Multiple sclerosis - symptoms, treatment

Multiple sclerosis is a disease that affects the spinal cord and brain, causing problems with muscle control, vision problems, body balance problems, and sensory problems (numbness). In multiple sclerosis, the nervous system is damaged by the body's own immune system. That is, in fact, multiple sclerosis is considered an autoimmune disease. Autoimmune diseases involve aggression of the immune system against its own organs and tissues (examples of autoimmune diseases are systemic lupus erythematosus and rheumatoid arthritis).

The central nervous system consists of nerves that act as the body's information system. Each nerve is covered with a fatty substance called myelin, which insulates the nerves and helps in transmitting electrical impulses along the nerves, carrying information from the brain to the organs. These nerve impulses control muscle movements such as walking and talking.

Multiple sclerosis gets its name from the increase in scar tissue in the brain or spinal cord. Scar tissue, or plaques, form when the protective and insulating myelin that covers nerves is broken down, a process called demyelination. Without myelin, electrical signals transmitted throughout the spinal cord and brain are interrupted or not transmitted. The brain then becomes unable to send and receive information. It is this breakdown in communication that causes MS symptoms.

Although nerves can reproduce myelin, the process is slow and does not keep pace with the damage caused by demyelination. Symptoms and their severity depend on the location of the scar tissue and the degree of demyelination.

In the United States, multiple sclerosis is one of the most common causes of neurological disability in middle-aged people.

MS is two to three times more common in women than in men and is extremely rare before puberty. Most often, multiple sclerosis occurs between the ages of 20 and 40; as a rule, it does not occur at older ages.

Causes

The causes of multiple sclerosis are still unclear, but evidence has emerged that genetics, environment and even viruses may play a role.

Epidemiological data have revealed several interesting trends in the disease of multiple sclerosis: different prevalence and certain ethnic dependence of the disease of multiple sclerosis have been noted. The disease is more common in northern countries and in people of the white race.

Research shows that MS is more common in certain parts of the world, but if you move from an area with a higher risk to an area with a lower risk, the risks are reduced if the move is before puberty.

In addition, MS is a disease of temperate climates. In both hemispheres, its prevalence increases with distance from the equator.

There have also been “epidemics” of MS in history, for example, a group of people living off the coast of Denmark fell ill with multiple sclerosis after World War II, perhaps due to some environmental problems.

Multiple sclerosis researchers believe that there is a specific genetic basis for the disease multiple sclerosis.

Researchers believe there is more than one gene that predisposes people to the risk of developing multiple sclerosis. In addition, scientists believe that a person is born with a genetic readiness to develop this disease under certain environmental triggers. With the development of gene analysis, it may be possible to obtain more information about the role of genes.

Certain studies do not exclude the role of viruses, especially Epstein-Bar, herpes zoster, even hepatitis vaccines. But obvious evidence of the involvement of viruses in the development of multiple sclerosis has not yet been obtained. Provoking factors for the development of multiple sclerosis also include sex hormones (estrogen and testosterone), which, when released in excess, can suppress the immune system, especially for estrogen (women get sick 2-3 times more often than men). But their role is also not obvious. Currently, scientists have concluded that the disease occurs due to a number of factors.

Symptoms and signs of multiple sclerosis

The most common signs of multiple sclerosis are impaired coordination of movements, muscle weakness, problems with urination, sensory disturbances, fatigue, dizziness, vision problems, decreased intellectual abilities, tingling and numbness of the limbs, impaired speech function, sexual dysfunction, problems with swallowing.

Let's look at the manifestation of these symptoms in more detail.

Impaired coordination of movements

The most common coordination disorders in multiple sclerosis are:

disturbances in the coordination of movements in different muscles - ataxia,
trembling of limbs,
loss of balance,
gait disturbances: it becomes unsteady and clumsy, and instability appears when walking.

Coordination disorders can be a response to sensitive genesis (in this case, the cause is impaired muscle-joint sensitivity), direct vestibular disorders, or malfunctions at the cerebellar level.

Muscle weakness

First of all, muscle weakness manifests itself through reduced motor activity.

Tendon reflexes in the knees and calves are disrupted.
The strength of one half of the body decreases (hemiparesis).
Muscle tone decreases. Natural muscle tension begins to be insufficient to ensure movement.
Painful spasms appear when straightening the legs. As the disease progresses, they are painful even when the person is in a lying position.

Often, impaired motor activity leads/is adjacent to osteoporosis. – a skeletal disease that is associated with metabolic disorders.

Sensitivity disorders

Another characteristic symptom at an early stage is paresthesia - sensitivity disorder.

Most often, the toes and cheeks begin to go numb, and the sensitivity of the legs decreases - from the ankles to the ribs.
I am worried about “crawling goosebumps” and tingling sensations in the body.
There may be false sensations of electric shock in the back and arms. This happens especially often when bending the head or making sharp turns.
A number of patients develop pronounced unilateral sensory disturbances in the facial area.

It is with a sensitivity disorder of 30-50% that multiple sclerosis begins in people at a young age.

Vision problems

Vision problems in multiple sclerosis are associated with damage to the optic nerve.

Retrobulbar or optic neuritis occurs in 60% of people suffering from multiple sclerosis. Its characteristic symptoms are:

Decreased visual acuity. In this case, the problem may appear in one or both eyes.
Painful sensations when moving the eyeballs.
The perception and distinction of colors becomes difficult; especially many difficulties arise in the perception of green and red colors.
Narrowing field of view. A person is forced to choose a convenient angle for himself.

In some patients, blindness progresses. Visual disturbances are also accompanied by headaches.

Urinary disorders

The nature of the disorders depends on the damage to the area of the brain.

With lesions in the area above the pons of the brain, urinary control decreases and urinary incontinence occurs:

If the lesions affect the thoracic and cervical parts of the spinal cord, the ability to relax is lost, an intermittent sluggish stream becomes characteristic of urination, and some people experience a feeling of incomplete emptying.
If the sacral region is affected, problems with the urge to urinate and chronic urinary retention begin. In this case, infection often develops quickly. Problems associated with leukocyturia and microflora come to the fore.

The early stages of multiple sclerosis are more characterized by delay, frequency, urgency (uncontrollable leakage), and the later stages are more characterized by incontinence and loss of urinary control.

Sexual disorders

Characteristic of most patients with urinary disorders.
The problem is aggravated by several factors: both damage to a number of parts of the central nervous system and fatigue characteristic of the disease.
In men, sexual dysfunction is associated with problems with ejaculation and erection. Many men experience decreased libido.
In women, problems manifest themselves in both pain during sexual intercourse and the inability to achieve orgasm.

Rare symptoms of multiple sclerosis

There is also a group of symptoms that occurs only in some patients suffering from multiple sclerosis. But these symptoms are also very serious:

Short-term semi-fainting - paroxysmal state (for a few seconds). Consciousness is not completely lost, but attacks can be repeated several times (sometimes dozens) per day. The problem, to a lesser or greater extent, is relevant for 5-10% of patients with multiple sclerosis.
Epileptic seizures. Occurs in approximately 2% of patients.
Acute psychoses (more often in women).
Sudden onset of back pain with a feeling of being compressed by a tight belt (transverse myelitis).
Respiratory disorders. Characteristic of patients with damaged brain stem.
Sweating disorder.
Hypothermia – a decrease in basal temperature (below 35 ° C).

Symptoms

Almost any neurological syndrome manifests itself in MS. It all depends on which area is affected by the antibodies.

Most often observed:

decreased visual acuity, blurred vision, double vision;
weakness in the arms and/or legs;
increased muscle tone (spasticity) in the arms and/or legs;
numbness of the skin of the face/arms/legs;
unsteadiness and instability when walking;
trembling of hands and feet;
urinary disturbance.

Multiple sclerosis has nothing to do with memory loss; cognitive impairment is not typical for it (the term describes pathomorphological changes).

Causes

Multiple sclerosis is a multifactorial disease. The causes and prerequisites are a combination of unfavorable external and internal factors.

Frequent infections - bacterial and viral in nature.
Increased radioactive background.
Suffered injuries. Often the disease is discovered after an accident.
Stressful situations.
Genetic predisposition (genes that are responsible for controlling the immune response are especially important).

Also, many doctors point to the autoimmune nature of multiple sclerosis. The immune system begins to recognize nerve cells as foreign.

Forms and causes of the disease. Prevention of the disease

There are two forms of tuberous sclerosis: - hereditary - spontaneous (de novo mutations)

Tuberous sclerosis is a hereditary disease. But even if the parents have a mutation in the genes, the birth of a healthy baby is quite likely. To do this, when planning a pregnancy, it is important to undergo a complete examination by a geneticist.

Bourneville disease is an autosomal dominant type. This is a type of inheritance in which a genetic disease manifests itself if a person has at least one mutated gene corresponding to it. The disease can be inherited from either parent with a 0-50% chance. Boys and girls get sick with the same frequency. The disease is not diagnosed immediately - either in infancy (up to 1 year) or in adolescence. Approximately one third of cases of tuberous sclerosis are due to heredity, the remaining two thirds are spontaneous, unpredictable genetic mutations.

Genes on chromosomes 9 and 16 are responsible for controlling the synthesis of hamartin and tuberin, proteins that suppress tumor processes. But when these genes are mutated, the barrier to the pathological growth of abnormal tissue disappears - and tumors form.

If the gene on chromosome 9 is damaged, tuberous sclerosis type I (TSC1) develops. With a mutation on chromosome 16, a diagnosis is made of TSC2 - type II of the disease.

But even if the parents have a mutation in the genes, the birth of a healthy baby is quite likely. Therefore, if there are hereditary diseases in the family, before planning a child, it is necessary to visit a geneticist for consultation and examination in order to exclude the possibility of the birth of a sick baby.

If tuberous sclerosis is suspected, it is necessary to consult a specialist (neurologist, dermatologist, geneticist, ophthalmologist, nephrologist, cardiologist, gastroenterologist, etc.) as soon as possible and undergo a comprehensive examination to reduce the risk of complications.

Routes of infection

Although the disease can be triggered by a viral or bacterial infection, it is impossible to directly become infected with multiple sclerosis from person to person.

An infection can only push the immune system to aggressively produce antibodies, and the body to replace organ parenchyma with dense connective tissue, forming pathological foci in the brain and spinal cord.

But since viruses and bacteria are “provocateurs”, people predisposed to the disease (for example, close relatives suffer from multiple sclerosis) are recommended to pay special attention to the prevention of colds and get vaccinated against infectious diseases in a timely manner.

Risk factors

Pay attention to the statistics:

Women suffer from multiple sclerosis more often than men.
The majority of patients diagnosed with the disease are people aged 18 to 50 years. But you can get multiple sclerosis in early childhood (up to 10% of diagnosed cases occur in childhood) and in adulthood.
Those who have problems with the endocrine system are at high risk of developing multiple sclerosis. The presence of diabetes mellitus and thyroid pathology is especially dangerous.
Chronic inflammatory diseases significantly increase the risk.

Excess body weight is also a risk factor. Especially if an overweight person has problems with lipids: in particular, when the content of low-density cholesterol in the blood is increased.

There is a relationship between the disease and a person’s geographic residence:

Most people with multiple sclerosis live in temperate climates. Here, 1 case is recorded per 300-1000 people.
In the tropics, one person with multiple sclerosis occurs in a population of 5,000–20,000 people
Among people who were born and live near the equator, there is the smallest number of cases

Smoking also significantly increases the likelihood of developing multiple sclerosis. This fact has been proven by Norwegian and American scientists. The fact is that smoking saturates the body with neurotoxins.

Diagnostics

Many diseases, especially at the first stage, are very similar in symptoms and clinical manifestations to multiple sclerosis. Therefore, in order to make an accurate diagnosis, a complex of studies is important. Classical computed tomography, CT agnography, laboratory diagnostics, cerebrospinal fluid puncture, Holter ECG, electroencephalography are of great help in making a diagnosis.

Tomography

The basic diagnostic procedure for detecting multiple sclerosis is tomography.

CT and CT agnography are available at the 5th hospital

CT helps detect large foci of demyelination and a number of other signs that occur in patients with multiple sclerosis.

Huge advantages in using CT agnography:

• The diagnostic method helps to organize the search for narrowings, dilations in the vessels or a complete cessation of blood movement through them. Allows you to create a complete picture of the condition of blood vessels.

• It is a radiological contrast study.

• Good alternative if MRI is contraindicated.

If it is necessary to determine the number and localization of areas of destruction of the myelin sheath of nerve fibers, the world of diagnostics also uses a type of tomography such as MRI.

Laboratory diagnostics

The examination is comprehensive. The following indicators are taken into account:

Leukocyte formula.
Glucose.
Protein.
Total number of cells.
Albumen.
Myelin protein (protein component of myelin).
Opening pressure
Oligoclonal IgG groups.

SSEP Study

Somatosensory evoked potentials are tested in some patients. They show how nerve impulses are transmitted to the brain from receptors in the lower and upper extremities. The method aims to look for delays in electrical responses to sensory stimulation.

SSEP is extremely important for diagnosing patients whose lesions are only in the spinal cord, and the brain is not affected by the disease.

Ultrasound of the brachiocephalic arteries (BCA)

A quick opportunity to take full control of the vessels of the neck, which are directly involved in the blood supply to the brain, to assess the degree of atherosclerotic lesions and metallogeny of the course of blood vessels in this area.

An ultrasound scan of the brachiocephalic arteries is very important if multiple sclerosis is accompanied by spinal osteochondrosis and there is a risk of stroke.

The vessels are viewed from different angles. The results of ultrasound diagnostics are a “picture” with the diameter and lumen of the vessels.

Holter ECG

In patients with suspected multiple sclerosis or its development, it is important to study in detail the state of the cardiovascular system as a whole. And you can’t just limit yourself to ECG here. The ideal option is a Holter ECG.

Monitoring is a recording of heart rhythm over a fairly large amount of time: a day or more.

At the same time, the heart rate is recorded in different phases: at rest, during movement, when eating food and, accordingly, chewing and swallowing it.

A solid picture of the rhythm (gastric extrasystoles, pauses), heart rate, and ischemic changes is visible.

Electroencephalography

Electroencephalography allows you to graphically record the electrical activity of brain cells.
The procedure is painless and harmless.
The study is based on recording ultrasonic waves.
Electroencephalography is effective for analyzing and monitoring brain structures and their displacements. Thanks to these results, the doctor can most accurately determine the degree of development of disorders.

Ophthalmological examination

70% of patients suffering from multiple sclerosis for more than 5 years have optic nerve disorders. Such patients require diagnostics of the structure of the eye disc, computer

computer perimetry to detect the affected area.

The changes in the retina and optic nerve head discovered during the examination are directly related to the level of degenerative lesions in the brain's white matter.

Diagnosis is based on anamnestic and clinical data. At the same time, in order to prescribe the correct treatment, it is important to determine the type of multiple sclerosis:

· Primary progressive. With the progression of the disease, but there are periods with periods of stabilization of the condition.

· Remitting. Two or more exacerbations, between which there is no increase in the severity of the disease. During periods of remission, complete restoration of impaired functions is possible;

· Secondary progressive. The severity of the neurological deficit is constantly and steadily increasing.

It is important to correctly determine the clinical form of the pathology. It can be cerebrospinal, spinal, optical, brainstem, or cerebellar.

Timely diagnosis is the key to choosing the right treatment regimen. But since the picture is often very blurred, it often takes 5 years from the onset of the disease to the diagnosis. This is due to the fact that many diseases are clinically similar. But the more comprehensive the examination, the higher the chance that the diagnosis will initially be made correctly, the patient will be prescribed adequate treatment in a timely manner, and no serious complications will arise.

Complications, prognosis

If treatment is not started in a timely manner, or treatment does not take into account the type of multiple sclerosis, the risk of complications is high:

bursts of causeless, uncontrollable laughter and crying,
urological infections,
bedsores,
tremor,
epileptic seizures;

paralysis in the upper and lower limbs,
trigeminal neuralgia,
depression,
diplopia - double vision,
Lhermitte's symptom is paresthesia (a sudden feeling of intense burning) with a sensation of electric current passing through the back.

Despite the fact that the disease is not simple, for some patients we can confidently voice a favorable prognosis.

If previously, when a diagnosis of “multiple sclerosis” was made, disability began to develop in most patients within 3-5 years, but now, with properly selected medications, it is possible to delay the progression of the disease by 10 and sometimes 20 years.

But much depends on the form of sclerosis. One of the most insidious is the primary progressive form. At first, the symptoms are most vague. The diagnosis is often not made immediately, and treatment, accordingly, is also delayed. But there are often cases when, 10 years after the onset of the disease, the patient simply cannot take care of himself and finds it difficult to move.

At the same time, up to 50% of patients are faced with a form of natural progression. while maintaining the ability to work and practically the usual way of life. The only thing is that they cannot visit baths or stay in the heat for a long time. The main difficulty is to learn to accept your diagnosis and live with it.

Treatment

Treatment of multiple sclerosis is aimed at solving several problems:

stopping the active immunoinflammatory process,
decreased activity of the immune system to nerve fiber sheaths,
slowing down the development of the disease, stopping the appearance of new “plaques”,
combating symptoms that significantly impair the quality of life.

To solve problems, medications and physiotherapy are used.

Complex drug therapy

During treatment, it is important to take immunomodulators and anti-inflammatory drugs. The following drugs are especially well known:

Interferons beta. The drugs have an immunomodulatory effect on the main components of immune reactions.
Medicines based on glatiramer acetate. Medicines in this group are capable of replacing myelin antigens and triggering the process of inhibition of T1 lymphocytes. In this case, T2 lymphocytes, on the contrary, are activated. Due to this, the drug has a neuroprotective and anti-inflammatory effect.
Fingolimod. Modulator of sphingosine-phosphate receptors on lymphocyte membranes. Significantly reduces the number of “autoaggressive” T cells circulating in the blood.
Natalizum. Slows down penetration through the blood-brain barrier and reduces the activity of T-lymphocytes in areas of axonal damage. The inflammatory process is significantly slowed down.

During exacerbations, when the disease is accompanied by obvious attacks, adrenocorticotropic hormone and corticosteroids (methylprednisolone) are used. Thanks to these drugs, it is possible to quickly reduce the movement of immune cells to the spinal cord and brain. But these drugs are only good as short-term therapy. They are not suitable for long-term use, as they can cause addiction.

If the disease is accompanied by signs of depression, the doctor may prescribe amitriptyline or melipramine. However, the prescription of these drugs is done extremely carefully - only after a detailed examination. Unfortunately, many patients already have urinary retention, and amitriptyline and melipramine can significantly aggravate the situation. An alternative for such patients can be all kinds of selective inhibitors without anticholinergic properties, but with an excellent ability to reuptake serotonin. These drugs include trazadone, sertraline, fluoxetine, and paroxetine.

Also, in the presence of depression, agomelatine has been widely used in recent years. This is a drug with a melatonergic mechanism of action. It normalizes circadian rhythms (oscillations).

If you have problems with urination, targeted therapy is needed to solve this problem.

If the main problem is urgency, tolterodine oxybutynin, amitriptyline, nifedipine are used.

If concerns are associated with emptying the bladder, the blocker terazosin helps. But it is important that when taking the drug there is careful monitoring to ensure that orthostatic hypotension does not develop.

Some patients may also be additionally prescribed medications aimed at reducing external sphincter tension. Among them are diazepam, tizanidine.

The above drugs are used in tablet and injection forms.

Hypobaric oxygenation

Oxygen saturation is a big help for patients with multiple sclerosis. This is possible through the hypobaric oxygenation procedure.

Hypobaric oxygenation is especially relevant for patients in whom multiple sclerosis is accompanied by cardiovascular diseases and diabetes.

Hypobaric oxygenation is carried out in a pressure chamber. Oxygen is supplied under high pressure. During the process of hypobaric oxygenation, adaptation and regeneration mechanisms are activated.

Massage

An excellent way to reduce discomfort and pain in patients with different types and stages of sclerosis is massage. Massage is especially useful for solving the following problems:

Relaxes muscles and relieves spasticity.
Activation of blood circulation.
Preventing bedsores. Relevant for people who have to spend most of their time in bed.

Diet therapy for multiple sclerosis

A common principle for all patients with multiple sclerosis is to limit sources of fast carbohydrates in the diet. The main ones are sugar and baked goods made from refined flour.
The remaining principles of nutrition largely depend on what specific problems the patient has in each particular case.
If chewing is difficult, it is recommended to eat pureed foods.

If you have constipation, you should use more liquid foods (if there are no problems with the urinary system at the same time) and products with bifidobacteria.

Multiple sclerosis is not a death sentence (Institute of Medical Communications)

Irina Vadimovna Kazantseva, neurologist, Ph.D. , head of the 1st neurological department of the Federal State Budgetary Institution "Clinical Hospital No. 1" of the Administration of the President of the Russian Federation (Volynskaya), told the Institute of Medical Communications (IMC) about what young patients face, how to lead a full life with a neurological disease and why multiple sclerosis - not a sentence.

The Institute of Medical Communications was founded in Paris in 1992 with the goal of qualitatively improving communication in medical and pharmaceutical activities. The goal of the project was to align the standards and procedures for providing medical care, including medicinal care, to the population of all countries of the world.

The activities of the institute are non-profit and carry educational motives aimed at the implementation of modern methods of treatment, management and control of the medical industry.

The Institute's target audiences are doctors, healthcare organizers, patients, the media, representatives of legislative and executive authorities, pharmaceutical and medical companies.

The Institute brings together the efforts of all stakeholders and organizations in the field of health care to improve the health of the population everywhere.

IMC: What problems do patients most often come to you with?

Irina Vadimovna: About half of all patients are admitted with chronic cerebrovascular insufficiency. 30% are patients with various types of pain: back pain syndromes, facial pain and headaches. Recently, the flow of patients with rare neurodegenerative pathologies has increased: Alzheimer's disease, Pick's disease. We also receive patients with multiple sclerosis for various neurological pathologies.

IMC: Probably each age has its own neurological diseases?

Irina Vadimovna: 20% of our patients are over 80 years old. The older the patient is, the more likely it is that he has accumulated some genetic defects or age-related changes that cause the problem.

Over the past few years, we have become deeply involved in cognitive impairment. Patients aged 30 and 40 come to us with complaints of poor memory. We have evidence and examinations that can show that memory impairment in a given patient significantly exceeds the threshold that exists in this age group.

In a young patient, these problems are most often associated with neurotic disorders. We all live in a state of stress and sometimes the brain is simply unable to absorb information and dismisses it as unnecessary. Our task is to identify the cause of violations. If it is a neurosis, then we give appropriate recommendations: depending on the cause, we prescribe mild nootropic or antioxidant drugs, recommend procedures to help you relax, and conduct classes with a neuropsychologist.

IMC: How does a doctor work with young patients with neuroses?

Irina Vadimovna: The task of a neurologist is to divide patients into two categories: with organic damage to the nervous system and with neurosis. Both categories may have the same symptoms: headaches, dizziness, but the causes are different.

Patients are often perplexed: “I came to you with a headache, and you say that the reason is that I cannot cope with my emotional stress.” We must examine the patient and show that the cause of headaches or heart pain is purely emotional.

IMC: How do you feel about the widespread practice of self-medication today?

Irina Vadimovna: I really don’t like it when patients start sitting on forums and reading annotations for medications. This means that the patient has not found a doctor who would become his assistant, advisor, or friend. A specialist must predict, warn, and help cope with symptoms. As a rule, help on forums is sought by those who have not been explained what and how to do, or by people with sad experiences with medicine. Our patient should not read discussions on forums. He must find his doctor or a medical institution where they will do everything possible to preserve his health.

IMC: What principles do you follow when working with patients?

Irina Vadimovna: The very atmosphere of our hospital has a psychotherapeutic effect and helps the patient relax. Our medical institution is an island of silence in stormy Moscow. Centuries-old trees grow on the territory, birds sing, squirrels jump. Patients do not have the feeling that they are in a hospital, but rather in a sanatorium-resort institution. Even our employees often wear colored gowns instead of white ones, so as not to create the impression of a standard hospital, which is associated with unpleasant odors, pain, and tears.

Our department professes the principle: if after communicating with the doctor the patient does not feel better, then he did not see the doctor. In relation to multiple sclerosis, we have a rule: we report every patient to whom we have given this diagnosis, while he is still being observed with us, to the Multiple Sclerosis Center in Moscow. This is the coordination center that is responsible for providing our citizens with free expensive medicines. At the moment when the patient needs to switch to anti-relapse therapy, they will already know about him and, thus, he will immediately be able to receive all the necessary drugs.

IMC: Do patients with a neurological pathology such as multiple sclerosis require special treatment?

Irina Vadimovna: This is written in all the manuscripts devoted to multiple sclerosis, we see this too: no two patients with multiple sclerosis who would have common problems. Patients are all different. You won’t see any common symptoms: someone came with transient blindness in one eye, someone with a distorted face because they have neuropathy of the facial nerve, for someone multiple sclerosis debuted through facial pain - trigeminal neuralgia.

Today, all necessary services have been created for patients with multiple sclerosis. Most importantly, he must understand the need for treatment and be regularly monitored by a doctor.

IMC: How many years can the period from the manifestation of the disease to the patient’s disability last?

Irina Vadimovna: Multiple sclerosis can occur with virtually no exacerbations, or it can recur regularly.

I have a patient that I have been seeing for 18 years. For many years, even her relatives did not know that she had such a serious illness. For 18 years, while using anti-relapse therapy, she had no exacerbations. She drives, works, and has no neurological defect. And there is a patient who was diagnosed 2 years ago, and she comes to us 3-4 times a year with exacerbations.

Much depends on how a person behaves and how deeply he listens to our recommendations. We had one patient whom we diagnosed with multiple sclerosis. She passed the selection and was going to go to a reality show in Mexico, where there was crazy heat, sun, and physical activity, which was strictly forbidden to her. But she decided that this was more important for her, and she went.

In medical practice, favorable and unfavorable prognostic signs have been identified. It is believed that the earlier a person gets sick, the milder and more prosperous the course of multiple sclerosis will be. Gender also has an impact: in women, the disease is more common and has a milder course. Even by what first symptom develops in a person, one can judge the development of the disease. And yet, with multiple sclerosis, everything is very individual. This disease is like a detective story: despite the fact that it has been studied a lot, a lot has been described, even more questions arise.

IMC: Is therapy also prescribed to patients individually?

Irina Vadimovna: There are two problems in the treatment of multiple sclerosis: to relieve exacerbation and clinical manifestations caused by the appearance of a new plaque, and to prevent relapse. As a rule, the symptoms with which the patient was admitted go away by the end of treatment in the hospital. Next, you need to understand when to start anti-relapse treatment and teach the patient how to carry it out.

The decision to prescribe a particular drug is made after the appearance of a second exacerbation. The difficulty is that after the symptoms are relieved, we send the person home, and we do not know when the next attack of multiple sclerosis will occur. If the patient was unable to relieve all symptoms after the first lesion, this may be a reason to prescribe anti-relapse therapy after the first episode.

Anti-relapse drugs are highly effective, and the state provides these expensive medications to patients, the main thing is adherence to treatment. However, many of them are difficult to tolerate. There are drugs from the group of interferons that a person injects every night or at a less frequent frequency, and each time after the drug is administered, the patient experiences symptoms similar to a flu attack: at night his temperature rises, he experiences muscle pain, and it is impossible to skip the injection.

If a particular drug is fundamentally unsuitable for a person, we have the opportunity to replace it with a drug from another group. All these problems are individual, but solvable. Much depends on how the person adheres to the treatment regimen. Some give up, and after some time they come to us with an aggravation.

IMC: Do doctors encounter difficulties when working with patients with multiple sclerosis?

Irina Vadimovna: Educating a patient and telling them how to live with an illness is a difficult task. But patients with multiple sclerosis are fighters, they rarely give up and always come to the doctor with hope.

We try not to set strict restrictions. If a patient has the opportunity to get a little pleasure from life, we do not prohibit it. For example, a person asks if he can go traveling. We try to find options so as not to completely limit a person and not change the quality of life for the worse.

Our doctors spend part of their working time on the phone with patients. If a patient has questions, he or his relatives can always call us and discuss any problem that has arisen.

http://www. instmedcom. org/news/esli-posle-obshcheniya-s-vrachom-pacientu-ne-stalo-legche-znachit-byl-ne-u-vracha

Conclusions:

Multiple sclerosis is a pathology affecting the nervous system. It is based on damage to the sheaths of nerve fibers and disruption of impulse conduction.
The disease is not hereditary, but with certain combinations of genes the risk is higher.
Increased background radiation, intoxication, stress, and previous injuries can provoke the development of the disease.
When the first symptoms of multiple sclerosis appear, it is important to consult a doctor promptly. It’s better to have it confirmed that it’s just overexertion and fatigue, and not to find yourself in a situation where one on one is the acute phase of the disease.
With multiple sclerosis, the quality of life deteriorates significantly. First of all, because physical activity decreases. But, if previously multiple sclerosis was immediately a death sentence, now there are methods and drugs through which it is possible not only to relieve the symptoms of the disease, but also to slow down the development of the disease. Doctors have learned to keep the disease under control. With timely diagnosis and treatment, the pathology no longer negatively affects life expectancy.
CT and laboratory diagnostics play an important role in diagnosis. When clarifying the diagnosis, it is essential where the problem areas are located: in the brain or spinal cord.

In the 5th hospital of the city, treatment of multiple sclerosis is one of the main profiles. The hospital base has expert-class equipment for diagnosing this disease. Consultations with experienced neurologists are available. Treatment is approached in a comprehensive manner. Drug therapy, massage, physical therapy, including cycling on special simulators, and hypobaric oxygenation sessions are organized.

Treatment of multiple sclerosis

Treatment for MS involves immunomodulation—correction of the immune system.

Exacerbations are treated with hormonal drugs, and in more severe cases, with plasmapheresis aimed at removing antibodies from the blood.

Prevention of exacerbations is carried out with drugs that change the course of multiple sclerosis - DMTs.

Progressive forms of MS require a complex combination of medications, including the use of cytotoxic drugs (slow down or completely stop cell division).

For some manifestations of MS, symptomatic therapy aimed at improving quality of life is possible.