Multiple sclerosis

Multiple sclerosis is a remitting disease of the nervous system caused by the appearance of foci of demyelination scattered over the brain and spinal cord; One of the most frequent organic diseases of the central nervous system.

Etiology is unknown, but the role of the pathology of immune mechanisms is obvious.

Pathogenesis. Demyelinating process, mainly affecting the white matter of the central nervous system. The damaged area may undergo remyelination, or, following the myelin decomposition, axial cylinders are also damaged, followed by the development of a characteristic dense gliotic plaque (the dimensions of which vary from a few millimeters to several centimeters). Remyelination is the basis of clinical remission. With the development of the same scars, the function of the damaged system is irreversibly damaged.

Symptoms, course. The disease occurs usually at a young age; In childhood and after 50 years, the onset of the disease is extremely rare. The first symptoms are transient motor, sensory (more often paresthesia) or visual disturbances. Over the years, the newly emerging lesions are no longer completely restored, the severity of the clinical picture is steadily increasing. Most often the pyramidal and cerebellar systems and optic nerves are affected. In the advanced stage of the disease, there is almost always lower spastic paraparesis or tetraparesis. Along with this, cerebellar disorders are expressed: ataxia, dysarthria, nystagmus. Usually there is a gross tremor of the extremities, less often of the head; Shaking is detected with active movements, but can also be static. The widely known triad of Charcot (nystagmus, intentional tremor, chanted speech) is noted in only 10% of patients. The defeat of the optic nerves is manifested by a decrease in visual acuity (persistent blindness is very rare) and pobednenniem temporal halves of the discs of the optic nerves of the fundus. Disorders of urination are common. Many patients have a peculiar euphoria; In the distance, those who entered the stages of the disease often have dementia. In some cases, paresis, ataxia, and vision loss are temporarily aggravated after a hot bath. The remitting course is typical: exacerbations are replaced by significant improvement, and often complete disappearance of all or separate signs of the disease. Duration of remission from several days to several years; They are especially valuable in the first years of illness. In a few years, however, most ballrooms need constant help because of paralysis and ataxia.

A significant role in diagnosis is played by changes in evoked potentials of the brain, computed tomography, examination of the fundus and changes in the composition of the cerebrospinal fluid. The latter are characterized by a (non-constant) small pleocytosis, a moderate increase in protein (usually no higher than 1 g / L), a "paralytic" type of Lange reaction, and an increase in gamma globulins.

Differential diagnostic problems are hardly a specific feature of the initial stages of multiple sclerosis, for which obligate pathognomonic tests do not yet exist. The most difficult to interpret is isolated retrobulbar neuritis (acute vision loss with the development of central scotoma, which is preceded by pain in the eye), also caused by multiple sclerosis in almost 90% of cases.

Treatment. In the beginning and with exacerbations of the disease, glucocorticoid hormones or ACHG are prescribed. Daily doses and the duration of treatment are determined individually. Immunosuppressors (azathioprine, etc.) and immunomodulators (levamisop, T-activin) can be used. During the periods of remission, a crucial role is played by massage, exercise therapy, prevention of intercurrent infections. Sooner or later, patients will learn about the true nature of their illness, but at the first stages of the disease the doctor should avoid mentioning multiple sclerosis in every possible way. The issue of childbirth is usually resolved in a negative way, which is determined not so much by the risk of exacerbation as by the inevitable severe disability of the mother in the future.

Forecast. The disease progresses over many years, disabling patients. The cause of death is most often caused by intercurrent infections (urological sepsis, pneumonia), incomparably less than direct damage to vital centers in the brain stem. Approximately in 25% of cases the disease is more benign and the patients for many years retain the ability to self-service and a certain degree of work capacity.