– a neurological pathology with a progressive course, caused by demyelination of the pathways with the subsequent formation of sclerotic plaques in the foci of myelin destruction. Among the symptoms of multiple sclerosis, motor disorders, sensory disorders, optic neuritis, dysfunction of the pelvic organs, and neuropsychological changes predominate. The diagnosis is confirmed by MRI of the brain, electrophysiological studies, neurological and ophthalmological examination. Drug pathogenetic therapy for multiple sclerosis is carried out with glucocorticoids, immunomodulators, immunosuppressants

General information

Multiple sclerosis is a chronic, progressive disease characterized by multiple lesions in the central and, to a lesser extent, peripheral nervous system. The concept of “multiple sclerosis” in neurology also corresponds to: plaque sclerosis, multiple sclerosis, spotted sclerosis, multiple sclerosing periaxial encephalomyelitis.

The onset of the disease usually occurs at a young, active age (20-45 years); In most cases, multiple sclerosis develops in people employed in the intellectual sphere. Multiple sclerosis more often affects residents of countries with temperate climates, where the incidence rate can reach 50-100 cases per 100 thousand population.

Causes and pathogenesis

The development of multiple sclerosis, which is a multifocal disease, is caused by the interaction of environmental factors (geographical, environmental, viruses and other microorganisms) and hereditary predisposition, which is realized by a polygenic system that determines the characteristics of the immune response and metabolism. Immunopathological reactions play a leading role in the pathogenesis of multiple sclerosis.

One of the first events in the pathogenesis of this disease is the activation of anergic CD4+ T cells autoreactive to myelin antigens in the periphery (outside the CNS). During this process, an interaction occurs between the T cell receptor and the antigen bound to class II molecules of the major histoconscience complex on antigen-presenting cells, which are dendritic cells. In this case, the antigen may be a persistent infectious agent.

As a result, T cells proliferate and differentiate predominantly into T helper type 1 cells, which produce proinflammatory cytokines that promote the activation of other immune cells. At the next stage, T helper cells migrate across the blood-brain barrier. In the CNS, T cells are reactivated by antigen-presenting cells (microglia, macrophages).

An inflammatory reaction develops, caused by an increase in the level of pro-inflammatory cytokines. The permeability of the blood-brain barrier increases. B-cell tolerance is broken with an increase in antibody titers to various structures of oligodendroglia and myelin. The level of reactive oxygen species and the activity of the complement system increase. As a result of these events, demyelination develops with damage to the nerve fiber already in the early stages of the pathological process, death of oligodendrogliocytes and plaque formation.

Classification

Currently, multiple sclerosis is classified according to the type of disease. There are main and rare variants of the development of the disease. The first include: remitting course, secondary progressive (with or without exacerbations), primary progressive.

1. Remitting course Multiple sclerosis is most typical (up to 90% of cases). There is a period of appearance of the first symptoms or a significant increase in existing symptoms lasting at least a day (exacerbation) and a period of their regression (remission). The first remission is often longer than subsequent ones, so this period is referred to as the stabilization stage.
2. Secondary progressive course Multiple sclerosis occurs after a relapsing course, the duration of which is individual for each patient. The stage of chronic progression begins with periods of exacerbation and stabilization. The increase in neurological deficit is due to progressive degeneration of axons and a decrease in the compensatory capabilities of the brain.
3. At primary progressive course multiple sclerosis (12-15% of cases) there is a steady increase in signs of damage to the nervous system without exacerbations and remissions throughout the disease. This course of the disease is due primarily to the neurodegenerative nature of the development of the pathological process. The spinal form of multiple sclerosis is extremely rare, with possible onset before age 16 or after age 50.

Symptoms of Multiple Sclerosis

The clinical picture of multiple sclerosis is characterized by extreme polymorphism, especially at the onset of the disease, which can be both poly- and monosymptomatic. Often the disease begins with weakness in the legs, less often with sensory and visual disturbances. Sensitivity disorders are manifested by a feeling of numbness in various parts of the body, paresthesia, radicular pain, Lhermitte's symptom, and optic neuritis with a pronounced decrease in vision, which is usually restored later.

In some cases, multiple sclerosis debuts with an unsteady gait, dizziness, vomiting, and nystagmus. Sometimes, at the onset of the disease, the function of the pelvic organs may be impaired in the form of delays or frequent urge to urinate. For the early stages of multiple sclerosis, the fragmentation of the appearance of individual symptoms is typical.

With the development of multiple sclerosis, the clinical picture most often reveals varying degrees of symptoms of damage to the pyramidal, cerebellar and sensory tracts, individual CNs and dysfunction of the pelvic organs. The severity of individual symptoms can vary not only over several days, but even over hours. Among the typical clinical manifestations of multiple sclerosis, the leading place is occupied by paresis. Lower spastic paraparesis is observed especially often, and tetraparesis is less common. The severity of spasticity depends on the patient's posture. Thus, in a lying position, muscle hypertonicity is less intense than in a vertical position, which is especially noticeable when walking.

Signs caused by damage to the cerebellum and its connections - dynamic and static ataxia, dysmetria, asynergia, intention tremor, megalography, scanned speech. When the dentate-red nuclear tract is damaged, intention tremor takes on the character of hyperkinesis, which sharply increases when movement is redirected, and in severe cases spreads to the head and torso. In most patients, pathological foot reflexes of the flexion and extension types are caused, in rare cases, pathological carpal reflexes, clonus of the feet and patellas. In 30% of cases, reflexes of oral automatism are detected. CN pathology in the form of optic neuritis and internuclear ophthalmoplegia is often observed.

A distinctive feature of multiple sclerosis is the so-called. “dissociation” syndrome, which reflects a discrepancy between the symptoms of damage to one or more systems. For example, a significant decrease in vision in the absence of changes in the fundus in the presence of optic neuritis or, conversely, significant changes in the fundus, changes in visual fields and the presence of scotoma with normal visual acuity. In some cases, in the later stages of the disease, involvement of the peripheral nervous system in the process is revealed in the form of radiculopathy and polyneuropathy. Among the neuropsychological disorders, the most common are affective disorders (euphoria, depressive syndrome), a kind of organic dementia, neurosis-like states (hysterical and hysteroform reactions, asthenic syndrome).

Diagnostics

There are certain criteria for diagnosing multiple sclerosis:

• presence of signs of multifocal damage to the central nervous system (mainly white matter of the brain and spinal cord)
• gradual appearance of various symptoms of the disease
• instability of some symptoms
• remitting or progressive course of the disease
• additional research data

Laboratory and instrumental diagnostic methods are used to identify subclinical lesions, as well as to assess the activity of the pathological process. The main method to confirm the diagnosis of multiple sclerosis is MRI of the brain, which allows us to identify the presence and topographic distribution of suspected foci of demyelination.

When the relevant afferent systems are involved in the process at a subclinical level, studies of SSEP, VEP and auditory evoked potentials are carried out. To register clinically significant disturbances in statics, as well as hearing and nystagmus, stabilography and audiometry are performed, respectively. In the early stages of multiple sclerosis, an ophthalmological examination is required to identify disorders typical of optic neuritis.

Differential diagnosis

Multiple sclerosis must be differentiated primarily from diseases accompanied by multifocal damage to the central nervous system - collagenoses and systemic vasculitis (Sjögren's syndrome and Behçet's disease, systemic lupus erythematosus (SLE), periarteritis nodosa, Wegener's granulomatosis) and infectious diseases with primary multisystem damage (HIV infection, brucellosis, syphilis). It should be remembered that for all of the above diseases, a combination with pathology of other organs and systems is typical. In addition, in case of multiple sclerosis, differential diagnosis is carried out with diseases of the nervous system - Wilson's disease, various types of ataxia, familial spastic paralysis, which differ from multiple sclerosis in sluggish progression or long-term stabilization of the pathological process.

Treatment of multiple sclerosis

Patients with multiple sclerosis should be constantly monitored by a neurologist. Treatment goals for multiple sclerosis include: relief and prevention of exacerbations, slowing the progression of the pathological process.

To relieve exacerbations of multiple sclerosis, pulse therapy with methylprednisolone is most often used for 4-7 days. If this pulse therapy is ineffective, after its completion, methylprednisolone is prescribed orally every other day with a gradual dose reduction over the course of a month. Before starting treatment, it is necessary to exclude contraindications to the use of glucocorticoids, and during the treatment process, add accompanying therapy (potassium supplements, gastroprotectors). In case of exacerbation, it is possible to carry out (from 3 to 5 sessions) followed by the administration of methylprednisolone.

The most important direction of pathogenetic therapy for multiple sclerosis is modulating the course of the disease in order to prevent exacerbations, stabilize the patient’s condition and, if possible, prevent the transformation of the remitting course of the disease into a progressive one. The components of the pathogenetic therapy of multiple sclerosis - immunosuppressants and immunomodulators - have a common name "DRUGS" (drugs that change the course of multiple sclerosis). use immunomodulators containing interferon beta (interferon beta-1a for subcutaneous and intramuscular administration) and glatiramer acetate. These drugs alter the immune balance towards an anti-inflammatory response.

Second-line drugs - immunosuppressants - block many immune reactions and prevent lymphocytes from crossing the blood-brain barrier. The clinical effectiveness of immunomodulators is assessed at least once every 3 months. Annual MRI is recommended. When using beta interferons, regular blood tests (platelets, leukocytes) and liver function tests (ALT, AST, bilirubin) are necessary. From the group of immunosuppressants, in addition to natalizumab and mitoxantrone, cyclosporine and azathioprine are used in some cases.

The goal of symptomatic therapy is to relieve and weaken the main manifestations of multiple sclerosis. To relieve chronic fatigue, antidepressants (fluoxetine), amantadine and central nervous system stimulants are used. For postural tremor, non-selective beta-blockers (propranolol) and barbiturates (phenobarbital, primidone) are used, for intention tremor - carbamazepine, clonazepam, for rest tremor - levodopa. To relieve paroxysmal symptoms, carbamazepine or other anticonvulsants and barbiturates are used.

Depression responds well to treatment with amitriptyline (a tricyclic antidepressant). However, you should be aware of the ability of amitriptyline to delay urination. Pelvic disorders in multiple sclerosis are caused by changes in the nature of urination. For urinary incontinence, anticholinergic drugs and calcium channel antagonists are used. In case of impaired bladder emptying, muscle relaxants, stimulants of the contractile activity of the bladder detrusor, cholinergic agents and intermittent catheterization are used.

Prognosis and prevention

With multiple sclerosis, the prognosis for future life is generally favorable. The possibility of death can be minimized with adequate treatment of the underlying disease and timely resuscitation measures (including mechanical ventilation). The natural course of multiple sclerosis involves disability of patients during the first 8-10 years of the disease.

There are currently no methods for primary prevention of multiple sclerosis. The main component of secondary prevention of multiple sclerosis is long-term immunomodulatory therapy.

Update: October 2018

The disease multiple sclerosis is a demyelinating disease of the central nervous system (CNS) with an undulating, chronic course.

This disease is characterized by multifocal, diffuse lesions of the white matter of the brain and spinal cord; in rare cases, the peripheral nervous system is involved in the pathological inflammatory process. We will talk about multiple sclerosis, symptoms, the main causes of its occurrence, and diagnostic methods in this article.

Today, multiple sclerosis does not have a clear geographical, age and gender distribution, as it was before: the disease was typical for countries farthest from the equator, and the risk group was women in the age group of 20-40 years.

Geographical zones with a high prevalence of multiple sclerosis still exist today (countries of northern and central Europe, southern Canada, northern USA, southern Australia and New Zealand), but, according to retrospective epidemiological history, in recent decades there has been an increase in the incidence of this pathology in most regions of the globe.

Women are more often affected, but this disease does not escape men either - about a third of all cases occur among them. The typical age boundaries of the disease expand equally in both directions: the disease is diagnosed in children under 15 years of age and in people over 50 years of age.

What is multiple sclerosis?

Under the influence of certain factors, which we will talk about later, a person increases the permeability of the blood-brain barrier, which normally protects brain antigens from the action of one’s own immune cells. This leads to the penetration of a significant number of blood cells (T-lymphocytes) into the brain tissue, which provokes the development of an inflammatory reaction. In this case, the myelin sheath is destroyed, since tolerance to myelin antigens (the substance that forms the nerve sheath) disappears and they are perceived as foreign.

Simply put, the disease occurs due to the fact that the immune system gradually begins to destroy neuroglial cells that form the myelin sheath of neurons, so the transmission of nerve impulses through neurons slows down, leading to serious consequences - from decreased vision to impaired memory and consciousness.

Of significant importance in the pathogenesis of the disease are the peculiarities of metabolic processes in brain tissue, changes in the speed of blood flow, disturbances of microelement metabolism, the exchange of polyunsaturated fatty acids, amino acids and other factors.

The result of all these negative influences and autoimmune reactions are irreversible degenerative changes in nerve fibers. Such a long-term autoimmune process causes depletion of the immune system, secondary immunodeficiency develops and the hormonal activity of the adrenal glands decreases.

Causes and risk factors of multiple sclerosis

The causes of multiple sclerosis are numerous external and internal (including hereditary) factors.

External factors, when exposed to an organism with a genetically determined predisposition, can stimulate the development of demyelination of nervous tissue. The greatest importance is given to infectious agents of a viral nature (measles viruses, infectious mononucleosis, rubella, herpes).

Various causative factors, both external and internal, can increase the permeability of the blood-brain barrier:

• back and head injuries
• physical and mental stress
• stress
• operations

Nutritional features, such as a large proportion of animal fats and proteins in the diet, have a significant impact on biochemical and immunological reactions in the central nervous system, forming a risk factor in the development of pathology.

• American researchers have concluded that people who have been obese since the age of 20 (increased levels of the adipose tissue hormone, leptin) have a 2-fold increased risk of multiple sclerosis.
• If a woman takes oral contraceptives, this risk increases by 35%.
• Another proven factor is the abuse of table salt (salty foods, processed foods, cheeses, fast food, sausages) leads to pathological activation of the immune system against its own cells, increasing the risk of multiple sclerosis.
• For family members of a patient with multiple sclerosis, the risk of developing the disease increases 4-20 times. A child or adult who has sick relatives with autoimmune diseases should not take any immunomodulators, otherwise this may result in the debut of any autoimmune process in the body.
• It has been established that the progression of multiple sclerosis is facilitated by elevated blood sugar levels.

The additional influence of other exotoxins (paints, petroleum products, organic solvents) aggravates autoimmune reactions.

Genetic factors of predisposition to multiple sclerosis have been proven to be involved in the development and spread of the disease, which include changes in enzyme parameters, insufficiency of T-suppressors, genotype characteristics, and others.

There are risk factors for developing multiple sclerosis:

• northern country of residence, distant from the equator
• white race
• autoimmune pathologies
• psychoemotional state disorder
• infectious-allergic diseases
• vascular diseases

The given risk factors are conditional and are realized under certain circumstances, proving the multifactorial nature of multiple sclerosis.

Diagnostics

Many scientists today are working to create an inexpensive, painless, reliable and safe method for diagnosing multiple sclerosis, which gives a clear picture of the course of the disease and its stage.

The most informative diagnostic method today is lumbar puncture, that is, taking a sample of cerebrospinal fluid, but this is a complex and painful method. MRI can also be used to make a diagnosis, but it is quite expensive. One research group believes that a method of detecting sclerosis based on a patient's breathing will soon be recognized as a possible diagnostic method.

Scientists from the American Medical Center of Southwestern University propose diagnosing this disease by the nature of the pupillary reflex. Since in multiple sclerosis there is a disturbance in the speed of transmission of nerve impulses and multiple lesions of the nervous system, this is reflected in the reaction of the pupil to light.

A study of 85 patients with multiple sclerosis found that their pupils responded to light by constricting 25 milliseconds slower than those of healthy people.

This diagnostic method will still be tested on a larger number of patients, and if its effectiveness is confirmed, it may become an excellent alternative to other diagnostic methods.

Russian employees (Krasnoyarsk) of the Institute of Biophysics have developed a completely new laboratory diagnostic method - detection of antibodies to the proteins of the myelin sheath of neurons in the blood.

Because myelin-damaging autoantibodies are a hallmark of multiple sclerosis, their detection would be the most sensitive way to diagnose MS. The essence of the discovery is that scientists synthesized a single-stranded RNA molecule that is capable of binding to autoantibodies, and attached the photoprotein obelin to it. That is, in the presence of such antibodies, obelin attaches to them and begins to glow. Perhaps this will soon become the most common, safe and simple method for diagnosing multiple sclerosis.

Symptoms, signs of the disease

Symptoms of multiple sclerosis depend on the specific location of the demyelination focus. As a result, the course of multiple sclerosis and its symptoms in each individual patient will be characterized by its own diversity and unpredictability. The following symptoms of multiple sclerosis will almost never occur at the same time.

Symptoms of multiple sclerosis are classified into: primary, secondary and tertiary. To understand what multiple sclerosis is, one should consider the symptoms of the disease that arise as the pathological process progresses.

Primary symptoms are a direct consequence of demyelination, which leads to disruption of the passage of electrical impulses through nerve fiber tissue. Secondary symptoms are a consequence of primary symptoms and arise against their background. Tertiary symptoms are evidence of the extent of the existing disease - a prime example is depression, which is very often diagnosed in patients suffering from the disease for a long time.

The first signs of multiple sclerosis can manifest themselves quite rapidly, or less often, they can develop almost unnoticed for many years. The most common primary manifestations of pathology include:

• tingling and numbness sensation
• weakness in the limbs, often unilateral
• double vision
• weakened and blurred vision
• pelvic disorders

Less common primary symptoms are paresis, changes in speech function, impaired coordination of movements and cognitive functions (memory, attention, concentration).

The first signs of multiple sclerosis according to the frequency of manifestation are presented in the table.

Symptoms	frequency %	Type of pelvic disorder	frequency %
Paralysis of facial muscles	1	Intermittent urination	42
Epilepsy	1	Sudden urges	43
	1	Feeling of incomplete emptying	48
Myokymia (eyelid twitching)	1	Urinary incontinence	48
Unsteadiness of gait, unsteadiness when walking	1	Difficulty urinating	48
Decreased cognitive performance, dementia	2	Nocturia - the predominance of nighttime urine output over daytime	62
Decreased vision	2
Pain	3
Lhermitte's sign - sudden pain when tilting the head, sensation of current passing through the spine	3
Urinary dysfunction	4
Dizziness	6
Ataxia - loss of coordination of movement	11
Diplopia - double vision of visible objects	15
Paresthesia - numbness of the skin	24
Weakness	35
	36
Decreased sensitivity	37

It should be noted that from the onset of the disease, urinary disturbances are a constant symptom in half of the patients, and in 15% of patients they may be the only first symptom of multiple sclerosis. Moreover, even if the patient does not feel any such disturbances, during examination (cystometry), incomplete emptying of the bladder is recorded in 50% of patients. If sclerosis continues in a person for more than ten years, pelvic disorders occur in almost every patient.

Research by scientists confirms that creative hobbies, music, painting, dancing, as well as running in place, walking, moderate physical activity, and aerobic exercise help improve the physical and psychological condition of a patient with multiple sclerosis. It has been proven (by tests for in-depth memory diagnostics and MRI results) that if you do light physical exercise or run, walk for 30 minutes 3 times a week for 3 months, this improves brain functions responsible for emotions and memory.

The progression of multiple sclerosis causes the following symptoms:

• Sensitivity disorders occur in 80-90% of cases

Unusual sensations such as goosebumps, burning, numbness, tingling, and transient pain do not pose a threat to life, but bother patients. Sensory disturbances begin from the distal parts (fingers) and gradually cover the entire limb. Most often, only the limbs of one side are affected, but symptoms can also transfer to the other side. Weakness in the limbs initially disguises itself as simple fatigue, then manifests itself as difficulty performing simple movements. The arms or legs become as if foreign, heavy, despite the remaining muscle strength (the arm and leg on the same side are most often affected).

• Visual impairment

in half of all cases they are represented by optic neuritis and are manifested by acute decrease in vision, impaired color vision and are more often diagnosed on one side. Often there are disturbances in the concordance of eye movements when abducted to the side, blurred vision and double vision.

• Tremor

appears quite often and seriously complicates a person’s life. or torso, occurring as a result of muscle contractions, deprives normal social and work activities.

• Headaches

A very common symptom of multiple sclerosis is headache, the cause of which remains unclear, it is assumed that muscle disorders and depression provoke pain in the head. It has been noted that headaches in MS occur 3 times more often than in other neurological disorders. Sometimes it is the first symptom of incipient sclerosis or as a harbinger of its exacerbation.

• Swallowing and speech disorders

symptoms accompanying each other. Swallowing disorders in half of the cases are not noticed by the sick person and are not presented as complaints. Changes in speech are manifested by confusion, chanting, blurred words, and slurred presentation.

• Gait disturbance

most often associated with symptoms of muscle weakness or muscle spasm. Difficulty walking may result from poor balance or numbness in the feet.

• Muscle spasms

are quite common in the multiple sclerosis clinic and often lead to patient disability. The muscles of the arms and legs are subject to spasms, which deprives a person of the ability to adequately control the limbs.

• Hypersensitivity to heat

occurs when overheated (in a bathhouse, on the beach, etc.) and leads to an exacerbation of existing symptoms of multiple sclerosis.

• Intellectual, cognitive impairment

relevant for half of all patients. Mostly they are manifested by a general inhibition of thinking, a decrease in the ability to remember and a decrease in concentration, slow assimilation of information, and difficulties with switching from one type of activity to another. This symptomatology deprives a person of the ability to perform tasks encountered in everyday life.

• Dizziness

often accompanies multiple sclerosis. It can manifest itself as a feeling of one’s own instability or “movement” of surrounding objects.

• Chronic fatigue

very often accompanies multiple sclerosis and is more typical in the second half of the day. The patient feels increasing muscle weakness, drowsiness, lethargy and mental fatigue.

• Sexual dysfunction

most often manifests itself after urination problems and is diagnosed in 90% of sick men and 705 women. The problem may have a psychological basis and act as a secondary symptom of the disease itself, or develop directly due to damage to the parts of the central nervous system responsible for the functioning of the reproductive system. Libido decreases, erection and ejaculation are impaired. However, almost 50% of men with impotence still have morning erections, which is evidence of its psychogenic nature. In women, sexual dysfunction is characterized by the inability to achieve orgasm, painful sexual intercourse, and impaired sensitivity in the genital area.

• Autonomic disorders

most likely indicates a long course of the disease, and rarely appear at the onset of the disease. Persistent morning hypothermia, increased sweating of the feet coupled with muscle weakness, arterial hypotension, dizziness, and cardiac arrhythmia are noted.

• Sleep disturbance

is diagnosed in half of the cases and manifests itself as difficulty falling asleep against the background of muscle spasms of the legs and tactile sensations. Sleep is restless - patients often wake up and cannot sleep. During the day there is a certain dullness of consciousness and stupor.

• Depression and anxiety disorders

are diagnosed in half of the patients. Depression can act as an independent symptom of multiple sclerosis or become a reaction to the disease, often after the diagnosis is announced. It is worth noting that such patients often make suicidal attempts; many, on the contrary, find a way out in alcoholism. Developing social maladjustment of the individual ultimately causes the patient’s disability and “covers up” existing physical ailments.

• Urinary disorders may include incontinence or urinary retention.
• Intestinal dysfunction can manifest itself as fecal incontinence or constipation.

Secondary symptoms of multiple sclerosis are complications of existing clinical manifestations of the disease. For example, urinary tract infections are a consequence of bladder dysfunction, pneumonia and bedsores develop due to limited physical capabilities, thrombophlebitis of the veins of the lower extremities develops due to their immobility.

Treatment of multiple sclerosis

When a person has monosymptoms (the presence of 1 characteristic symptom), as well as a late onset of the disease, this is a good prognostic sign. However, this disease is considered incurable, so symptomatic therapy is most often prescribed to improve the quality of life, as well as hormone therapy, immunotherapy, and spa treatment that prolongs remission.

• Hormone therapy is used as pulse therapy - the use of large doses in short courses, no more than 5 days.
• Since corticosteroids are used, magnesium and potassium supplements are also prescribed -
• Medicines that protect the gastric mucosa - Losek, Omez, Ortanol, Ultop
• To treat intensively progressive sclerosis, the immunosuppressant Mitoxantrone is used.
• β-interferons are indicated to reduce the severity of an exacerbation or to prevent relapse - Avonex, Rebif
• Plasmapheresis provides a short-term effect, but it is not always used, since it has a number of contraindications
• - cipramil, amitriptyline, ixel, fluoxetine, paxil, tranquilizers - Phenozepam, muscle relaxants - Baclosan.
• For pelvic disorders - prozerin, detrusitol, amitriptyline.
• Vitamin therapy (especially B vitamins, vitamin E), nootropics, enterosobbents (Enterosgel, Polyphepan), amino acids.
• For pain, antiepileptic drugs are indicated - gabapentin, finlepsin, Lyrica.
• To alleviate the symptoms of the disease and reduce the number of exacerbations, an immunomodulator that stops the destruction of myelin, glatiramer acetate, Copaxone, is indicated.

Complications of multiple sclerosis

In some cases, with an initially severe course of the disease with impaired respiratory function and cardiac activity, early death is possible.

The cause of death can be pneumonia, which is characterized by a severe course and can develop one after another. Bedsores can lead to the development of severe sepsis, which ends in the death of the patient.

Multiple sclerosis cannot be completely cured and leads to disability. Most often, disability occurs during a long, multi-year course of the disease, when there are no longer periods of subsidence of symptoms.

People who are far from medicine, hearing the phrase “multiple sclerosis,” immediately associate it with forgetfulness, absent-mindedness, memory loss and consider it “grandmothers’ disease.” To some extent, they are right, since they mean one of the types of sclerosis - senile. In fact, sclerosis can affect various organs and systems, and has several types:

• absentminded;
• lateral amyotrophic;
• cerebral vessels;
• subchondral sclerosis of the endplates;
• senile;
• tuberose.

It has one distinctive feature: the disease causes damage to the myelin sheath of the nerve fibers of the brain and spinal cord. Foci of demyelination appear as a result of the replacement of healthy nerve fibers with connective tissue. They can be scattered in random order in various parts of the brain and spinal cord, while disrupting the functionality of the entire area. With timely and correct treatment of a mild form of the disease, the patient can remain productive and care for himself for a long time. The transition of the disease to a severe form leads to disability; a person will not be able to care for himself without outside help.

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

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

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

When do the first symptoms appear?

Multiple sclerosis is a disease of young people. It is initially diagnosed between the ages of 15 and 40 years. 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, is more susceptible to women - almost 2 times more often than men. There are several theories about the causes of multiple sclerosis, including the theory of the influence of hormonal levels. The most common version of the occurrence of multiple sclerosis involves the immune system recognizing the body’s nerve cells as “foreign, hostile” and their further destruction. Considering the identification of immunological disorders during diagnosis, the basis of treatment for multiple sclerosis is the correction of immune disorders.

In most cases, there can be several factors influencing 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, chicken pox, rubella, etc.);
• increased background radiation;
• ultraviolet radiation (especially for white-skinned people 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 tension, stress;
• obesity;
• prediabetes, diabetes mellitus;
• hazardous production (working with toxic paints, solvents, etc.).

The first signs of multiple sclerosis usually go unnoticed. Diagnosing the disease at an early stage is quite difficult due to the variety of primary symptoms, ways of their manifestation and the stage of the disease. One patient may experience several symptoms at different times, 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 absolutely healthy. But this is the time when the disease is “hidden” and has not gone away - the next exacerbation will be stronger. A variety of factors can trigger a relapse: colds, viral diseases, 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.

Moderate weight. Long periods of remission (sometimes up to several years) are followed by an exacerbation phase with the appearance of new symptoms or the intensification of previously existing ones.

Severe degree. It has two phases: primary and secondary progressive. In primary, there is a constant slow increase in symptoms after the disease is identified and diagnosed, 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 of the condition 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 does this manifest itself?

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

Frequent headaches. It occurs three times more often in MS than in other neurological disorders. Its occurrence is caused by 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 dysfunction. They manifest themselves in confusion of speech, changes in articulation, and slurred pronunciation. Symptoms appear simultaneously and are invisible to the patient, but are pronounced to 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 one’s own instability and reaches a state when it seems that everything around is moving.

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

Autonomic disorders. Characteristic of moderate and severe stages of the disease. It manifests itself as increased sweating of the feet, muscle weakness, low blood pressure, and dizziness.

Night sleep disturbance. There are problems falling asleep due to muscle spasms and unpleasant tactile sensations. Restless sleep does not provide the desired rest, which in the daytime leads to dullness of consciousness and incoherence of thoughts.

Sensory impairment. 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 throughout the entire limb. Most often it spreads on one side, but it can also occur on both sides. Initially, the patient perceives these symptoms as ordinary fatigue, but gradually difficulty appears when performing simple small movements. The limbs feel foreign and disobedient.

Cognitive and intellectual disorders. They manifest themselves in general lethargy, decreased concentration, ability to remember 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 everyday matters.

Tremor. One of the symptoms that may initially be mistaken for Parkinson's disease. Trembling of the limbs and torso does not allow full work and 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 attempted suicide or, conversely, in alcoholism. Being in a depressed state contributes to receiving a disability group.

Change in gait (unsteadiness). Numbness of the feet, muscle spasms, weakness and tremors may cause problems with walking.

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

Sensitivity to temperature changes. When overheated in a bathhouse, sauna, or prolonged exposure to the sun, symptoms worsen.

Sexual desire disorder. It can be both a psychological disorder and the result of a dysfunction of the central nervous system. Libido decreases, but men can have morning erections. Women's sensitivity decreases, they cannot achieve orgasm and sexual intercourse brings pain.

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

Intestinal dysfunction. It manifests itself either as 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 at all, the course of the disease passes slowly, and only in rare cases can the onset become acute. The asymptomatic nature of the disease can be explained by the fact that if there are already areas of damage to nerve cells, healthy nerve 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 symptom, which, in his opinion, is the most important and worrisome.

For example, if vision is impaired (no longer able to distinguish colors, a dark spot appears, etc.), the patient goes to see an ophthalmologist. The doctor prescribes treatment and cannot always correlate this symptom with multiple sclerosis and refer it to a neurologist. At the time of the examination, the optic discs may not yet change their color, and quite 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 early treatment.

If the doctor suspects multiple sclerosis based on the first signs, he refers 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), a lumbar puncture of the spinal canal, SPES (superposition electromagnetic scanning), and 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 another one with similar symptoms.

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

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

Multiple sclerosis (MS) is a severe chronic disease with a poor prognosis. Although sclerosis is often colloquially referred to as memory impairment in old age, the name “multiple sclerosis” has nothing to do with either senile “sclerosis” or absent-mindedness.

The disease received its name because of a distinctive pathological feature: the presence of scattered foci of damage to the myelin sheath passing around the nerve fibers in the central nervous system. The nerves become exposed and cannot conduct signals. This occurs due to disturbances in the functioning of the immune system. Damage to the myelin sheath leads to a gradual breakdown of the nervous system, which affects the physical and psycho-emotional state of the patient.

Why is multiple sclerosis dangerous?

Multiple sclerosis occurs as a progressive primary autoimmune disease of the central nervous system with a steady deterioration of the pathological process. Unfortunately, it should be stated that multiple sclerosis has a disappointing prognosis for life - the disease is now incurable and its course is unpredictable. Sometimes it proceeds benignly (with exacerbations and remissions), but spasmodic or steady progression of the disease is also possible. Even during remission, there is an active process of damage to nerve cells, and disorders of the immune system continue.

The clinical picture of multiple sclerosis is very extensive and includes the following pathological disorders:

• a sharp decrease in visual acuity and field of vision, color vision disturbances;
• disturbances in the movement of the eyeball, pupillary disorders;
• Sensory disturbances – numbness or tingling in the hands and feet;
• pain syndromes;
• movement disorders - muscle weakness, muscle spasticity, lack of coordination;
• swallowing disorders;
• dizziness;
• dysfunction of the pelvic organs - urination, defecation, sexual activity;
• mental disorders;
• fatigue;
• a complex of functional disorders caused by impaired regulation of vascular tone;
• disturbances in sleep, level of consciousness and wakefulness.

The causes of multiple sclerosis are not clear. Treatment of the disease is one of the most serious problems of modern medicine, since there is no medicine that would cure the disease completely. Therapy is aimed at relieving the severity of exacerbations of the pathology, stopping its neurological symptoms and strengthening the immune system.

When treating a disease, it is of great importance how it manifests itself - aggressively or more gradually. The aggressive course of multiple sclerosis requires the use of strong drugs that develop many side effects.

Multiple sclerosis inevitably leads the patient to disability. The disease usually affects young people, and in recent years new cases of the disease have been increasingly registered in children, adolescents, and young women.

Mechanism of disease development

The development of multiple sclerosis occurs on the basis of three main pathological processes:

• inflammatory response in the central nervous system;
• damage to the myelin sheath that runs around the nerve fibers of the central or peripheral nervous system - demyelination;
• progressive death of nerve cells.

Plaque formation (inflammation) mainly occurs in the white matter. The process of their formation is especially active in the posterior and lateral columns of the spinal cord, in the pons, in the cerebellum and optic nerves. It is at these moments that a new symptom of pathology appears or existing signs of the disease clearly worsen. The frequency of exacerbation (attack) of the disease is associated with this pathological process.

The destruction of the myelin sheath alternates with stages of remission - the process of myelin restoration. At this time, the patient's condition clearly improves. Remission that lasts more than a month is already defined as stable.

However, even when the myelin sheath is restored in the initial stages of plaque formation, this process is not efficient enough. Therefore, in the later stages of pathology, restoration of the myelin sheath is weakly expressed. This worsens common symptoms of neurological deficits (neurological symptoms). Chronic progression of multiple sclerosis begins: the severity of symptoms increases over several weeks without stabilization or improvement.

At-risk groups

The disease affects people of all ages. Women get sick more often. However, men suffer from the most dangerous, rapidly progressing form. With this disease, several parts of the nervous system are simultaneously affected, which is characterized by the appearance of various neurological disorders. The first signs of the disease include: a feeling of numbness or aching. These symptoms may appear, then pass and not appear for a long time.

Plaques vary in size, from a few millimeters to a centimeter or more. If the disease progresses, they join together, forming large scars. Special examination methods make it possible to identify new and old lesions in the same patient, since the process does not stop, but only subsides for a while, then resumes again.

Multiple sclerosis affects a fairly large number of people. According to statistics, there are more than 2 million such patients on our planet. The largest number of such patients live in large cities. In Russia in 2016, 150 thousand patients were registered. When studying the epidemiology of the disease in Moscow, it was found that the onset of multiple sclerosis before the age of 16 was observed in 5.66% of people.
The geographic latitude of the place of residence is also important. The incidence rate is highest in those who live north of the 30th parallel. This is typical for residents of all continents.

Belonging to a certain race also matters. People of the Caucasian race are more often exposed to this disease than residents of Asian countries: China, Japan, Korea.

Recently, the number of people suffering from multiple sclerosis has been increasing. This is happening both due to an increase in the number of sick people, and also due to the modernization of diagnostic equipment.

Is multiple sclerosis inherited?

Years of research have supported the theory that there is a genetic predisposition to multiple sclerosis. It is determined by a set of genes, both related and not related to the immune response (this depends on what ethnic group the sick person belongs to). Hereditary factors can determine the characteristic clinical form of multiple sclerosis and the progression of the disease.

There is an assumption that in Europeans the disease is associated with a set of the DR2 gene form on the sixth chromosome. This association turned out to be most significant when examining cases of pathology with an early onset of the disease, that is, before the age of 16 years.

The hereditary factor of multiple sclerosis is often combined with external causes. Of particular importance for the formation of a provoking background in the development of the disease in a child are:

• frequent infectious diseases, especially viral ones, as well as mycoplasmas, staphylococci, streptococci, spirochete pallidum, fungi;
• psycho-emotional stress;
• Vitamin D deficiency, as it can suppress reactions associated with a disorder of the body's immune system.

High levels of vitamin D in the blood reduce the risk of developing multiple sclerosis in Europeans.

Causes

It has not yet been possible to establish what causes multiple sclerosis. Scientists suggest that multiple sclerosis occurs from the random coincidence of several factors harmful to health:

• infections of various etiologies;
• poisoning;
• radiation (including solar);
• poor nutrition;
• frequent stress.

Multiple sclerosis is not inherited, but genetic dependence is of great importance. Not always, but often observed in close relatives.

How does multiple sclerosis manifest? What are the signs?

In the early stages, the disease may not manifest itself even in the presence of plaques in the brain. This happens because if a small number of nerve fibers are affected, then healthy ones completely compensate for their function. As the pathological process spreads, neurological symptoms also appear. The clinic depends on the location and degree of damage to the patient’s brain tissue.

At first, the disease is unstable. Symptoms may appear, last for a certain period of time, then go away and reappear. Over time, periods of remission become shorter, then disappear completely, and the intensity of painful phenomena increases. Functional impairment depends on where the scars are located, which impede the passage of nerve impulses. Most often, patients are concerned about:

• causeless fatigue;
• frequent weakness;
• visual acuity decreases, double vision appears, then partial or complete paralysis of the ocular or facial nerves may occur;
• feeling of numbness or tingling;
• tremor or trembling in the limbs;
• muscle weakness;
• gait becomes unstable;
• tactile sensitivity decreases in 60% of patients;
• retention of urination and stool appears, followed by incontinence;
• sexual function decreases;
• in the early stages there are frequent changes in mood, which leads to conflicts with others, then depression, behavioral disturbances and decreased intelligence;
• some patients may experience pain - headache, back or limbs;
• eventually partial or complete paralysis occurs.

Several syndromes, which are also signs of the disease, help doctors diagnose the disease:

1. “Hot bath” syndrome in multiple sclerosis is the most common. It manifests itself as a deterioration of the condition, an increase in neurological symptoms, especially motor and visual disturbances after a bath, a hot bath, or with an increase in ambient temperature.
2. “Clinical splitting” syndrome is a manifestation of a discrepancy between the symptoms of damage to certain systems. For example, blanching of the optic discs, narrowing of the visual fields with normal visual acuity and, conversely, a significant decrease in vision with normal fundus. Or a spastic gait with weak muscle tone when lying down.
3. Syndrome of “inconstancy of clinical signs” - the severity of neurological manifestations fluctuates over the course of a day or several days.

Clinicians call an atypical sign of the disease pain that is associated with impaired muscle tone, painful muscle spasms, sensitivity disorders, associated changes in the spine and joints, and concomitant diseases.

The signs of multiple sclerosis are individual for each patient. It depends on which parts of the central nervous system are affected and on the depth of the damage. The appearance of new neurological symptoms or the intensification of already manifested symptoms indicates an exacerbation of multiple sclerosis.

Diagnosis of the disease

Until recently, the time when the diagnosis of “multiple sclerosis” would be correctly established was not of decisive importance, since treatment had no effect on the course of the disease. Now the situation has changed dramatically: early diagnosis is of fundamental importance. This is due to the fact that immunomodulatory drugs have been found that have a positive effect on the course of the disease and slow down the progression of multiple sclerosis.

Early diagnosis and appropriate treatment can reduce the likelihood of developing disability and provide a good prognosis for the patient, who can maintain his social activity, family life, and remain a full member of society.

Unfortunately, modern medicine does not have specific tests and methods for examining multiple sclerosis. Diagnosis is difficult and is based on the clinical picture, the patient’s complaints, the results of magnetic resonance imaging (MRI) and studies of the cerebrospinal fluid, which also reveals characteristic changes for this disease.

Magnetic resonance imaging is one of the most effective modern examination methods that can detect changes in the brain and spinal cord that are characteristic of multiple sclerosis. This research technique allows you to obtain a clear image of the structures of the brain and spinal cord and describe the extent of their damage by the pathological process.

Foci of demyelination (active plaques) have a characteristic shape and location. The size of the lesions, as a rule, is 1–5 mm, but sometimes due to fusion and swelling they reach 10 mm. “Fresh” lesions of the brain have an uneven, unclear outline. The most typical locations for lesions are along the lateral ventricles, in the corpus callosum. Foci of damage to the spinal cord can also be identified.

Variants of the course of the disease

Multiple sclerosis as a disease has a varied course. If a patient has minimal neurological symptoms for more than ten years, the disease is defined as mild, non-aggressive. If during the first five years there are frequent exacerbations with residual symptoms or rapid progression leading to complete helplessness of patients, such multiple sclerosis is defined as malignant.

Clinical forms of the disease are based on how multiple sclerosis occurs:

1. Relapsing-remitting multiple sclerosis.

An undulating course of the disease with periods of deterioration and improvement. It occurs with exacerbations and remissions, complete or incomplete restoration of functions in the periods between exacerbations. During periods of remission there is no increase in symptoms. This is a classic version of the disease.

As a rule, over time, remissions are observed less frequently and in the majority of patients they enter the stage of secondary progression of the pathological process.

1. Secondary progressive multiple sclerosis.

A gradual increase in symptoms with rare exacerbations (or without them). There are periods of stabilization. After 15–20 years from the onset of the disease, almost all patients become disabled. But about 50% of patients can care for themselves.

1. Primary progressive multiple sclerosis.

Steadily progressive increase in neurological disorders from the very beginning of the disease, without exacerbations and remissions. In a quarter of patients, the condition worsens every year. After 25 years of the disease, almost all patients have problems with self-care. The prevalence of multiple sclerosis of this form is 10–15% of cases.

1. Primary progressive multiple sclerosis with exacerbations.

A progressive increase in neurological symptoms from the very beginning of the disease, against the background of which exacerbations occur. A rare form of the disease, observed in 3–5% of cases.

The main indicators of the course of the disease are the presence and frequency of clinically detectable exacerbations and the rate of increase in neurological symptoms.

Treatment of exacerbations of multiple sclerosis

The goal of treating multiple sclerosis is to make the course of the disease milder, the remissions to be long-lasting, and the neurological impairments to be less severe. It is important to help the patient maintain his ability to work, delay the onset of disability, helplessness in everyday life, and reduce the severity of disability.

Exacerbation of the disease is assessed according to three parameters: how often, how long and how severe the clinical symptoms are. An MRI is performed to identify hyperintense lesions of nerve cells.

To treat exacerbation of the disease, hormonal therapy is carried out with methylprednisolone, a synthetic glucocorticoid drug. When taking medications from this group, the following side effects may develop:

• the occurrence of gastritis, stomach ulcers;
• high blood pressure;
• disturbance of water-electrolyte metabolism, excretion of potassium salts;
• increased intraocular pressure, development of steroid cataracts;
• activation and accession of infections;
• reactivation of the tuberculosis process is possible;
• mental disorders - anxiety, sleep disorders, emotional changes, steroid psychoses;
• increased levels of glucose in the blood, urine, manifestation of latent diabetes mellitus, steroid diabetes;
• , aseptic necrosis of the femoral neck with long-term use;
• disturbance of heart rhythm when prescribing high doses.

To correct the side effects of corticosteroids, a diet rich in potassium, medications containing potassium and calcium, diuretics, and drugs that protect the gastric mucosa are simultaneously prescribed. It is also necessary to monitor blood pressure levels, blood glucose, and electrocardiogram monitoring.

Contraindications for corticosteroid therapy are:

• significant increase in blood pressure;
• diabetes mellitus with high blood glucose levels;
• pulmonary tuberculosis;
• the presence of any other infectious process;
• the presence of erosive gastritis or stomach ulcers.

In this regard, all patients, before prescribing hormonal therapy, need to conduct a blood glucose test, chest x-ray and gastroscopy (endoscopic examination of the digestive tube).

Hormonal pulse therapy not only stops exacerbations of multiple sclerosis, but also slows down the progression of the disease. In case of severe exacerbations, plasmapheresis is indicated - a blood purification procedure.

The second direction of treatment of the disease is immunocorrective therapy. It is aimed at reducing the frequency of exacerbations. Medicines that modify the course of multiple sclerosis include beta interferons (immunomodulators) and glatiramer acetate. The inflammatory process is limited by immunoglobulin G, used in high doses intravenously. The main problem with treatment with drugs that affect the frequency of exacerbations and the rate of progression is that they are expensive.

The third direction of treatment of the disease is symptomatic treatment: treatment of increased muscle tone, damage to the optic nerve, pain syndromes, urinary incontinence, disorders of the large intestine, decreased potency in men and other manifest signs of the disease.

If patients have persistent movement disorders, they may require rehabilitation measures aimed at reducing spasticity in the limbs, improving coordination or fine motor skills in the presence of tremors or weakness in the arms.

Patients with multiple sclerosis especially require regular psychological support due to the difficult process of accepting the diagnosis and the emotional disorders that arise during the progression of the disease. Therefore, psychotherapy is indicated at all stages of the disease.

Multiple sclerosis: disease prognosis

In half of patients, relapsing-remitting multiple sclerosis develops into a secondary progressive form of the disease after 10 years. After 25 years, almost all patients receive little help from treatment.

If there is no supportive treatment, over 15 years of disease development, 80% of patients have organ dysfunction, 70 percent of patients find it difficult to care for themselves, and half of the patients cannot move independently.

Autonomic disorders are detected in 80% of patients:

• constant moderate decrease in body temperature;
• dizziness, high blood pressure;
• sweating disorders;
• during an exacerbation of the disease, cardiac arrhythmia develops;
• reduced physical activity forms osteoporosis;
• respiratory dysfunction - shortness of breath, feeling of lack of air, difficulty coughing, prolonged hiccups.

With multiple sclerosis in children, secondary progression of the disease occurs after about 30 years. The quality of life of adolescents is worsened by depressive states, chronic fatigue, and anxiety.

The outcomes and prognosis of the disease depend on the timeliness of diagnosis and the initiation of adequate treatment of the disease with drugs that modify the course of multiple sclerosis. Medicines slow down the increase in disability.

Research into the cause of multiple sclerosis, the course of the disease, and the search for drugs to treat it are being carried out very actively. The time is approaching when ways will be found to prevent secondary progression of the disease. The treatment of multiple sclerosis will change dramatically. Treatment will be aimed at influencing the mechanisms of the onset and development of the disease.

Multiple sclerosis is a disease characterized by a chronic form of manifestation.

The peculiarity of this disease is that it is associated with a malfunction of the immune system, as a result of which the spinal cord and brain are affected.

The disease manifests itself in the form of disorders associated with coordination, vision, and sensitivity.

This is all caused by the fact that a process such as demyelination of nerve fibers occurs in the body, namely, their stripping of myelin.

The disease is one of the autoimmune diseases in which the functioning of the immune system is disrupted. Its main goal becomes “erroneous” and instead of foreign cells and bacteria, it directs its action to its own.

The main essence of this disease is the formation of areas of sclerotic tissue or scars in the areas of the spinal cord and brain.

As a result of this phenomenon, all electrical impulses passing through these barriers are either suppressed or their character is distorted.

As a result, this leads to the inability of the brain to control and coordinate the entire process, that is, to efficiently send and receive incoming information from the entire organism.

The first sign of multiple sclerosis appears at the age of 20-30 years. But there are cases when multiple sclerosis manifests itself both at an older age and in children.

Signs of multiple sclerosis appear more often in women than in men. And it is typical for the countries of northern Europe, but in countries with a tropical climate this disease is a rare occurrence.

Types of disease

Depending on the type of multiple sclerosis and its characteristics, it is possible to predict the complexity of the course of the disease, as well as the response to treatment methods.

The following types are distinguished:

1. Primary progressive- characteristic constant deterioration of the condition. Attacks may be mild or not pronounced. Symptoms include problems with walking, speaking, seeing, urinating, bowel movements,
2. Relapsing-remitting– appears at the age of 20. The attacks occur periodically. Symptoms of manifestation are constantly changing, but mainly manifest themselves in the form of pain in the eyes, legs, dizziness, imbalance, coordination, thinking, depression,
3. Secondary progressive– develops after a relapsing-remitting disorder that has occurred over many years. This type is characterized by a stable onset without relapses or remissions. Symptoms include a significant increase in weakness and loss of coordination, leg muscles become stiff and dense, significant changes appear in the functioning of the intestines and bladder, fatigue quickly sets in, depression increases, problematic thinking,
4. Progressive-relapsing- is a less common species. It is characterized by periodic attacks, persistence of symptoms, which intensify between relapses. Symptoms include similar disturbances in the functioning of the musculoskeletal system, intestines, bladder, visual function, sensitivity, coordination, depression, etc.

Why does the disorder occur?

The exact reasons that would provoke the development of multiple sclerosis have not yet been identified. But despite this, there are theories that relate to the development of this disease.

These include:

• absence of a hereditary nature, but a risk factor for development is present if such a diagnosis is present in close relatives;
• A viral infection can contribute to the appearance of this disease;
• lack of vitamin D - can lead to a decrease in the body's protective response to multiple sclerosis;
• autoimmune reaction - is a process of destruction of myelin, in which the body mistakenly tries to fight against its own cells;
• poor nutrition;
• strong frequent stress can act as triggers for the development of this disease;
• chronic intoxication;
• traumatic brain injuries.

Main symptoms and signs

The course of the disease for each patient is an individual phenomenon.

For some, the manifestation can be quite violent, while for others it may not be noticeable at all for a long period.

The main symptoms of multiple sclerosis include:

• tingling sensation, numbness;
• double vision;
• weakness in the limbs;
• decreased vision;
• lack of coordination;
• "unrelated" speech;
• neuropathic disorders that lead to problems with urination;
• psychopathic changes - manifested in the form of irritability, lethargy, apathy, depression.

For convenience, all symptoms of sclerosis are divided into groups:

1. Primary– they are characterized by symptoms that are the result of demyelination, which is based on the process of disruption of the conduction of impulses along nerve fibers. These include: tremors, muscle weakness, visual disturbances, bowel, bladder, balance, paralysis.
2. Secondary– represent a consequence of the primary group. For example, due to paralysis, bedsores, diaper rash, etc. follow. These symptoms can be cured, or prevention techniques can be applied to them,
3. Tertiary– This group is characterized by symptoms of a psychological scale. For example, depression.

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Features of treatment

There are no complete methods that would guarantee a 100% cure for multiple sclerosis today.

Only those measures are singled out that help cope with an exacerbation, prevent its occurrence, or reduce the severity of its manifestation.

A professional approach to the treatment of multiple sclerosis should be based on the following signs:

1. Individual approach. The stage of the disease at a specific moment is determined, the peculiarity of its course,
2. Examination in dynamics. These include: MRI of the brain and spinal cord, immunological blood test, electrophysiological, psychotherapeutic methods,
3. Constant supervision by a number of specialists(neurologist, immunologist, electrophysiologist, neuropsychologist, urologist, neuro-ophthalmologist).

Main objectives of treatment:

• stop exacerbation;
• stimulation of compensatory and adaptive mechanisms;
• prevent the development of new exacerbations, reduce their strength;
• selection of activities that will help the patient adapt to the existing consequences.

Types of drugs that are used in the treatment of multiple sclerosis:

Preventive measures

Prevention of multiple sclerosis is a set of measures that are aimed at eliminating provoking factors and preventing relapses.

The constituent elements are:

1. Performing anti-relapse treatment. It must be regular, regardless of whether the disease manifests itself or not,
2. Excluding hot foods from the diet, avoiding any thermal procedures, even hot water. Following this recommendation will help prevent the appearance of new symptoms,
3. Maximum protection(prevention) against viral infections,
4. Diet, the essential elements of which are Omega-3 polyunsaturated fatty acids, fresh fruits, vegetables,
5. Therapeutic gymnastics– moderate loads stimulate metabolism, creating conditions for the restoration of damaged tissues,
6. Maximum calm, avoidance of stress and conflicts.

Thus, multiple sclerosis is a rather dangerous disease that can lead to disability if left untreated.

Despite the uncertain nature of the origin of this disease, there are quite adequate treatment methods.

Thanks to the right approach, it is possible to reduce or even avoid exacerbations over a long period.

The desire to live, to fight, to overcome difficulties, to avoid provoking factors is the real key to successfully overcoming the disease.