MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic, often progressive disease of the central nervous system, which is characterized by the formation of multiple foci of demyelination in the brain and spinal cord, as well as the optic nerve. Etiology and pathogenesis remain largely unknown, but it is found that an important role is played by hereditary predisposition, expressed by the peculiarities of immune responses, as well as environmental factors (possibly viruses), which act mainly in childhood.

The disease occurs between 15 and 55 years. At a younger age, the disease usually begins with acute or subacute developing focal neurological symptoms - with a violation of sensitivity with a feeling of numbness, paresthesias in pains on the extremities or trunk, unstable walking, loss of vision in one eye, accompanied by pain during movement of eyeballs, doubling, weakness In the extremities, sometimes dizziness. After a few days or weeks, the symptoms usually completely disappear, but after a few weeks or months, new symptoms appear or old ones recur. With each new exacerbation, the recovery becomes less complete, and the residual symptoms (residual neurological defect) gradually accumulate. The remitting course, characteristic of the initial stages of the disease, is replaced by a secondary progression without clear exacerbations and remissions, but sometimes with an uneven course. In the late stages, a relatively stereotyped pattern is formed, including spastic para- or tetraparesis, pelvic disorders, instability and unsteadiness in walking, impaired coordination in the extremities, gross intentional tremor , chanted speech, partial atrophy of the optic nerves.

Suspicion of multiple sclerosis should cause: neuralgia of the trigeminal nerve, which occurred at a young age, repeated episodes of facial nerve neuropathy, especially bilateral, facial myochemia (subtle wave-like twitching of facial muscles), unmotivated asthenia, transient dysfunction or decreased vision. A significant part of patients are disrupted cognitive functions, there is depression, which, as the volume of affected brain tissue increases, can be replaced by euphoria.

Treatment begins when the patient is informed of the diagnosis. The task of the doctor and the medical staff is to minimize the severe psychological stress of the patient who has learned that he is suffering from multiple sclerosis, informing him that the disease is often benign, that although it is incurable, there are real opportunities to help the patient. It should also draw the patient's attention to what he can do himself and warn him against ineffective and costly treatments. It is advisable for a patient to recommend a diet with a low content of animals and a high content of vegetable fats, moderate physical activity (within his capabilities), refusal to smoke or excessive consumption of alcohol, prevention of colds. Treatment of an exacerbation consists primarily in the use of corticosteroids. However, quite often the condition of patients deteriorates somewhat under the influence of overwork, intercurrent infection (respiratory or urinary), overheating. In such cases, you can wait and not prescribe corticosteroids immediately. And only when there is a new or significant worsening of the existing symptoms, which lasts more than 24 hours, the appointment of hormones is advisable. Kortyikosteroids can significantly accelerate the recovery, but in this case, apparently, they do not reduce the severity of the residual defect after exacerbation and do not affect the rate of neurological defect accumulation. Corticosteroids should be prescribed as a short course in a high dose on a daily basis. In severe exacerbations, especially when the focus is located in the trunk or upper cervical spinal cord, in addition to corticosteroids, plasmapheresis is used. When treating corticosteroids, you should follow the usual precautions: to avoid gastric bleeding antacids are prescribed, low-salt diet should be adhered to, potassium losses must be compensated in a timely manner, diuretics (diacarb or thiazides) are indicated in case of fluid retention, diazepam (relanium for the night) Or other benzodiazepines, with a history of tuberculosis, lung calcifications or a positive tuberculin test, isoniazid . Regular monitoring of blood pressure and heart rhythm is important, in patients with glaucoma. - intraocular pressure. With the development of psychosis, a consultation of a psychiatrist, the appointment of neuroleptics, the withdrawal of the drug (or, at least, a reduction in its dose) is indicated.

Prevention of exacerbations during remittent disease is possible with long-term use of immunomodulating (alpha and beta interferons, copaxone) or immunosuppressive agents (azathioprine, methotrexate). With increased fatigue, rational work organization with frequent breaks, dosed physical activity, midantane, amiridine, antidepressants are recommended. Spasticity treatment includes special * stretching exercises in combination with baclofen, clonazepam or tizanidine. If depression is combined with emotional lability, pain or sleep disorders, tricyclic antidepressants are used. To treat cognitine disorders use nootropic drugs (piracetam, encephabol, cerebrolysin). To reduce tremor resort to weighting of the limb (wearing a bracelet), taking carbamazepine (finlepsin), clonazepam, sodium valnroate, propranolol, vitamin B6, isoniazid. In paroxysmal conditions (for example, in trigeminal neuralgia or tonic convulsions), carbamazepine (finlepsin) is prescribed.

The disease progresses for many years, leading to disability of the patient. The cause of death is most often an intercurrent infection (urological sepsis , pneumonia). However, in 25% of cases it proceeds more benignly, and the patient for many years retains ability to work and self-service ability. The course of the disease is unpredictable, in some cases severe disability occurs after 5 years (10%), in others, patients do not lose their ability to work (30%). Favorable prognostic factors are: onset of the disease at a young age, female sex, remittent disease, beginning with visual impairment (retrobulbar neuritis), and not with paresis or cerebellar disorders, prolonged remission after the first exacerbation.