Multiple sclerosis
Multiple sclerosis (multiple, disseminated sclerosis) is a chronic autoimmune progressive disease of the nervous system, in which the membranes of nerve fibers (axons), brain and spinal cord cells demyelinate.
The content of the article:
Classification of multiple sclerosis
Etiology and pathogenesis of multiple sclerosis
Clinical picture of multiple sclerosis
Diagnosis of multiple sclerosis
Treatment of multiple sclerosis
Prognosis for multiple sclerosis
Prevention of multiple sclerosis
Multiple sclerosis
In conditions of genetic predisposition, autoimmune chronic inflammation occurs caused by a virus or infection, under the adverse effects of external factors: environmental, geographical. The functioning of the human immune system is disrupted, which begins to fight and destroy its own nerve cells, mistaking them for foreign ones.
Myelin is the sheath of nerve cells, through which impulses are transmitted along nerve fibers, it also protects and nourishes cells. With multiple sclerosis, myelin loss occurs. Thus, the cells become unprotected, and the ability of axons to conduct impulses decreases. Places of destruction of myelin sheaths are called foci or plaques. The size of the plaques is from a few millimeters to several centimeters, they can merge with each other, forming large areas of demyelination.
The foci of sclerosis are scattered, that is, they can occur simultaneously in different parts of the central nervous system (less often the peripheral nervous system), hence the name of the disease. This is one of the most common diseases of the nervous system after epilepsy and vascular diseases. Women of young and middle age (18-40 years old) suffer mainly, although cases of morbidity among children and older people have been recorded.
Classification of multiple sclerosis
Multiple sclerosis has a large number of clinical manifestations, and therefore its clinical forms are not distinguished. The classification of the disease is based on the nature and characteristics of the course of pathological processes. There are such basic types:
remitting (relapsing-remitting). This type of disease is the most common and occurs in 70-80% of patients. A characteristic feature will be the undulation of the course and the variability of symptoms. Periods of exacerbation (relapse, “attack”) are replaced by periods of remission, which last several months, years or even a decade. With exacerbation, the patient has a sharp, rapid deterioration of the condition, aggravation of existing symptoms or the appearance of a new one. During remission, symptoms may significantly weaken or not manifest at all;
primary-progressive (primary-progressive). With this type of patients, there is a gradual, steady deterioration in their health. Periods of exacerbations are absent or occur extremely rarely. As a rule, the spinal cord is mainly affected, later and to a lesser extent — the brain. The patient, as a rule, retains intellectual abilities, but disability occurs faster and more often than with other types of the course of the disease. It occurs in 10% of patients, while the percentage of male patients is no less than women, more often they are middle-aged people;
secondary-progressive. Approximately half of the patients who had a remitting type of the course of the disease in the early stages of the disease, after 10-15 years there is a transition to a secondary progressive phase. Periods of remission are reduced, the patient’s condition improves slightly, in turn, the disease progresses slowly, rare relapses persist. The disease becomes chronic and after 10-12 years it can turn into a progressive form;
progressive-recurrent. It is observed in 5% of patients. Along with the gradual development of the disease, relapses occur. After an exacerbation, a short-term remission occurs, but the improvement is insignificant.
Etiology and pathogenesis of multiple sclerosis
Multiple sclerosis refers to multifactorial diseases. Its appearance and development occurs due to the presence of the following factors:
infectious factors (bacterial, viral infections). To date, no specific causative agent of multiple sclerosis has been identified. Antibodies to a variety of viruses (measles, rubella, herpes simplex, chickenpox, etc.) are found in the tissues of the cerebrospinal fluid of patients. Doctors claim that the disease occurs under the influence of not one, but several chronic infectious agents that affect the human immune system;
genetic predisposition. It depends on several independent genes responsible for the immune response, the production of antibodies and immunoglobulins;
injuries;
stress;
external environment (geographical, environmental factors). It has been proven that multiple sclerosis is most common in people living in cool and humid climates. The closer to the equator, the lower the risks.
Based on this, we can talk about the influence of:
lack of vitamin D, which is produced mainly endogenously under the influence of sunlight;
the lack of a number of trace elements in the composition of soil and water, such as: iodine, zinc, manganese;
nutritional features (predominance of animal fats in the diet);
the level of urbanization;
radiation.
The pathogenesis of multiple sclerosis is based on a violation of the immune system caused by a combination of the main adverse factors in a particular person. At the same time, none of these factors, taken separately, can be the cause of multiple sclerosis.
The formation of the site of myelin loss (plaques, foci) begins with the activation of microglia and astroglia, which attract T-lymphocytes, B-lymphocytes, macrophages to inflammatory foci. The myelin sheath is destroyed, nerve impulses are worse and slower conducted along nerve fibers, which leads to the manifestation of clinical symptoms. With prolonged and extensive demyelination, axons die, and symptoms become persistent.
Clinical picture of multiple sclerosis
The disease can begin unexpectedly and rapidly or manifest itself gradually, so that the patient does not pay attention to the deterioration for a long time and does not resort to medical care. In most cases, it occurs at the age of 18-40 years.
With the development of the disease, persistent symptoms of multiple sclerosis appear. The most common ones are:
failures in the pyramid system (pyramid paths). The main muscle function is preserved, but there is increased fatigue, moderate loss of strength in the muscles, various paresis are not uncommon in the later stages. The lower extremities usually suffer more than the upper ones. Violations of reflexes: abdominal, periosteal, tendon, periosteal. Muscle tone changes, hypotension, dystonia are observed in patients;
damage to the cerebellum (impaired coordination). It may manifest itself slightly and inconspicuously: dizziness, uneven handwriting, slight tremor, unstable shaky gait. With the development of the disease, symptoms worsen, more serious disorders appear: ataxia, nystagmus, chanting of speech, cerebellar (intentional) tremor, cerebellar dysarthria. Motor and speech functions are disrupted, a person loses the ability to eat independently;
cranial nerve dysfunction. Depending on the location of the plaques (intracerebral, extracerebral), clinical symptoms can be of a central or peripheral nature. Disorders of the oculomotor and optic nerves (strabismus, double vision, various nystagmus, ophthalmoplegia), facial, trigeminal are most often observed in patients;
deterioration of sensitivity. This series of symptoms is characteristic of multiple sclerosis along with impaired movement. Many patients feel numbness of the limbs, cheeks, lips. There is a Lermitt syndrome — a feeling of electric shock in the muscles, muscle pain;
disorders of the sphincters (pelvic function). Frequent or, conversely, rare urge to urinate and defecate, in later stages — urinary incontinence;
intellectual changes. In patients, memory, attentiveness, the ability to think and perceive information deteriorates, there is rapid fatigue in intellectual activity, difficulties with transferring attention from one activity to another. On the psychoemotional side, patients often suffer from depression, anxiety, apathy, nervousness, and euphoria occur. In rare cases, patients develop dementia;
failures of sexual function. Decreased libido, menstrual cycle changes in women, impotence in men.
Diagnosis of multiple sclerosis
Modern medicine does not have the ability to diagnose multiple sclerosis with a single study. A number of diagnostic measures are used, the results of which can be evaluated only in aggregate and over some time (several months-years). This is due to repeated periods of exacerbations and remissions.
It is important to identify the disease at an early stage, timely treatment can greatly facilitate the patient’s life, slow down the development of the disease. However, it is sometimes difficult to do this, since the first clinical manifestations may not be taken seriously by a person, they may be forgotten over time. With repeated exacerbation, the symptoms that occurred the previous time may not recur, but new ones will appear. From the moment of the onset of the disease before the patient resorts to the help of doctors, it may take more than one year.
The primary method of diagnosing multiple sclerosis is a thorough collection and analysis of the patient’s medical history. The doctor needs to ask questions not only to the patient, but also to his family members and relatives. This will help to find out the period of occurrence of the disease. The doctor also evaluates the clinical manifestations. After that, laboratory and instrumental diagnostics are used.
Basic instrumental methods:
MRI (magnetic resonance imaging) and CT (computed tomography) of the brain and spinal cord. The use of MRI in the diagnosis of multiple sclerosis is much more effective than CT. With the help of MRI, it is possible to determine the disease with 90-95% probability. This study reveals the foci of demyelination, their localization, size, maturity in different parts of the brain and spinal cord;
investigation of evoked potentials. In the early stages of the disease, it is not informative enough, so it is practically not used. It is advisable to carry out at later stages. The study of the effect of stimuli on the receptor apparatus and nerve structures, their responses, make it possible to assess the degree and localization of damage to the central and peripheral nervous system.
Laboratory methods:
examination of the cerebrospinal fluid makes it possible to detect lymphocytosis, increased concentration of immunoglobulins, oligoclonal antibodies in the patient. Changes in the composition of cerebrospinal fluid are one of the indicators of multiple sclerosis, which should be evaluated in conjunction with other studies when making a diagnosis.
Differential diagnosis
Diagnosing multiple sclerosis is not easy. Its many clinical manifestations make it necessary to carefully approach the examination and differentiate it among other diseases that are characterized by certain symptoms of multiple sclerosis. These are: Lyme disease, sarcoidosis, acute multiple encephalomyelitis, systemic lupus erythematosus, Behcet’s disease, nodular periarteritis, Sjogren’s syndrome, syphilis, HIV infection, Wilson’s disease, various ataxias, paralysis and others.
Treatment of multiple sclerosis
The main tasks in the treatment of multiple sclerosis are to slow down the progression of the disease, prevent and stop exacerbations, conduct symptomatic therapy at all stages of the disease, and preserve the patient’s psychoemotional health.
Treatment of exacerbations is possible with the help of corticosteroid drugs, cytostatics, plasmapheresis.
With the help of immunomodulatory drugs (copaxone, beta-interferon), it is possible to reduce the frequency of relapses in multiple sclerosis by 30% and significantly slow down the process of disability of the patient, reduce the activity of plaques and their number.
Symptomatic and medico-social treatment of patients with multiple sclerosis is aimed at restoring motor functions, pelvic organs, coordination, pain relief. It is important to deal with the neuropsychological problems of the patient.
Prognosis for multiple sclerosis
The course of this disease can be benign or malignant. With a benign form (20% of cases) rare exacerbations are observed in patients, and during remissions there is a significant improvement in the condition, up to complete recovery and disappearance of clinical manifestations of the disease. In such a situation, a person remains able to work for a long time.
With the malignant course of the disease, the patient’s health worsens, symptoms worsen, periods of remission, if they occur, do not bring noticeable improvements. The patient sooner or later becomes disabled. However, multiple sclerosis is rarely the cause of death, the disease does not significantly affect life expectancy. An exception can be considered cases of suicide among patients due to psychoemotional disorders or deep depression.
Prevention of multiple sclerosis
The root causes of multiple sclerosis have not been reliably clarified, so it is not necessary to talk about any specific methods of prevention. However, there are a number of general preventive recommendations: to lead a healthy lifestyle, eat right, monitor your health, avoid stress and bad habits. Vitamin D, which a person can get from sunlight, is of great importance. If there have been cases of multiple sclerosis in the family, then special care should be taken.
The manifestation of the following signs of multiple sclerosis should serve as a reason to consult a doctor:
motor disorders: weakness of the limbs, frequent stumbling and falling when walking, tremor;
gait change (shakiness, instability);
numbness or tingling in the extremities;
headache, muscle pain;
visual impairment, neuritis;
vestibular disorders: vomiting, dizziness, loss of balance;
speech impairment;
psychological disorders.
