Multiple sclerosis - a disease of the nervous system that occurs in young and middle age (15-40 years).
A feature of the disease is the simultaneous failure of several different parts of the nervous system that leads to the appearance of the patients varied neurological symptoms. Another feature of the disease - relapsing-remitting course. This means alternating periods of deterioration (exacerbations) and improvement (remission).
The basis of the disease is the formation of foci destruction of nerve sheath (myelin) in the brain and spinal cord. These lesions called plaques of multiple sclerosis.
The dimensions of the plaques, usually small, a few millimeters to a few centimeters, but the progression of the disease, the formation of large confluent plaques.
Causes
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
- frequent viral and bacterial infections;
- influence of radiation and toxic substances;
- feeding habits;
- geoecological residence, especially its great influence on the organism of children;
- trauma;
- frequent stressful situations;
- genetic susceptibility, probably due to a combination of several genes that determine violations primarily in immune regulation system.
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.
Manifestations of Multiple Sclerosis
The symptoms of multiple sclerosis are associated with damage to several different brain and spinal cord.
Signs of pyramidal pathway can be expressed by an increase of pyramidal reflexes without compromising with little or decrease in muscle strength or the appearance of fatigue in the muscles when performing movements, but while maintaining the basic functions.
Signs of cerebellar and conductors appear tremor, incoordination.
The severity of these symptoms can vary from a minimum up to the inability to perform any movements.
Typical lesions of the cerebellum is a decrease in muscle tone.
In patients with multiple sclerosis can be detected lesions of the cranial nerves, the most common - of oculomotor, trigeminal, facial, hypoglossal nerve.
Signs of deep and superficial sensitivity detected in 60% of patients. At the same time it can be detected tingling and burning sensation in the fingers and toes.
Frequent symptoms of multiple sclerosis are disorders of pelvic organs: the extra urgency, increased frequency of urine and stool delays at later stages - incontinence.
Perhaps the incomplete emptying of the bladder, which is often the cause urogenital infections. Some patients may experience problems with sexual function, which may coincide with the dysfunction of the pelvic organs or be a symptom of an independent function.
In 70% of patients revealed symptoms of visual functions: visual acuity decrease in one or both eyes, change the visual fields, blurring of the image objects, loss of vision brightness, color distortion, a violation Contrast.
Neuropsychological changes in multiple sclerosis include decreased intelligence, behavioral disorder. More frequently in patients with multiple sclerosis prevails depression. In multiple sclerosis, the euphoria is often combined with decreased intelligence, underestimate of severity of his condition, behavior disinhibition.
About 80% of patients with multiple sclerosis in the early stages of the disease show signs of emotional instability with multiple sharp change of mood in a short period of time.
The deterioration condition of the patient when the ambient temperature increases due to increased sensitivity of affected nerve cells to changes in electrolyte balance.
In some patients the pain syndrome can be observed:
- headache,
- pain along the spine and intercostal spaces in the form of a "belt"
- muscle pain caused by increased tone.
Typically, multiple sclerosis proceeds as follows: overall health among sudden appearance of signs of disease.
They may be visual, motor, or any other disorders, the severity of which ranges from subtle to roughly breaking body functions.
The general condition is satisfactory. Following the aggravation into remission, during which the patient feels almost healthy, then re-aggravation.
It already runs harder, leaving a neurological defect, and so is repeated until, until it is disabled.
Diagnostics
Diagnosis of MS is based on patient data survey, neurological examination and additional methods of inspection results.
To date, most information is considered to be magnetic resonance imaging head and spinal cord and the presence of oligoclonal immunoglobulins in the cerebrospinal fluid.
Given the central role of immunological reactions in the development of multiple sclerosis, particularly important for disease surveillance becomes a regular study in patients with blood - the so-called immunological monitoring.
It is necessary to compare indicators of immunity with previous figures of the same patient, but not healthy people.
Treatment of Multiple Sclerosis
In the treatment using antiviral drugs. The reason for their applications is the assumption that the viral nature of the disease.
The most effective drug in multiple sclerosis Betaferon is. The total duration of treatment of them - up to 2 years; has strict indications: prescribed to patients with relapsing forms of current and structurally unstable neurological deficit.
Experience of Betaferon showed a significant decrease in the number of exacerbations, easier for them, decrease according to magnetic resonance imaging of the total area of inflammation foci.
Similarly effect has reaferon-A. Reaferon designate 1.0 V / m to 4 times a day for 10 days, followed by 1.0 V / m 1 times a week for 6 months.
Applied also interferon inducers:
- Proper-mil (proper myl),
- prodigiozan,
- zymosan,
- dipyridamole,
- nonsteroidal antiinflammatories (indomethacin, voltaren).
Ribonuclease - an enzyme preparation obtained from the pancreas of cattle, delayed multiplication number of RNA viruses.
Ribonuclease is administered at 25 mg / m 4-6 times a day for 10 days.
The preparation is used after the test: working solution RNAse at a dose of 0.1 is administered subcutaneously in the inner surface of the forearm. The symmetrical portion similarly injected with 0.1 ml of saline (control). The reaction is read after 24 hours. Negative - in the absence of local manifestations.
When redness, swelling insertion site RNAse preparation is not applicable.
Antiviral, immunomodulating action has Dibazolum. It is appointed in microdoses of 5-8 mg (0,005-0,008) in the form of pills every 2 hours for 5-10 days.
hormone therapy
In multiple sclerosis use hormones - glucocorticoids. Schemes use of glucocorticoids in multiple sclerosis are many.
Sinakten depot - a synthetic analogue of corticotropin hormone, it consists of the first 24 amino acids, is a very effective drug for the treatment of multiple sclerosis.
It can be used as an independent means and in combination with glucocorticoids. Action sinaktena depot continues after a single injection 48 hours.
Use of some embodiments: the drug is administered at 1 mg once a day for a week, then the same dose 2-3 3-4 times of the day, and then once a week, or 3-4 times administered to 1 mg of 3 days, then 2 days later 3 minutes, 20 treatment injections.
Complications when receiving the drugs in this group - Cushing's syndrome, increased blood sugar, Edema, asthenia, bacterial infections, stomach bleeding, cataract, cardiac insufficiency, hirsutism, Vegetative-vascular disorders.
When high doses of glucocorticoids, simultaneously designate Almagelum, a diet low in sodium and carbohydrate rich in potassium and protein drugs potassium.
Ascorbic acid is involved in the synthesis of glucocorticoids. Its dosage varies widely and depends on the patient's condition.
Etimizol activates the pituitary hormonal function, which leads to an increase in the blood level of glucocorticosteroids, anti-inflammatory and antiallergic effect. Assign to 0.1 g of 3-4 times per day.
Additional methods of treatment
Nootropilum (piracetam) administered 1 capsule three times a day and the dose was adjusted to 2 capsules 3 times a day, while achieving a therapeutic effect to reduce the dose of 1 capsule three times a day.
In the treatment of piracetam possible complications in the form of allergic reactions, which to a large extent due to the presence in the formulation of sugar. Therefore, during the course it is necessary to limit the amount of sugar in food and sweets excluded from the diet. nootropil treatment - 1-3 months.
Glutamic acid - 1 g three times a day.
To improve the metabolic processes in the brain shows aktovegin. The drug is administered / drip in an amount of 1 mg glucose at a rate of 2 ml / min.
Effect has close solkoseril which is prescribed in / in. Improves metabolic processes of tissue regeneration.
Cerebrolysin in multiple sclerosis recommend administered in / in to 10 ml, total of 10 injections.
plasma transfusion - a highly effective method of treatment. Use native and fresh frozen plasma of 150-200 ml / 2-3 times at intervals of 5-6 days between injections.
Desensitizing therapy: found wide application in calcium gluconate / in or tablets Suprastinum, Tavegilum et al.
Decongestants are used relatively rarely.
Of diuretics furosemide preference - 1 tablet (40 mg) once daily in the morning. With little effect is repeated in the next day or the next course of treatment is carried out: for 3 days, 1 tablet, followed by a 4 day break and receive a further 3 days under the same scheme.
By means of increasing the excretion of urine, you can add gemodez. This drug has also protivointoksikatsionnym action. Gemodez administered in / 200-500 (adults) in the form of heat (at a temperature of 35-36 ° C 40-80 drops per minute, with 5 injections with an interval of 24 hours. In some cases, injections gemodeza helpful to alternate with the introduction reopoliglyukina.
Reopoligljukin addition to detoxifying effect improves blood counts, restores blood flow in the capillaries.
Dalargin normalizes regulatory proteins, an immunomodulator, acts on the functional state of cellular membranes and nerve conduction. It is recommended to 1 mg / m 2 twice a day for 20 days.
T-activin is applied from 100 micrograms daily for 5 days, then after 10-day break even at 100 xg for 2 days.
plasmapheresis in the treatment of multiple sclerosis
This method is used in severe cases during exacerbation. Recommended from 3 to 5 sessions.
For this application plasmapheresis enough from 700ml to 3 liters of plasma during each session (the rate of 40 ml per 1 kg body weight), an average of 1,000 ml. Reimburse the removal of liquid albumin, polyionic solutions rheopolyglucin. The course is 5-10 sessions.
Dosing plasmapheresis: 2 days on the third or 5 times a day.
Typically, plasmapheresis is combined with the introduction metipred (after a session of plasmapheresis introducing / 500-1000 mg / 500 ml in saline) 5 times, followed by transition to reception of prednisone every other day at the rate of 1 mg / kg at a dose reduction to 5 mg each subsequent to receiving a maintenance dose (10 mg 2 times a week).
Cytochrome-C - an enzyme derived from bovine tissue of the heart. It is prescribed by 4-8 ml of 0.25% solution 1-2 times a day intramuscularly. Before starting the use of cytochrome determine individual sensitivity thereto: inputting / c 0.1 ml of the preparation. If within 30 minutes is not observed facial flushing, itching, hivesIt is possible to start treatment.
Means to improve circulation
Has pronounced vasodilating action nicotinic acid. Used drug administration in increasing doses from 0.5 (1.0) to 7.0 mL / m and from 7.0 to 1.0.
Similarly effect has ksantinola nikotinad. Synonyms: teonikol, komplamin. The preparation combines the properties of a group of substances theophylline and nicotinic acid, acts on the peripheral circulation, increases cerebral blood flow.
In multiple sclerosis, he has worked well cinnarizine. Its use is long (several months) at a dose of 25-75 mg (depending on the severity of the condition) 3 times a day.
Cinnarizine has multilateral action: improves cerebral and coronary circulation, microcirculation, positive effect on the blood, removes vascular spasms, etc...
In the treatment of multiple sclerosis is used cavinton. If there are no contraindications (pregnancy, arrhythmia), Its prescribed orally 1-2 tablets (0.02) 3 times a day. It selectively expands vessels of the brain, improves the oxygen supply to the brain, brain promotes the absorption of glucose.
There is information about the possibility of using cavinton as I / injection (drip). It is administered at a dose of 10-20 mg of (1-2) of the ampoule in a 500 ml isotonic solution.
Close to Cavintonum effect have Trentalum, chimes, pentamer, agapurin. Trental administered in a dose of 0.2 (2 tablets) 3 times a day after meals. After the therapeutic effect dose was reduced to 1 tablet, 3 times a day. B / administered 0.1 mg (1 ampoule) in 250-500 ml of isotonic solution over 90-180 minutes. Subsequently the dose may be increased.
Means of improving cerebral and coronary circulation is Curantylum. It is well tolerated, it should not be prescribed only in severe forms of coronary atherosclerosis and prekollaptoidnyh states. Normally it is taken in a dose of 25 mg for several months at 1-2 tablets per hour before meals 3 times daily.
Tonic, improving brain function is phytin, organic phosphorus complex preparation containing a mixture of calcium and magnesium salts of various acids inozitfosfornyh. In multiple sclerosis, take 1-2 tablets 3 times a day.
Tocopherol acetate (vitamin E), - an antioxidant, protects the oxidation of various tissues changes involved in the biosynthesis of proteins, cell division, tissue respiration. It has the ability to inhibit lipid peroxidation. The daily intake - 50-100 mg for 1-2 months (one drop of 5%, 10% or 30% solution of the drug contains an eyedropper respectively 1, 2, 6.5 mg tocopherol acetate).
Folk remedies for the treatment of multiple sclerosis
Seeds of wheat germ 1 tablespoon wheat washed with warm water, is placed between the layers of canvas or other fabric, put in a warm place. After 1-2 days sprouts appear magnitude of 1-2 mm.
Wheat germ is passed through a meat grinder, pour hot milk and cook gruel. To eat the next morning, on an empty stomach. Taken daily for a month, then 2 times a week. Course - 3 months. The seeds sprouted wheat contains B vitamins and hormonal substances, trace elements.
Propolis - a product of bees life. Preparing a 10% solution of: 10.0 the propolis is ground, mixed with 90.0 warmed to 90 ° butter, mix thoroughly. Take 1/2 teaspoon seize honey (good tolerability) 3 times a day. Gradually, the reception can be increased to 1 teaspoon 3 times a day. The course of treatment - 1 month.
