People who are far from medicine, having heard the phrase "multiple sclerosis", immediately associate it with forgetfulness, absent-mindedness, memory loss and consider it "grandmother's disease". To some extent, they are right, because they mean one of the varieties of sclerosis - senile. In fact, sclerosis can affect various organs and systems, and has several types:

• scattered;
• lateral amyotrophic;
• vessels of the brain;
• subchondral sclerosis of endplates;
• senile;
• tuberous.

Has one distinguishing feature: when the disease occurs, the myelin sheath of the nerve fibers of the brain and spinal cord is damaged. Foci of demyelination appear as a result of the replacement of healthy nerve fibers with connective tissue. They can be scattered randomly in various departments brain and spinal cord, while disrupting the functionality of the entire area. With timely and proper treatment light form disease, the patient can remain functional for a long time, serve himself. The transition of the disease to a severe form leads to disability, a person will not be able to serve himself without outside help.

With all other types of disease, functional organs are replaced by connective tissues (plaques), and scars are formed. In atherosclerotic vascular disease, plaques form as a result of cholesterol deposition.

Multiple sclerosis is a fairly common disease. There are about 2 million patients in the world, and the largest number of patients are in Western countries and the USA. In large industrial cities, the number of patients per 100,000 population ranges from 30 to 70 cases.

Depending on the stage of the disease, a person with multiple sclerosis can live to a ripe old age. Someone with even minimal or no symptoms. Often the cause of death is infectious diseases- pneumonia, urosepsis or bulbar disorders, in which swallowing, chewing, speech functions are impaired. However, there are no problems with the respiratory system and the heart.

When do the first symptoms appear?

Multiple sclerosis is a disease of young people. It is first diagnosed between the ages of 15 and 40. There are cases when the disease is diagnosed in children and adults over the age of 50, but this is the exception, not the rule. Multiple sclerosis, like all autoimmune diseases, affects women to a greater extent - almost 2 times more often than men. There are several theories about the causes of multiple sclerosis, among them the theory of the influence of hormonal background. The most common version of the occurrence of multiple sclerosis involves the recognition by the immune system of the body's nerve cells as "foreign, hostile" and their further destruction. Given the identification of immunological disorders in the diagnosis, the basis for the treatment of multiple sclerosis is the correction of immune disorders.

In most cases, there may be several factors that affect the manifestation of the disease at the same time:

• heredity (the risk of the disease increases by 20-30% if the family has direct relatives (brother, sister, etc.) suffering from multiple sclerosis);
• viral diseases(measles, herpes, chickenpox, rubella, etc.);
• increased background radiation;
• ultraviolet radiation (especially in whites with a strong tan in southern latitudes);
• autoimmune diseases (psoriasis, lupus erythematosus, rheumatoid arthritis, etc.);
• previous operations and injuries of the spinal cord and brain;
• frequent psycho-emotional stress, stress;
• obesity;
• prediabetes, diabetes mellitus;
• hazardous production (work with toxic paints, solvents, etc.).

The first signs of multiple sclerosis usually go unnoticed. Diagnose the disease early stage rather difficult due to the variety of primary symptoms, ways of their manifestation and stage of the disease. One patient in different time several symptoms may appear at once, and then only one remains. The stages of exacerbation and remission alternate in random order - from several hours to several months.

It is almost impossible to determine the frequency and predict the onset of the next attack. There are cases when periods of remission can last several years, and at the same time the patient feels completely healthy. But this is the time when the disease "hidden" and did not go anywhere - the next exacerbation will be stronger. A variety of factors can provoke a relapse: a cold, a viral disease, trauma, stress, hypothermia, alcohol consumption, etc.

There are three main phases of the course of multiple sclerosis:

Easy. Rare exacerbations alternate with long-term remission, during which the patient's condition is satisfactory. During the next exacerbation, the symptoms remain the same, no new symptoms are detected.

Medium severity. Long periods of remission (sometimes up to several years) are replaced by an exacerbation phase with the appearance of new symptoms or with an increase in previously existing ones.

Severe degree. It has two phases: primary and secondary progressive. In the primary, there is a constant slow increase in symptoms after the detection of the disease and the diagnosis, and there are practically no exacerbation phases. The patient's condition is gradually deteriorating. In the secondary-regressive phase, after a long remission, a sharp deterioration occurs.

Signs and symptoms of multiple sclerosis

The signs of multiple sclerosis in women at the initial stage and in men are the same:

• damage to the cranial nerves;
• cerebellar disorders;
• sensitivity disorders;
• pelvic disorders;
• movement disorders;
• emotional and mental changes.

How is it shown?

Vision problems. The most common sign of the onset of the disease. It manifests itself in a violation of color perception, decreased vision, double vision, uncoordinated eye movement when trying to take them to the side. Visual acuity may decrease sharply, usually in one eye.

Frequent headaches. It occurs three times more frequently in MS than in other neurological disorders. Its occurrence is due to depression and muscle disorders in the body. It may be a harbinger of an exacerbation of the disease or precede the debut of pathology.

Speech and swallowing disorders. Manifested in confusion of speech, changes in articulation, slurred pronunciation. Symptoms appear simultaneously and are imperceptible to the patient, but are expressed for the environment.

Dizziness. It is observed at almost all stages of the disease. Throughout the course of the disease, the symptom only intensifies: it begins with a feeling of its own instability and reaches a state where everything seems to be moving around.

Chronic fatigue. It mainly manifests itself in the afternoon, when the patient feels lethargic, weak, wants to sleep, does not perceive information well.

Vegetative disorders. Characteristic for the middle and severe stages of the disease. Manifested by increased sweating of the legs, muscle weakness, low blood pressure, dizziness.

Violation of night sleep. There are problems with falling asleep due to muscle spasms, unpleasant tactile sensations. Restless sleep does not give the desired rest, which in the daytime leads to dullness of consciousness, incoherence of thoughts.

Violation of sensitivity. Occurs in almost 90% of cases. It manifests itself in the form of unusual sensations: burning, numbness, tingling, itching of the skin, first in the fingers, and then in the entire limb. It usually occurs on one side, but it can also be on both sides. Initially, the patient perceives these symptoms as normal fatigue, but gradually there is difficulty in performing simple small movements. Limbs feel foreign, naughty.

Cognitive and intellectual disorders. Manifested in general lethargy, reduced concentration, ability to memorize and assimilate new information. It is difficult for the patient to switch to another type of activity, which leads to the need for constant care in domestic matters.

Tremor. One of the symptoms that may initially be mistaken for a sign of Parkinson's disease. Trembling of the limbs and torso does not allow to work fully, significantly complicates the patient's self-care.

Depression, anxiety. It can be both a symptom of the disease and the patient's reaction to the diagnosis. Almost 50% of patients suffer. The way out of this state is seen in a suicide attempt or vice versa, in alcoholism. Being in a depressed state contributes to obtaining a disability group.

Change in gait (unsteadiness). Foot numbness, muscle spasms, weakness, and tremors can cause walking problems.

Spasms of the muscles of the limbs. They are an indication for the patient's disability, since they do not allow a person to adequately control movements. Movement becomes possible in a special wheelchair.

Sensitivity to temperature changes. With overheating in the bath, sauna, prolonged exposure to the sun, symptoms worsen.

Violation of sexual desire. It can be both a psychological disorder and the result of a dysfunction of the central nervous system. Decreased libido, but men may have morning erections. In women, sensitivity decreases, they cannot achieve orgasm, and sexual intercourse is painful.

Urinary incontinence. As the disease progresses, the problem with urination only gets worse.

Intestinal dysfunction. It is manifested either by permanent constipation or fecal incontinence.

The first signs of multiple sclerosis - what to do?

The initial stage of the disease practically does not manifest itself in any way, the course of the disease passes slowly, and only in rare cases can the onset be acute. The asymptomatic nature of the disease can be explained by the fact that if there are already lesions of nerve cells, healthy nervous tissue compensates for the functions of the affected areas, performing their functions.

The first signs of multiple sclerosis can be completely different, not giving a complete picture of the disease. After all, during the initial examination, the patient complains about one sign, which, in his opinion, is the most important and worrisome.

For example, in case of visual impairment (stopped distinguishing colors, a dark dot appeared, etc.), the patient goes to see an ophthalmologist. The doctor prescribes treatment and cannot always correlate this symptom with multiple sclerosis and refer to a neurologist. At the time of the examination, the optic discs may not yet change their color, and a lot of time will pass before this happens. By the way, it is visual impairment as a primary symptom that gives a state of long-term remission. The patient loses the chance to receive treatment at an early stage.

If the doctor assumes multiple sclerosis by the first signs, he sends you for a consultation with a neurologist, who, during the initial examination and based on the results of the survey, prescribes a more detailed examination.

For a complete diagnostic picture, you will need to perform an MRI, PMRS (proton magnetic resonance spectroscopy), do a lumbar puncture from the spinal canal, SPES (superposition electromagnetic scanning), determine the electrical activity of the brain using an electroencephalograph.

Based on the results of these studies, the doctor either confirms the diagnosis of "Multiple Sclerosis", or denies it and makes a different one, similar in symptoms.

Since 2001, physicians have used MacDonald's diagnostic criteria to diagnose MS. They are based on the number of clinical attacks and a combination of criteria groups. Over the years, the criteria have been revised several times, improved and greatly simplified the diagnosis in adults.

In any case, with early diagnosis of the disease, there is every chance to live a long time without a significant deterioration in the quality of life. The prognosis of MS treatment is most favorable if the disease manifests itself at a later age, exacerbations are rare, new symptoms of the disease do not appear, and the primary ones do not increase.

Multiple sclerosis (multiple encephalomyelitis) - severe chronic illness central nervous system. The disease often affects women, often manifesting at a young age (20-40 years), it is steadily progressing. According to statistics, in last years multiple sclerosis in men has become much more common, and cases of detection of the disease in children under 16 have also become more frequent. Let's talk about the symptoms and treatment of the disease.

Predisposing factors

Multiple sclerosis is an autoimmune disease in which the structure of nerve fibers is disrupted - they lose their ability to transmit impulses.

Multiple sclerosis is a multifactorial disease, that is, it is impossible to reliably establish the specific cause of its development. In most cases, the disease manifests itself under the simultaneous influence of several factors:

• genetic predisposition (in families in which there are people suffering from multiple sclerosis, the likelihood of the disease increases by 20-30%);
• transferred viral diseases (, etc.);
• the presence of any autoimmune diseases;
• spinal cord and brain injuries, operations;
• constant psycho-emotional stress, stress;
• , especially, ;
• impaired glucose tolerance;
• occupational hazards (constant work with paints, solvents, refined products, etc.).

Also, scientists came to the conclusion that the likelihood of developing multiple sclerosis is higher in white people living in the Northern regions.

Symptoms of multiple sclerosis

Multiple sclerosis has a very large number of symptoms, one patient may experience only one of them or several at once. The disease proceeds with periods of exacerbations and remissions. Any factors can provoke an exacerbation of the disease: acute viral diseases, stress, diet errors, hypothermia or overheating, etc. The duration of remission periods can be more than a dozen years, the patient leads a normal life and feels completely healthy. But the disease does not disappear, sooner or later a new exacerbation is sure to occur.

A mild (benign) course of the disease is distinguished, in which rare exacerbations are replaced by long periods of remission, during which the patient feels satisfactory. During periods of exacerbation, new symptoms of the disease do not appear.

With a moderate severity of the disease (remitting course), during exacerbations, new symptoms of multiple sclerosis appear or the previously existing ones are aggravated. Remission periods can last from several months to several years.

The severe course of multiple sclerosis is divided into primary progressive and secondary progressive. The first option is characterized by a constant slow increase in symptoms after the onset of the disease for the first time, there are no exacerbations as such, but the condition of patients is constantly deteriorating. In the secondary progressive course of multiple sclerosis, the condition worsens after a long remitting course.

Multiple sclerosis occurs as a result of the appearance of foci of demyelination of nerve fibers and a slowdown in the behavior of nerve impulses. The nature of the symptoms of the disease depends on the localization of these foci. The first signs of the disease can be so diverse that it is not immediately possible to establish the correct diagnosis. If you experience the following symptoms, you should consult a doctor:

• pain and impaired sensitivity in the fingers, arms, legs, torso, manifested in the form of numbness or tingling (patients have sensations of the following nature: “as if lying down”, “I walk as if on soft ground”, “I feel badly the ground under my feet”, “ I lose my slippers, but I don’t notice”);
• violation of motor activity due to the appearance of strong tension in the limbs, perhaps even the appearance of paresis and paralysis, the occurrence of pathological reflexes;
• impaired coordination of movements, unstable (staggering) gait, and legs, awkwardness when performing the most common manipulations (“hands do not obey”), in severe cases, it is difficult for patients to serve themselves on their own;
• visual disturbances: decreased visual acuity, possibly only one eye, a feeling of a veil or cloudy glass in front of the eyes, doubling of objects;
• speech disorder (slow, slurred or slurred speech);
• violation of the functions of the pelvic organs (, gas, stool,);
• decrease in muscle tone of one half of the face, a violation of taste sensitivity (food becomes tasteless);
• disorders in the psycho-emotional sphere (anxiety, depression, irritability, euphoria, apathy, etc.);
• increased fatigue, a constant feeling of fatigue even after light exercise, the symptoms of multiple sclerosis may increase after taking a hot bath, drinking hot drinks, insolation, staying in a stuffy room.

Treatment of multiple sclerosis

Multiple sclerosis cannot be cured, but adequate therapy started in a timely manner leads to an improvement in the patient's condition and an increase in his social activity.

Patients in whom the disease is diagnosed for the first time are usually hospitalized in the neurological department of the hospital for a detailed examination and therapy. Treatment is selected individually, depending on the severity of the disease and symptoms. Multiple sclerosis is an incurable disease, but timely therapy can reduce the manifestations of the disease and improve patient adaptation.

Hormone therapy (pulse therapy) - a short course of treatment with large doses (Dexamethasone, Prednisolone, etc.) - helps to speed up the recovery of lost functions and reduce the duration of the exacerbation period. The sooner treatment is started, the better the prognosis.

Immunomodulators (Copaxone, Betaferon, etc.) contribute to the weakening of the manifestations of the disease and increase the duration of remission periods.

Drugs with an immunosuppressive effect (Mitoxantrone, Natalizumab, etc.) are drugs that suppress the activity of the immune system of patients, preventing damage to the myelin sheath of nerve fibers during an exacerbation of multiple sclerosis.

Symptomatic therapy is selected individually using a very wide range of drugs: nootropics, drugs that reduce muscle hypertonia, b-blockers, antidepressants, sedatives, vitamins, etc.

The prognosis of the disease is considered the most favorable if the disease manifests itself at a later age, exacerbations occur rarely, new symptoms of multiple sclerosis do not appear, and the previous ones do not intensify.

Which doctor to contact

When the first symptoms of disruption of the brain or nerves appear, you should contact a neurologist. Additionally, the patient may need to consult an endocrinologist (for the treatment of obesity and impaired glucose tolerance), a nutritionist, and a geneticist.

is a neurological pathology characterized by a progressive course with multiple lesions in the central nervous system and with fewer lesions in the peripheral nervous system. In neurology, you can find the terms "multiple sclerosis", "spotted sclerosis", "plaque sclerosis", "multiple sclerosing encephalomyelitis", they are all designations for the same disease. The course of the pathology is undulating, the character is chronic.

If earlier the majority of people with multiple sclerosis lived in countries far from the equator, then at the moment there is no clear geographical distribution. In the past few decades, there has been an increase in pathology in most regions of the globe, although countries with a temperate climate still remain in the lead. There, rates reach from 50 to 100 people per 100,000 population.

Most often, women are ill, although about a third of cases of multiple sclerosis occur in the male population of the planet. Pathology manifests more often at a young age, affecting active people from 20 to 45 years old - this is almost 60% of all cases. Most often, multiple sclerosis is diagnosed in people engaged in intellectual work.

In addition, scientists are currently revising the age limits of the onset of the disease in the direction of their expansion. So, in medicine, cases of the development of multiple sclerosis at the age of two, as well as at the age of 10-15 years, are described. Number of patients in childhood varies according to different data from 2 to 8% of the total number of cases. The risk group now includes people over 50 years of age.

Causes of multiple sclerosis

As a result of the influence of a number of factors, there is an increase in the transmission capacity of the blood-brain barrier (its main function is to protect brain antigens from the destructive effects of the immune system's own cells). As a result, a greater number of T-lymphocytes enter the brain tissue and the process of inflammation starts. The result of this inflammation is the destruction of the myelin sheath of the nerve, as the immune system perceives myelin antigens as foreign. The transmission of nerve impulses in the same volume becomes impossible and the person begins to suffer from the symptoms of the disease.

The causes of multiple sclerosis are multiple external and internal factors Therefore, it is considered as a multifactorial pathology.

The following etiological circumstances attract special attention of scientists:

Influence of viruses on the occurrence of the disease. These are retroviruses, herpes viruses, measles and rubella virus, infectious mononucleosis, especially in combination with endogenous retroviruses. The transferred bacterial infections - streptococcal, staphylococcal, etc. have a negative effect. However, scientists have come to the conclusion that there is not a single virus that would directly lead to the development of the disease. However, they are trigger factors that support and induce the development of the inflammatory and autoimmune process, thereby stimulating neurodegenerative changes.

The influence of chronic intoxication on the human body. Of particular danger are poisonings with chemicals, organic solvents, metals, gasoline, etc. Living in an ecologically unfavorable area, especially in childhood, is considered a negative factor.

Features of the diet. In this regard, the danger is animal fats and proteins, their excessive consumption under the age of 15 years. If a person suffers from obesity from the age of 20, then the risk of developing the disease increases by 2 times. It has also been proven that excessive consumption of table salt leads to pathological activity of the immune system.

Frequent psycho-emotional overstrain, chronic stress.

Physical stress.

Head and back injuries, surgical operations.

Genetic predisposition to develop the disease. This is especially evident in a family history of multiple sclerosis. The risk of disease in blood relatives ranges from 3 to 10%.

Taking oral contraceptives increases the risk of developing the disease by 35%.

Elevated blood sugar leads to rapid progression of the disease.

Scientists have also identified epidemiological risk factors for the development of the disease:

Belonging to the European race. So, for example, among the Eskimos, Native Indians, Majori and some other races, the disease is extremely rare.

Having familial multiple sclerosis

Belonging to the female sex, it is women who prevail in all populations of patients, however, the unfavorable course of the disease is typical for men.

A change in the area of ​​residence affects the change in the frequency of occurrence of the disease among the migrated population.

There are cases of a sharp increase in the incidence in a limited area in a certain time period.

Symptoms of multiple sclerosis in 40% of cases of the disease are disturbances in motor functions - such as weakness in the muscles, impaired coordination of movement. Also, in 40% of cases, there are violations in the sensitivity of the limbs - for example, numbness, a feeling of colic in the hands and feet.

In 20% of cases of multiple sclerosis, there are visual impairments, movement disorders when walking, voluntary urination, fatigue, and sexual dysfunction. With a long course of the disease, a decrease in intelligence is observed.

Signs of the development of multiple sclerosis depend on where the focus of demyelination is localized. Therefore, symptoms vary from patient to patient and are often unpredictable. It is never possible to simultaneously detect the whole complex of symptoms in one patient at the same time.

The first signs of the disease are the result of demyelination, which causes obstruction electrical impulses along nerve fibers. They are most often manifested rapidly, inconspicuous, latent course of the disease, doctors rarely observe.

So, the most common early signs of multiple sclerosis are:

A feeling of tingling and numbness in the extremities.

Periodically occurring feeling of weakness in the limbs, which is most often observed, on the one hand.

Blurred vision, reduced clarity, double vision. In addition, there may be a veil before the eyes, passing blindness in one or both eyes. Oculomotor disorders such as strabismus, diplopia, vertical nystagmus, internuclear ophthalmoplegia are frequent first signs of the onset of the disease.

Pelvic disorders. It is violations of the process of urination observed in almost half of all patients. This symptom in 15% of people with multiple sclerosis is the only sign. Possible incomplete emptying Bladder, nocturia (when more urine is excreted at night than during the day), difficulty urinating, urinary incontinence, the occurrence of a sudden urge to empty it, intermittent urination.

Already in the initial stages of the disease, there is an increase in fatigue or the so-called "chronic fatigue syndrome".

The first signs of an impending disease can be: neuritis of the facial nerve, dizziness, staggering while walking, ataxia (static and dynamic), horizontal nystagmus, hypotension, etc.

The main symptoms of multiple sclerosis

As the disease progresses, the following symptoms of multiple sclerosis are noted:

Violation of sensitivity. Sensations uncharacteristic for a healthy person: numbness, itching, burning of the skin, tingling, transient pains - all these signs begin to disturb the patient more often. The violation of sensitivity begins from the distal sections, namely from the fingers of the limb with its gradual complete capture. Violations are more often unilateral, but sometimes there is a transition to the second limb. Weakness in the initial stages of the development of the disease can be confused with fatigue, but as sclerosis progresses, it will become increasingly difficult for a person to perform even simple movements. The limbs become alien, there is no way to maintain muscle strength.

Visual disturbances. On the part of the organ of vision, there is a violation of color perception, the development of optic neuritis, an acute decrease in vision is possible. Most often, the lesion is also unilateral. Fuzziness and double vision, lack of familiarity of eye movement when trying to take them to the side - all these are symptoms of the disease.

Tremor of the limbs. This symptom significantly affects the quality of life of the patient. It is possible that not only the limbs, but also the torso of a person will be affected by tremor. This occurs as a result of uncontrolled muscle contractions, which leads to the inability to carry out labor and social activities.

Swallowing and speech disorders. These symptoms usually appear in parallel. If in 50% of cases patients do not pay attention to swallowing disorders, then it is impossible not to notice speech failures. This is manifested in its stiffness, blurring, indistinctness.

Gait disorders. Difficulties while walking are caused by numbness of the feet, imbalance, muscle spasms, muscle weakness, tremors.

Muscle spasm. It is this symptom that often becomes the cause of the patient's disability. As a result of the resulting spasms, a person is not able to adequately control the movements of the arms and legs.

Increased sensitivity to heat. It is possible to exacerbate the symptoms of the disease when the body overheats. Similar situations often occur on the beach, in the sauna, in the bath.

Mental disorders, cognitive decline. This symptom is typical for 50% of all patients with multiple sclerosis. They have inhibition of thinking, memory impairment, decreased concentration of attention, difficulties in perceiving information, it is difficult to switch from one type of activity to another. As a result, the patient becomes unable to perform even elementary daily tasks.

Chronic Fatigue Syndrome. Excessive fatigue is most clearly manifested in the afternoon. The patient experiences not only muscle, but also emotional weakness, mental exhaustion, drowsiness and lethargy.

Violations of sexual desire. Up to 90% of men and up to 70% of women suffer from disorders in the sexual sphere. This violation can be the result of both psychological problems and the result of damage to the central nervous system. Libido falls, the process of erection and ejaculation is disturbed. However, up to 50% of men do not lose their morning erection. Women are unable to achieve orgasm, sexual intercourse can be painful, and there is often a decrease in sensitivity in the genital area.

Problems with night rest. It becomes more difficult for patients to fall asleep, which is most often due to spasms of the limbs and other tactile sensations. Sleep becomes restless, as a result, during the day a person experiences dullness of consciousness, lack of clarity of thought.

Violations of the vegetative regulation. How longer sickness exists, the higher the risk of developing autonomic disorders. A person suffers from morning hypothermia, from hyperhidrosis of the feet in combination with muscle weakness, from arterial hypotension, dizziness and cardiac arrhythmias.

depressive moods, elevated level anxiety. Depression can be the result of an underlying illness or a person's response to a diagnosed problem. In this regard, there are frequent cases of suicide attempts, alcoholism. As a result, a person becomes completely socially maladapted, his personality is destroyed.

Violations of the process of urination. All the symptoms associated with the process of urination at the initial stages of the development of the disease worsen as it progresses.

Intestinal dysfunction. This problem can manifest either as fecal incontinence or intermittent constipation.

Rare symptoms of the disease. About 6% of all patients with multiple sclerosis suffer from hearing impairment, most often it is not deafness that develops, but hearing loss, which occurs as a result of damage to the auditory nerve.

Loss of smell is another rare but common symptom of the disease. The reasons may be damage to the mucous membranes of the nose, bone deformities.

Epileptic seizures occur in 2-3% of patients. Which may be due to the periodically occurring excessive excitation of neurons as a result of exposure to a nearby focus of demyelination.

Emotional lability, which manifests itself in unexpected mood swings.

In addition, against the background of existing symptoms, secondary symptoms of the disease may occur. Thus, the risk of urinary tract infection increases due to dysfunction of the genitourinary system, pneumonia and bedsores may develop, which is the result of a sedentary lifestyle, etc.

If multiple sclerosis is initially characterized by a severe course, then the risk of developing a fatal outcome with impaired respiratory function and cardiac activity is not excluded.

Often the causes of death of patients are pneumonia, which are characterized by a severe course, and replace one another.

The occurrence of pressure sores is another consequence of multiple sclerosis. They, in turn, can lead to severe sepsis, which causes the death of the patient. Seriously ill people who are immobilized for a long time are prone to bedsores and diaper rash.

Disability awaits all patients with multiple sclerosis, however, with well-conducted therapy, it can be avoided for a long time.

Diagnosis of multiple sclerosis

Doctors use special diagnostic criteria to determine the disease:

The presence of signs of multiple focal CNS lesions - white matter brain and spinal cord;

Progressive development of the disease with the gradual addition of various symptoms;

Instability of symptoms;

progressive nature of the disease.

Performing MRI of the brain and some parts of the spinal column makes it possible to identify the presence of foci of demyelination and to detect their distribution. Most often they are localized near the ventricles of the brain, where its white matter is located. Priority is given to performing MRI with the introduction of a contrast agent, which allows more accurate detection of lesions in which the blood-brain barrier is broken. This allows you to determine the activity of the inflammatory process at the time of the study.

Sometimes, to confirm the diagnosis, a spinal puncture is required and its biochemical, as well as microscopic examination. The composition of the fluid during the disease changes; a moderate increase in the number of lymphocytes is observed in it, while the number of erythrocytes remains normal - this can be seen from a microscopic examination.

The key point in the biochemical analysis of the fluid is the determination of myelin and the degree of its activity. Its amount during an exacerbation of multiple sclerosis in the cerebrospinal fluid will be increased, especially in the first 2 weeks from the onset of the acute phase of the disease.

It may be necessary to study the bioelectrical activity of the brain, study VEP, SSEP, auditory evoked potentials, audiometry and stabilography.

An ophthalmological examination is mandatory in the early stages of the disease.

Answers to popular questions

How long do people live with multiple sclerosis? The life expectancy of the patient depends on the timeliness of the start of therapy, on the nature of the course of the disease, on the presence of concomitant pathologies. If therapy is absent, then the patient will not live more than 20 years from the moment of diagnosis. When negative impact factors are minimized, average duration human life is reduced by an average of 7 years compared with the life expectancy of a healthy person. In addition, life expectancy is influenced by the age at which the disease manifested. The older the person, the higher the risk of rapid development of sclerosis and the onset of death during the first five years.

Is multiple sclerosis hereditary? Multiple sclerosis is not considered a hereditary disease, although there is a tendency for family predisposition to it. Doctors explain this by the monotony of provocative factors that influence the development of the disease in the conditions of one family.

Can you drink alcohol with multiple sclerosis? Bulgarian scientists conducted a study that revealed that a small amount of alcohol has an anti-inflammatory effect in multiple sclerosis. However, doses are important in this regard. When intoxication occurs in patients, coordination and speech disorders are more pronounced, with the abuse of alcohol, the number of exacerbations of the disease increases. In addition, some doctors insist that the prognosis worsens even with small doses. Therefore, the question of the compatibility of alcohol and multiple sclerosis is still open and each person makes his own decision.

Is it possible to bathe in the bath with multiple sclerosis? No. Any increase in body temperature (when in a bath, during summer heat, with fever, etc.) leads to a deterioration in the patient's condition, to a violation of nerve conduction. During a visit to the bath, a feeling of numbness of the limbs, fatigue, tremor will increase. In addition, visual disturbances are aggravated and cognitive abilities are reduced. However, it is worth considering that the symptoms of the disease will decrease as the body temperature decreases. That is, being in the bath will not lead to persistent organic lesions in sclerosis.

Dr. Myasnikov on multiple sclerosis:

Multiple sclerosis is currently considered incurable. However, people are shown symptomatic therapy, which can improve the quality of life of the patient. He is prescribed hormonal drugs, means to increase immunity. Sanatorium-and-spa treatment has a positive effect on the condition of such people. All these measures allow you to increase the time of remission.

Treatment with hormonal drugs is carried out according to the scheme of pulse therapy. That is, the patient is prescribed high dosages of drugs for up to 5 days.

Reception of corticosteroids is caused by the appointment of drugs of magnesium and potassium. It could be Panangin and Asparkam.

To protect the gastrointestinal tract, Omeprazole, Omez, Ortanol, Losek, Ultop are prescribed.

It is possible to use an immunosuppressor - Mitoxantrone, which is prescribed for a recurrent and intensively progressive form of the disease.

To eliminate depression, Ixel, Paxil, Cipramil, Fluoxetine, as well as tranquilizers, such as Phenosemap, are prescribed.

Detrusitol, Prozerin, Amitriptyline help to cope with pelvic disorders.

Auxiliary agents that reduce the symptoms of the disease include nootropic drugs, vitamins B and E, enterosorbents, antioxidants.

Helps to reduce the number of exacerbations of the drug from the group of immunomodulators - Copaxone.

Drugs help to cope with pain - Lyrica, Gabapentin, Finlepsin.

Gliatilin for multiple sclerosis

This is a nootropic drug. It is able to have a direct effect on the central nervous system, accelerate the transmission of nerve impulses, improve membrane elasticity, and increase the functionality of receptors. In addition, Gliatilin enhances cerebral blood flow, activates the brain. It is taken for the prevention and correction of the disease.

Contraindication to the appointment is individual intolerance to the components of the drug, breastfeeding time and pregnancy. In the acute period, intramuscular administration of 1 ampoule per day is indicated. The course of therapy, as a rule, is 10 days, however, it is possible to increase the duration of treatment if it is not possible to achieve positive dynamics at this time.

To prevent the disease, the drug is taken in the form of capsules, the dose is calculated by a doctor. The course of treatment can last up to six months.

Sermion for multiple sclerosis

Sermion refers to alpha-blockers that improve cerebral and peripheral blood supply. During its long-term use, cognitive abilities are noticeably improved, behavioral deviations are reduced.

The drug is prescribed in a dosage of 30 mg twice a day, or 5-10 mg three times a day. Sermion is prescribed for a long period, which cannot be less than 3 months.

Postponed myocardial infarction, acute bleeding, the period of bearing a child, breast-feeding, age under 18 years and bradycardia are contraindications to prescribing medicinal product. In case of impaired renal function, a dosage reduction is required.

Novantron for multiple sclerosis

Novantron refers to drugs prescribed for cancerous tumors. However, it is recommended for use in multiple sclerosis, as a means of having a depressing effect on the immune system. As a result, it is possible to reduce the activity of the inflammatory process and reduce the symptoms of the disease. The drug is recommended for use with a rapidly deteriorating patient's condition, as well as with a progressively relapsing form of the disease.

The drug is administered intravenously once every 90 days, or up to 4 times a year. The maximum allowable number of doses is from 8 to 12.

Side effects from Novantron treatment are quite serious, including nausea, thinning hair, up to hair loss, and a drop in the number of leukocytes in the blood.

In addition, the drug is prohibited for administration with gout, with viral infections, with diseased teeth, with liver pathologies, during pregnancy and lactation, and with some other diseases. It should be borne in mind that the drug depresses the immune system, so the risk of developing other infections increases. In case of any deterioration in the condition, you should consult a doctor.

Abaggio for multiple sclerosis

Abaggio or teriflumonide is used to treat relapsing forms of multiple sclerosis. This drug is taken by mouth every day. It belongs to the group of immunomodulators, has anti-inflammatory properties.

Possible side effects include nausea, diarrhea, liver dysfunction, loss of hairline. For multiple sclerosis, take 1 tablet daily. The course of treatment is determined by the doctor.

Prolips

Prolips are purified bovine myelin proteins. Its reception contributes to the prevention of autoimmune aggression of the body. Prolips is prescribed at a dosage of 150 mg, the frequency of administration is after 1 day. To prevent exacerbations of the disease, it must be taken throughout the year.

Education: In 2005, she completed an internship at the First Moscow State Medical University named after I.M. Sechenov and received a diploma in Neurology. In 2009, she completed her postgraduate studies in the specialty "Nervous Diseases".

What does he think a common person when you hear the name "multiple sclerosis"? Of course, his brain draws the image of a deep old man suffering from absent-mindedness and sclerosis. In reality multiple sclerosis, being one of the most common neurological diseases, it is not at all similar to senile dementia. On the contrary, an active part of the population suffers from multiple sclerosis - people young age and especially the fair sex.

Multiple sclerosis belongs to the category of chronic diseases, it can affect every area of ​​​​the nervous system, it is impossible to completely recover from it. The symptoms of multiple sclerosis are extremely wide: from slight numbness in the hand to loss of vision, severe paralysis and shortness of breath. Using mathematical methods, it was possible to calculate the number possible symptoms multiple sclerosis - 685! However, none of them is specific, that is, characteristic exclusively of multiple sclerosis.

What happens in multiple sclerosis

Multiple sclerosis is characterized the formation of so-called "holes" in the white matter, those. defective foci myelin, in the place of which there is a proliferation of connective, or sclerotic, tissue. In other words, the formation of foci of "sclerosis" occurs. Their ability to form in any part of the spinal cord and brain indicates their "dispersion in space." Therefore, the disease is called multiple sclerosis.

In addition to foci in the white matter, pathological foci of a different nature also appear in the gray matter, in addition, along with the central nervous system, the peripheral nervous system (nerve fibers leading to the legs, arms, internal organs and face, spinal roots) may be affected.

A few words about the structure of the nervous system

The CNS consists of white and gray matter. Gray matter is the bodies of nerve cells. White matter is a process of such cells that are covered with myelin - a special fatty membrane. The processes through electrical impulses connect one center of the brain with another. The purpose of the myelin sheath is to increase the speed of transmission of impulses and "fencing off" the processes from each other. A similar structure resembles insulating wires.

Symptoms of multiple sclerosis

Like any other chronic disease, multiple sclerosis occurs in two phases: a period of exacerbation is followed by a period of remission (subsidence). A similar pattern is seen in 85 % sick. This variant of the course of the disease is called remitting, or transient.

Duration period of exacerbation usually ranges from one day to two months. Often, after the first exacerbation, the disease does not manifest itself in any way for a dozen or even two decades, while the patient feels completely healthy. However, then the disease is gaining momentum, exacerbations appear. At first, in the intervals between exacerbations (during remissions), all temporarily lost functions of the body are fully restored, but after a while, it is noted growth of a neurological defect and its maintenance even during remission.

Less common are other options for the development of multiple sclerosis - for example, the symptoms that were present initially progress steadily over time, while there are no remissions (the so-called primary progredient course). This variant of the course of the disease is more characteristic of the elderly, while the remitting course is observed more often in those who fell ill in their youth.

Manifestations of multiple sclerosis

The foci of the disease can be located in any area of ​​the peripheral and central nervous system, hence the completely different symptoms and individual compatibility in different patients. However, There are a number of symptoms that are present in patients most often:
1. Sensitivity disorders:
sensations of numbness or tingling (“as if lying down”) in the legs, arms or one half of the body,
the floor is not felt under my feet (“I feel that there are cotton pads under my feet”, “often the slippers fall off my feet, but I don’t notice this”).
2. Violations of the motor sphere:
due to an increase in muscle tone, there is a pronounced tension in the legs or arms (less often),
high tendon reflexes
there may be a decrease in muscle strength in the legs and arms (paralysis).
3. Cerebellar lesions:
body coordination is disturbed,
feeling of loss of control over the limbs: awkwardness and trembling in the legs and arms, staggering when walking.
4. Visual disturbances:
a black dot appears in the center of the field of view;
vision in one eye falls, in some cases he may stop seeing completely;
before the eye is a veil, cloudy glass. All of these signs point to the presence retrobulbar neuritis, in which the optic nerve behind the eyeball is affected due to damage to its myelin sheath.
5. Urination disorders:
with the urge to urinate there is no strength to endure,
urinary incontinence appears (“did not have time to run to the toilet”).
6. Due to traffic violation eyeballs(nystagmus) there is a feeling that the objects are bifurcated.
7. Emotional Disorders:
increased anxiety,
euphoria - inappropriate gaiety, underestimation of one's own state,
depression is a low mood background.
8. Damage to the facial nerve:
decreased taste sensitivity (“as if chewing grass”),
the muscles on one half of the face weaken (“the eye does not close completely”, “the face is twisted”, “the mouth moves to the side”).
9. Other characteristic symptoms:
persistent fatigue, even light physical and mental stress can tire the patient;
when the patient bows his head, he has a feeling that an electric current is passing down the spine;
symptom of "hot bath": after a bowl of hot soup, a cup of hot tea, after taking a bath, there is an increase in existing symptoms.

This list of symptoms of multiple sclerosis is far from complete. All of the listed symptoms, one by one or in various combinations, develop in a few days and, when the exacerbation period ends, they disappear almost completely (usually after two to three weeks).

At the same time, at the first stages of the disease, all functions can be restored even in the absence of treatment in a short time. It may be that a woman does not notice a short numbness of the palm, slight instability or a decrease in visual acuity. Let's talk again: each patient has multiple sclerosis "individual", that is, it proceeds according to a scheme peculiar only to him. It is impossible to predict in advance how severe the manifestations of the disease will be, how often exacerbations will appear and what the duration of remissions will be. Statistics show that in one out of four cases of multiple sclerosis, the course of the disease is benign: even after 20-25 years from the onset of the disease, you can remain almost a healthy person.

Causes of multiple sclerosis

Multiple sclerosis remains to this day a disease that is incomprehensible and mysterious. According to scientists, it is an autoimmune disease. In other words, the human immune system becomes aggressive not only to external factors (viruses, bacteria, etc.), but also to the myelin sheaths of nerves, that is, to the body's own tissues, and damages them. During the period of exacerbation of the disease in the white matter of the brain, foci devoid of myelin appear, the so-called. foci of demyelination, as well as inflammation. It is also important that against the background of powerful treatment of inflammatory processes or even without it, myelin can be restored, and with it comes remission. This continues until the next aggravation occurs.

In addition to white matter, other tissues are also affected: nerve fibers (inside myelin) and gray matter (nerve cell bodies). The mechanism of their defeat is somewhat different: tissues age at a rapid pace. This process occurs both during the period of exacerbation and during remission.

Factors in the development of multiple sclerosis

The "revolt" of the immune system does not occur in all people. This happens if the prerequisites for the malfunctioning of the immune system were inherited by a person, or if a person lives in that part of the Earth where the likelihood of developing multiple sclerosis is increased. However, the totality of these factors alone is not enough for the onset of the disease. Plays a significant role provoking factor, which triggers the failure of the immune response. For example, prolonged exposure to the sun, a viral infection, work with animals and harmful substances. It's hard to believe, but even frequent episodes in childhood and a love of meat products can cause multiple sclerosis in adulthood.

Preventive actions

There are a number of factors that provoke the emergence of a new exacerbation of the disease. Knowing them, you can protect yourself. These include:
emotional or physical stress;
infections (not an exception for ARVI);
prolonged exposure to the sun, hypothermia or, conversely, overheating;
head injuries;
vaccinations;
nicotine addiction.

If you exclude the factors listed above, you can delay the appearance of another exacerbation. However, in many cases need for drug prophylaxis if the course of the disease is accompanied by frequent exacerbations or severe manifestations. Medicines are used that make the immune system work properly, the so-called. immunomodulators: copaxone and beta-interferon ( rebif, betaferon, avanex). They are used in the form of injections (daily, every other day or less often) for many years. The use of such drugs will greatly increase the period of remission, reduce exacerbations and help reduce the rate of development of the disease.

Complications of multiple sclerosis

Multiple sclerosis can result in disability. As a rule, this happens in the later stages of the disease, when the symptoms do not disappear after a period of exacerbation. However, in some cases, an extremely severe course of the disease is noted already at its first stages, up to the risk of death, when cardiac activity is disturbed and the patient loses the ability to breathe independently.

Diagnosis of multiple sclerosis

We mentioned earlier that multiple sclerosis does not have any one specific symptom. For this reason, during the first attack of the disease, it is often not possible to make a diagnosis until a second exacerbation occurs. Although in most cases the patient can remember how once in the past for several days he was slightly staggered, and there was also urinary incontinence. Such an episode can be considered the first exacerbation.

Surveys to be carried out:
MRI (magnetic resonance imaging) of the brain and, if necessary, the spinal cord is necessary to detect foci of demyelination. To find out if the focus is currently in the active stage, you need to enter a contrast agent.
Evoked potentials (EPs) of all modalities are required as a means of detecting the level and extent of pathway damage and, in addition, the involvement of the optic nerves.
Lumbar puncture - the study of cerebrospinal fluid.
Protein electrophoresis - analysis of the protein composition of the blood.
Study of the immune status.
You need to visit an ophthalmologist.

Treatment of multiple sclerosis

Depending on the severity of the exacerbation, appropriate treatment is prescribed.

If the exacerbation is mild (emotional and sensory disorders are isolated), the following apply:
means of a general strengthening nature,
drugs to improve the supply of blood to tissues,
antioxidants,
vitamins,
sedatives (if necessary, antidepressants).

When the stage of exacerbation is more severe, apply:
corticosteroids ( prednisolone, metipred) are hormones. The so-called "pulse" therapy is used - large doses of hormones are administered for five days. Droppers with such powerful and immunosuppressing agents should be started as early as possible, only in this case the recovery processes are accelerated, and the duration of exacerbations is reduced.
due to the fact that hormonal drugs are administered for a short time, side effects they are weakly expressed, but “just in case” they are given simultaneously with drugs to protect the gastric mucosa ( omez, ranitidine), magnesium and potassium ( panangin, asparkam), as well as a complex of vitamins and minerals.

Symptomatic treatment of multiple sclerosis

In addition, in the treatment of multiple sclerosis, a symptomatic method of treatment is used, the essence of which is to eliminate a specific symptom:
with spasticity (increased muscle tone), muscle relaxants are used, in particular baclosan,
patients who have trembling and awkwardness in the limbs are prescribed finlepsin, clonazepam,
with increased fatigue prescribed neuromidin,
if we are talking about violation of urinary processes, apply amitriptyline, detrusitol, prozerin,
with chronic pain, they drink antiepileptic drugs ( gabapentin, finlepsin, lyrica), antidepressants ( ixel, amitriptyline),
if the patient has anxiety, depression, as well as vegetative dystonia syndrome, he is prescribed sedatives, antidepressants ( cipramil, amitriptyline, fluoxetine, paxil), tranquilizers ( phenazepam),
taking into account the fact that patients with multiple sclerosis have withering of brain structures, they need neuroprotectors - drugs that protect nerve tissue from harmful influence (cortexin, actovegin, cerebrolysin, mexidol etc.).

Symptomatic treatment of multiple sclerosis is also used in the following cases:
if the symptoms of the disease are observed without exacerbation,
the course of the disease is primary progressive.

Multiple sclerosis and pregnancy

Since multiple sclerosis tends to affect young women, the following questions are often relevant: should the pregnancy be terminated? How does multiple sclerosis manifest itself during pregnancy? Are independent births allowed? How can a mother's illness affect the child in the future?

Alas, hereditary factor plays a significant role in disease development, for this reason, the child of a sick woman is more likely to develop multiple sclerosis than other children. The disease does not affect the course of pregnancy and natural childbirth. At the same time, pregnancy itself has a positive (!) Influence on the course of the disease: there is scientific confirmation that during pregnancy there are much fewer cases of exacerbation of multiple sclerosis.

However, one should not forget to be careful, because within six months from the moment the child is born, the likelihood of exacerbations increases. To prevent this, it is necessary to undergo treatment with immunomodulators after childbirth. During pregnancy, do not use beta-interferon and copaxone. If an exacerbation does occur during pregnancy, treatment is carried out with the help of plasmapheresis, avoiding the use of corticosteroids if possible.