoid colds and other diseases. Any infection can trigger an attack.
- Drink more fluids. This will help prevent the development of bladder infections.
- Avoid stress. Strong psycho-emotional stress provokes exacerbation. In order to learn to relax, it is recommended to practice yoga, to meditate.
- Get enough rest. Constant muscle pain, some medications lead to sleep disorders. To avoid lack of sleep, you need to consult with your doctor about medications that remove disorders.
How many live with multiple sclerosis
For multiple sclerosis, it is common to use the “five-year rule”. It was formulated by John Kurtzke. In accordance with this rule, the course and prognosis of pathology depends on how it showed itself in the first five years. If during this period the patients scored no more than 3 points on the EDSS scale, the prognosis of life expectancy in multiple sclerosis is favorable. In some cases, due to aggressive external factors are exceptions.
The prognosis is unfavorable if a secondary progressive form occurs, with the first signs of multiple sclerosis appearing at a young age in men. The primary symptoms in this case are mental or motor impairments, the period of remission between exacerbations is less than a year. The prognosis is unfavorable. Death from multiple sclerosis is usually due to concomitant serious diseases.
In the case of a primary progressive course, about a quarter of patients seven years after the appearance of the first signs move with a cane. After 25 years, many are bedridden.
Life with multiple sclerosis depends on the severity of symptoms. With a weak degree, a person is active, playing sports. With severe pathology, the patient suffers from paralysis, pain, there are dangerous consequences. Treatment is aimed at reducing the rate of development of the disease, the removal of symptoms. The prognosis depends on the form of the lesion and the symptoms that first appeared.
The following sources were used to prepare the article:
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Gordeev Ya. Ya., Shamova TM, Semashko V.V. The scale for assessing the neurological status in multiple sclerosis // Journal of Grodno State Medical University – 2006.
Kotov S. V., Yakushina T. I., Lizhdvoy V. Yu. Long-term comparative study of the effectiveness of drugs that change the course of multiple sclerosis // Clinical Medicine Almanac – 2011.
Zavalishin I. A., Peresedova A. V. Modern ideas on the pathogenesis and treatment of multiple sclerosis // Journal Nervous diseases – 2005.