Multiple Sclerosis - Causes, Symptoms and Treatment .MF .
Causes Multiple Sclerosis Symptoms and signs
Diagnosis Treatment and Prevention of Complications
Multiple Sclerosis, or more correctly disseminated encephalomyelitis - a chronic, progressive demyelinating disease of the central nervous system.First described the disease in 1868 by the French neurologist Jean-Martin Charcot.Previously it was thought that the most common in women, and the critical age - 20 - 40 years, but now frequent multiple sclerosis in men and people of the second half of life, people of the white race, the inhabitants of the northern regions (Scandinavia, Russia, the St. Petersburg area, Karelia).
Causes Multiple Sclerosis
main causes of disease - viruses (measles, mumps, herpes, rabies, rubella ...) who live for years in nerve cells, disrupt cellular structure, destroying the myelin sheath and replace them sformirovshimsya foreign protein - prion.Prion is shown as antigen and the body responds to it autoaggression - produces antibodies.Thus formed the heavy autoi
own immune system in multiple sclerosis gradually destroys the nervous system - the white stuff, seeing him for the "alien."Activated macrophages and T-helper cells, increases the permeability of the blood-brain barrier, increased migration of T lymphocytes, which are synthesized antibodies protivomielinovye - formed foci of chronic inflammatory demyelination (destruction or sclerosis).Such pockets of scattered sclerosis space in the brain and spinal cord, hence the name of the disease - multiple sclerosis.One patient at different stages of the disease can be detected at different periods of education hotbeds - acute (active process), the old (inactive process), chronic activation signs, shadows plaques (possible remyelination).
addition affects the white matter and other tissues: gray matter (nerve cell bodies) and nerve fibers (myelin inside).Their loss occurs through a different mechanism: the tissue gradually fade, speed up aging.And this process is constant, occurs not only during an exacerbation.
Risk factors for multiple sclerosis
risk factors can be considered - the white race, the northern country of residence, impaired psycho-emotional state, autoimmune diseases, infectious and allergic diseases, vascular diseases, genetic predisposition (lack of T-suppressors, the change of enzyme indicators).
Symptoms of multiple sclerosis
process of transmission of a nerve impulse is broken at the loss of the myelin sheath of the nerve.
define arrays with demyelinating lesion of the axons and the formation of a pink-gray sclerotic plaques, proliferation and foci of necrosis.It axons defeat ensures the irreversibility of neurological defect.Demyelination can occur in any place, disturbed nerve impulse, and there are a variety of neurological disorders.
In multiple sclerosis exacerbation followed by periods of remission.In the initial stages when remyelination neurological symptoms may disappear or decrease during exacerbation, ie a new demyelination - worsen or cause new, depending on the functional significance of the lesion of the nervous system.Foci of demyelination "scattered" throughout the nervous system, are multiple.
And the same many-sided symptoms.Depending on the location of the lesion area appears appropriate neurological defect.
range of symptoms of multiple sclerosis is quite wide: from mild numbness in an arm or staggering when walking to enuresis, paralysis, blindness and difficulty in breathing.It so happens that the first acute disease does not manifest itself in the next 10 or even 20 years, a person feels completely healthy.But the disease takes its consequence, again comes the aggravation.
most common symptoms among the predominant motor impairment - paresis, paralysis, increased muscle tone, hyperkinesis, visual disturbances.Violations are beginning to wear a transitory nature, ie to appear and disappear.
neurologist at survey can detect nystagmus, double vision, increased tendon reflexes, anizorefleksiyu, loss of abdominal reflexes, pathological signs, impaired coordination - statics and dynamics, dysfunction of pelvic organs - delays and urinary incontinence, a violation of the cranial nerves, vegeto symptomsvascular dystonia, psychiatric disorders - neurosis-like symptoms, asthenia, euphoria, uncritical, depression, sensory disturbances, reduced vibration sensitivity.Moreover, all of the above can be in any combination of mono and symptom.
severity distinguished: mild course of MS - relapsing-remitting (with occasional exacerbations and remissions lasting), moderate - remittiruyusche-progressive, heavy - progressive course (primary, secondary).The forms of multiple sclerosis according to the prevalent symptoms - cerebral, spinal, cerebrospinal, eye, hyperkinetic, atypical.
provoke an aggravation of any disease can even SARS, hypothermia and hyperthermia, insolation, neuro-emotional overload.
Symptoms of multiple sclerosis
Depending on the location of foci of demyelination, symptoms of multiple sclerosis are individual for each patient.Should alert:
- sensitivity Violations: tingling ( "like a lie down") or numbness in the fingers, hands, feet, or half of the body;violation feeling firm ground under his feet ( "go as the mattress", "as if the cotton pillow under your feet," "often loses slippers and do not notice it").
- movement disorders: a pronounced tension in the feet or hands (by increasing muscle tone), and possible paralysis ( "reduced muscle strength in the arms and legs").
- Violation of the coordination body, staggering when walking, clumsiness and trembling of the hands and feet ( "limbs do not obey") tells of the defeat of the cerebellum.
- Visual impairment: reduced vision in one eye, even blindness;a black dot in the center of the field of view;feeling hazy glass veil in front of eye.This manifestation of optic neuritis (with the eyeball optic nerve lesion at the site of the defeat of its myelin sheath).
- Impaired eye movement ( "objects dvoyatsya") - nystagmus.
- urinary disorders: urinary incontinence ( "not reaches the toilet").
- weakness of muscles of one side of the face ( "face contorted," "eyes did not close completely", "mouth moves down in the direction");decrease in taste sensitivity ( "chew the grass").They say about the defeat of the facial nerve.
- Emotional disorders often develop on the background of multiple sclerosis: excessive anxiety, low mood, depression or, on the contrary, underestimation of its condition, inappropriate cheerfulness (euphoria).
- constant tiredness and fatigue even after mild physical and mental stress;a sense of "passing an electric current" down the spine at an inclination of the head;worsening of existing symptoms after a hot cup of tea, a bowl of soup, after taking a bath (a symptom of "hot bath").
is impossible to predict in advance how severe will be the manifestations of the disease in a particular patient, how often will occur exacerbation, and there will continue for long remission.
diagnosis of multiple sclerosis
As specific simptomv in multiple sclerosis not only diagnostic tool.
The diagnosis is confirmed by finding patches of demyelination in magnetic resonance imaging.The most reliable research on machines from 1.5 T with contrast administration.The absence of plaques does not refute the diagnosis.It requires dynamic observation at the neurologist, ophthalmologist examinations to test the visual fields and fundus.Lead is a clinical picture.
Magnetic resonance imaging - given plaques - foci of demyelination
Marburg disease - atypical malignant form of multiple sclerosis are described rare cases.It is characterized by acute onset in young adults, the rapid progressive course without remission.Predominantly affects brain stem.Expressed motor disorders - hemi or tetraplegia, bulbar syndrome - disorders of speech, swallowing, breathing, violation of oculomotor nerves, cognitive functions, aphasia, disturbance of consciousness up to coma.Outbreaks are massive demyelination and multiple character.Prognosis is generally unfavorable.
The differential diagnosis is carried out with almost everything, again due to the versatility of the symptoms.
progression of neurological symptoms leading to the patient's disability.There are special scales for determining the degree of severity, severity of motor disorders, paresis, disability scale - EDSS.
treatment of multiple sclerosis
good prognostic sign of multiple sclerosis - late onset of the disease and monosemeiotic.
Patients with multiple sclerosis debut be hospitalized in specialized centers for treatment of multiple sclerosis.They pick up the treatment schemes, in most centers, there are treatment programs with randomized trials.All patients should be composed on the dispensary at the neurologist.What matters is the state of the patient's psyche, his social adaptation.
treatment is prescribed individually, depending on the stage and severity of the disease.
- Hormone - pulse therapy with high doses of hormones (corticosteroids).Use of hormones in large doses for 5 days.It is important to start as soon as possible to do the dropper with these anti-inflammatory and immune depressing drugs, then they accelerate the recovery process and reduce the duration of exacerbations.Hormones are administered a short course, so the severity of their side effects is minimal, but for secure with them taking drugs that protect the stomach lining (ranitidine, omez), potassium and magnesium products (asparkam, Pananginum), vitamins and minerals;
- β-interferrony (Rebif, Avonex).Β-interferrony - is prevention of exacerbations of the disease, reducing the severity of exacerbations, inhibition activity of the process, the extension of active social adaptation and ability to work;
- symptomatic therapy - anti-oxidants, nootropics, amino acids, vitamin E and B complex, anticholinesterase drugs, vascular therapy, muscle relaxants, chelators.
- For the treatment of rapidly progressing forms of multiple sclerosis are used immunosuppressant - mitoxantrone.
- Immunomodulators: Copaxone - prevents the destruction of myelin, softens the course of the disease, reduce the frequency and severity of exacerbations.
- During periods of remission may sanatorium treatment, physiotherapy, massage, but with the exception of thermal treatments and sun exposure.
Unfortunately, fully sclerosis is not curable, it can only reduce the symptoms of this disease.With adequate treatment can improve quality of life with multiple sclerosis and prolong periods of remission.
Symptomatic treatment of multiple sclerosis
For mild exacerbations with isolated sensitive or emotional disorders using: fortifying agents, improving blood supply to tissues, vitamins, antioxidants, sedatives, antidepressants, if necessary.
muscle relaxants (baklosan) is used to relieve the increased muscle tone (spasticity).Trembling, clumsiness in the limbs removed clonazepam, finlepsin.When fatigue is used neuromidin.When violations of urination - detruzitol, amitriptyline, Neostigmine.In chronic pain - antiepileptic drugs (finlepsin, gabapentin, lyrics), antidepressants (amitriptyline, Ixel).Depression, anxiety, vegetative dystonia syndrome remove sedatives, tranquilizers (Phenazepamum), antidepressants (amitriptyline, tsipramil, Paxil, fluoxetine)
often in multiple sclerosis is necessary administration of drugs that protect nerve tissue from the harmful effects (neuroprotective) - Cerebrolysin, cortexin, mexidol aktovegin et al.
sclerosis during pregnancy
spite of the insidious disease, pregnancy exacerbation of multiple sclerosis occur much less frequently.This is due to the fact that the mother's immune system is suppressed in order to avoid aggressive action on the fetus, and autoimmune reactions subside.If exacerbation during pregnancy yet occurred, then try to avoid possible corticosteroids, and the treatment is carried out by using plasmapheresis.From prevention copaxone and beta-interferon during pregnancy should be abandoned.In the first six months after birth, on the contrary, the risk of recurrence is very high and it is necessary in advance to worry about preventive treatment.
Complications of Multiple Sclerosis Multiple sclerosis
leads to disability.Most often it occurs in the late stages of the disease when the symptoms do not disappear after calming down aggravation.But sometimes from the very beginning there is a very severe course of the disease in violation of spontaneous breathing and heart activity, in this case, possibly fatal.
prevention of multiple sclerosis
Primary prophylaxis (directly aimed at the prevention of the disease) does not exist.You can save yourself a bit of multiple sclerosis or relapse, excluding any infection, stress, trauma, surgery, smoking.
Smoking destroys the nerves
Smoking increases the chance of developing multiple sclerosis in several times, shows the joint study of American and Norwegian scientists.Scientists from the University of Bergen (Norway) and Gardvardskogo University (USA) have shown that cigarette smoke contains chemicals that are potent neurotoxins.As a consequence, active smokers more likely to develop nervous system diseases, including incurable (the latter applies to multiple sclerosis)."We found that of the 87 examined patients suffering from multiple sclerosis, 76 percent in the past were active smokers, with the experience of not less than 15 years - said in an interview with" BBC "Dr. Alberto Asher, head of the study -. Therefore, the link between smoking andthis terrible disease is not in doubt. "
But often there is a need of drug prevention aggravation if the disease occurs with severe symptoms and exacerbations occur if very often.Use immunomodulators - drugs that cause the immune system to work properly: a beta-interferon (Betaferon, Rebif, avaneks) and Copaxone.These drugs are used in injections every day, every other day, or less - for many years.Acceptance of these drugs increases the duration of remission, reduces the symptoms of relapse and helps slow the progression of multiple sclerosis.
neurologist Kobzev SV