Treatment involves the use of immunomodulators and symptomatic treatment. Action immune drugs aimed at stopping the process of destruction of the nervous structures of antibodies. Symptomatic medications eliminate the functional consequences of this destruction.
What it is?
Multiple sclerosis - chronic autoimmune disease in which the myelin sheath of nerve affected brain and spinal cord fibers. Although colloquially "sclerosis" is often referred to as memory impairment in old age, the name "multiple sclerosis" has no relation to senile "sclerosis" or to absent-mindedness.
"Sclerosis" in this case means "scar" and "dispersed" means "multiple", since the distinctive feature of the disease in postmortem study - presence scattered throughout the central nervous system without a specific localization of foci of sclerosis - the replacement of normal nerve tissue junction.
Multiple sclerosis was first described in 1868 by Jean-Martin Charcot.
Statistics
Multiple sclerosis - a fairly common disease. There are around 2 million patients in Russia - more than 150 thousand. In a number of Russian regions the incidence is quite high and ranges from 30 to 70 cases per 100 thousand. population. In large cities and industrial areas it is higher.
The illness usually occurs around the age of thirty years, but can occur in children. Primary-progressive form is more common in the age of about 50 years. Like many autoimmune diseases, multiple sclerosis is more common in women begins in their average 1-2 years earlier, while men dominated by the unfavorable current progressive form disease.
In children, gender distribution can be up to three cases in girls against a single case of boys. After 50 years of age with multiple sclerosis ratio of men and women is approximately equal.
Causes of MS
The cause of multiple sclerosis is not exactly clear. Today, the most common is the belief that multiple sclerosis can occur at by accidental combinations of a given person of adverse external and internal factors.
Adverse environmental factors are
- geoecological residence, especially its great influence on the organism of children;
- trauma;
- frequent viral and bacterial infections;
- influence of radiation and toxic substances;
- feeding habits;
- genetic predisposition is probably due to a combination of several genes that determine violations primarily in immunoregulation system;
- frequent stressful situations.
Each person in the regulation of immune response is involved multiple genes. The number of interacting genes may be large.
Recent research confirmed the obligatory participation of the immune system - primary or secondary - in the development of multiple sclerosis. Abnormalities in the immune system are associated with the features of a set of genes that control the immune response. The most widespread autoimmune theory of the origin of multiple sclerosis (nerve cell recognition by the immune system as "foreign" and their destruction). Given the central role of immunological disorders, the treatment of this disease is primarily based on the correction of immune disorders.
In multiple sclerosis, as the pathogen is considered virus-1 NTU (or related unknown pathogen). It is believed that the virus or group of viruses in the body cause the patient serious violations of immune regulation with the development of inflammation and the breakdown of the myelin structures of the nervous system.
Symptoms of Multiple Sclerosis
In the case of multiple sclerosis symptoms are not always appropriate to the stage of the pathological process exacerbation may be repeated at different intervals: at least a few years, at least a few weeks. Yes, and relapse may last only a few hours, and can reach up to a few weeks, but each new aggravation more severe the previous one, due to the accumulation of plaque and the formation of the drain, the exciting new areas. This means that is typical for remitting to Sclerosis Disseminata. Most likely, because of such volatility neuroscientists have come up with another name for multiple sclerosis - a chameleon.
The initial stage, too, are uncertain, the disease can develop gradually, but in rare cases, is capable of giving a rather acute onset. In addition, in the early stages of the first signs of the disease may not be noticed, because during this period is often asymptomatic, even if the plaques are already taking place. A similar phenomenon is explained by the fact that in a few foci of demyelination healthy nerve tissue takes over the functions of the affected areas and thus compensates for them.
In some cases, you may receive any one symptom, such as blurred vision in one or both eyes in cerebral form (eye kind) SD. Patients in this situation are generally will not treat or limit visits to an ophthalmologist, who is not always able to attribute these symptoms to the first signs of a serious neurological disease, which is the multiple sclerosis because of the optic nerve (MN) color your can not yet change (hereinafter in MS temporal half ZN blackness). In addition, this form of giving long-term remission, so patients can forget about the disease and consider themselves quite healthy.
Progression of Multiple Sclerosis causes the following symptoms:
- sensory disturbances occur in 80-90% of cases. Abnormal sensations such as tingling, burning, numbness, itching, tingling, transient pain is not life-threatening, but concerned about the patients. sensory disturbances start at distal parts (fingers) and gradually cover the whole limb. Most often affects only one side of the limb, but possible symptoms and the transition to the other side. Weakness of limbs initially masked by simple fatigue, difficulty is manifested then performing simple movements. Hands and feet become like strangers, heavy, despite the continuing muscle strength (most affected arm and leg on one side).
- Violations by the view. On the part of the organ of vision there is a violation of color may develop optic neuritis, acute decrease in vision. Most often the defeat is also one-sided. Blurred and double vision, lack of binocular movement when trying to take them away - all symptoms of the disease.
- Tremor. It appears frequently and seriously complicates the life of a person. Trembling of the limbs or trunk, which occurs as a result of muscle contractions, deprives normal social and working life.
- Headache. Headache is a very common symptom of the disease. Scientists theorize that it is related to the occurrence of muscle disorders and depression. Namely multiple sclerosis headache occurs three times more often than with other neurological diseases. Sometimes it may be a harbinger of an impending aggravation of disease or pathology feature debut.
- Violations of swallowing and speech. Symptoms related to each other. Dysphagia in half of the cases are not noticed by the sick person, and are not presented as a complaint. Changing the manifest confusion of speech, chant the words blur, unclear writing.
- Violations by the gait. Difficulties in walking are numb feet, balance disorder, muscle spasms, muscle weakness, tremor.
- Muscle spasms. It is quite common in the clinic for multiple sclerosis and often lead to patient disability. Muscle spasms exposed arms and legs, which deprives a person of the possibility of adequate control limbs.
- Increased sensitivity to heat. The possibility of exacerbation of symptoms of the disease when the body overheats. Such situations often occur on the beach, in the sauna, in the bath.
- Intellectual, cognitive impairment. Relevant for half of all patients. Mostly they are shown the total inhibition of thinking, remembering and reduce the possibility of a decrease in concentration, delayed the assimilation of information, difficulties in switching from one activity to other. These symptoms deprives a person of the possibility of the problems encountered in everyday life.
- Dizziness. This symptom occurs in the early stages of the disease and is exacerbated as it progresses. A person can feel as their own instability, as well as suffering from the "movement" of his environment.
- Chronic fatigue. It is often accompanied by multiple sclerosis, and is more common in the second half of the day. The patient feels the increasing muscle weakness, drowsiness, lethargy and mental fatigue.
- Violation of sexual desire. From disorders in the sexual sphere affects up to 90% of men and 70% women. This disorder can be the result of both the psychological problems, and the result of CNS. Libido falls, disrupted the process of erection and ejaculation. However, up to 50% of men do not lose a morning erection. Women are unable to achieve orgasm, sexual intercourse can cause pain, often a decrease in sensitivity in the genital area.
- autonomic disorders. With high probability indicates the long-term course of the disease, and rarely appear in the debut of the disease. It noted persistent morning hypothermia, excessive sweating legs along with muscle weakness, hypotension, dizziness, heart arrhythmia.
- Problems with the night's rest. Patients becomes more difficult to fall asleep, which is most often caused by spasms of the limbs and other tactile sensations. Sleep becomes restless, as a result of the day a person is experiencing dullness of consciousness, lack of clarity of thought.
- Depression and anxiety disorders. Diagnosed in half of patients. Depression can be a symptom of multiple sclerosis independent or becomes a reaction to the disease, often after scoring diagnosis. It should be noted that such patients often attempt suicide, many, on the contrary, find a way out of alcoholism. Growing social exclusion of the person eventually is the cause of the patient's disability, and "closes" the existing physical ailments.
- bowel dysfunction. This problem can manifest itself or fecal incontinence, or recurring constipation.
- Voiding process. All symptoms associated with voiding process in the early stages of the disease as it progresses compounded.
Secondary symptoms of multiple sclerosis - a complication of existing clinical manifestations of the disease. For example, urinary tract infections are due to bladder dysfunction, pneumonia and bedsores develop due to physical disabilities, thrombophlebitis of the lower limbs develops due to their immobility.
Diagnostics
Instrumental methods of research allow us to determine demyelinating lesions in the white matter of the brain. The optimal method is MRI of the brain and spinal cord, with which you can determine the location and size of sclerotic lesions and their change over time.
Additionally, patients spend brain MRI with administration of contrast agents based on gadolinium. This method makes it possible to verify the degree of maturity of sclerotic foci: the accumulation of active substance occurs in fresh outbreaks. MRI of the brain with contrast allows you to set the degree of activity of pathological process. For diagnosis of multiple sclerosis is carried out a blood analysis for the presence of high titer antibodies to neyrospetsifichnym proteins, in particular myelin.
Approximately 90% of people with multiple sclerosis in studies of CSF oligoclonal immunoglobulins are detected. But we must not forget that the appearance of these markers is observed in other diseases of the nervous system.
How to treat multiple sclerosis?
Treatment assigned individually, depending on the stage and severity of multiple sclerosis.
- plasmapheresis;
- cytostatics;
- For the treatment of rapidly progressing forms of multiple sclerosis are used immunosuppressant - mitoxantrone.
- Immunomodulators: Copaxone - prevents the destruction of myelin, softens the disease, reduces the frequency and severity of exacerbations.
- β-interferrony (Rebif, Avonex). Β-interferrony - is prevention of exacerbations of the disease, reducing the severity of exacerbations, inhibition of the activity of the active extension of social adaptation and disability;
- symptomatic therapy - anti-oxidants, nootropics, amino acids, vitamin E and B complex, anticholinesterase drugs, vascular therapy, muscle relaxants, chelators.
- Hormone - pulse therapy with high doses of hormones (corticosteroids). Use large doses of hormones for 5 days. It is important to start as soon as possible to do with these anti-drip and depressing immunity drugs, then they accelerate the recovery process and reduce the duration exacerbation. Hormones are administered short course, so the severity of their side effects is minimal, but for secure them together take preparations which protect the gastric mucosa (ranitidine, omez), potassium and magnesium preparations (asparkam, Pananginum), vitamins and minerals complexes.
- During periods of remission may sanatorium treatment, physiotherapy, massage, but with the exception of all heat treatments and sun exposure.
Symptomatic treatment is used to facilitate the specific symptoms of the disease. The following formulations may be used:
- Mydocalm, sirdalud - reduce muscle tone at the central paresis;
- Neostigmine, galantamine - at disorder of urination;
- Sibazon, Phenazepamum - reduces tremor and neurotic symptoms;
- Fluoxetine, paroxetine - in depressive disorders;
- Finlepsin, antelepsin - used to eliminate seizures;
- Cere nootropil, glycine, vitamin B, glutamic acid - applied courses to improve the functioning of the nervous system.
Unfortunately, multiple sclerosis polnost not curable, can only reduce the symptoms of the disease. With adequate treatment can improve quality of life with multiple sclerosis and to extend the period of remission.
experimental drugs
Some doctors have reported a positive effect of low (up to 5 mg at night) doses of naltrexone, an antagonist opioid receptor that has been used to reduce symptoms of spasticity, pain, fatigue and depression. One of the tests showed no significant side effects of low-dose naltrexone and reduction of spasticity in patients with primary progressive multiple sclerosis. In another study also observed an improvement of quality of life according to surveys of patients. However, too many dropped out of studies of patients reduces the statistical power of the trial.
Pathogenetically justified to use drugs that reduce permeability of the BBB and strengthen the vascular wall (angioprotectors), antiplatelet agents, antioxidants, inhibitors of proteolytic enzymes, drugs that enhance the metabolism of brain tissue (in particular, vitamins, amino acids, nootropics).
In 2011, the Health Ministry approved the drug for the treatment of multiple sclerosis Alemtuzumab, Russia registered name Campath. Alemtuzumab is currently used for the treatment of chronic lymphocytic leukemia, is a monoclonal antibody against the CD52 cell receptor on T lymphocytes and B-lymphocytes. In patients with relapsing-remitting multiple sclerosis in early stages of Alemtuzumab it was more effective than interferon beta-1a (Rebif), but while more common severe autoimmune side effects such as immune thrombocytopenic purpura, thyroid damage and infection.
On the site National Society of patients with multiple sclerosis in the US regularly publishes information about clinical trials and their results. Since 2005, for the treatment of MS effectively used bone marrow transplantation (not to be confused with stem cells). Initially, patients were chemotherapy to destroy the bone marrow, then transplanted Donor bone marrow donor's blood passes through a special separator for separating erythrocytes.
Relevant information about the clinical trials of drugs to treat multiple sclerosis, held in You can find the Russian Federation, the timing of their implementation, the protocol features and requirements for patients on portal IHB RAS.
In 2017, Russian scientists announced the development of the first national drug for multiple sclerosis patients. The effect of the drug is a maintenance therapy, which allows the patient to be socially active. The drug is called "Ksemus" and It will appear on the market until 2020.
Projections and consequences
Multiple sclerosis, many live with him? Prognosis depends on the form of the disease, its detection time, the frequency of exacerbations. Early diagnosis and appropriate treatment contribute to the fact that the sick person practically does not change its way of life - working in his previous job, is active communication and external signs not noticeable.
Long-term and frequent exacerbations can lead to many neurological disorders as a result of which the person becomes disabled. Do not forget that MS patients often forget to take their medication, ie it affects their quality of life. Therefore, the help of relatives in this case is not replaceable.
In rare cases, the disease is worsening with the deterioration of cardiac and respiratory activity and the lack of medical care during this time can lead to death.
preventive measures
Prevention of multiple sclerosis is the set of actions aimed at eliminating triggering factors and preventing relapse.
As the constituent elements are:
- Maximum calmness, avoidance of stress, conflict.
- Maximum protection (prevention) of viral infections.
- Diet binding elements wherein the polyunsaturated fatty acid is omega-3, fresh fruit and vegetables.
- Physiotherapy - moderate load stimulate the metabolism, the conditions for the recovery of damaged tissue.
- Execution of anti-treatment. It should be a regular character, regardless of whether or not manifested disease.
- Exception of a diet of hot food, avoiding any thermal treatments, even hot water. Implementation of this recommendation will prevent the appearance of new symptoms.
