Обновление: Октябрь 20one8 Болезнь рассеянный склероз представляет
a demyelinating disease of the central nervous system (central nervous
system) with a wave-like, chronic course.
This disease is characterized by multifocal, diffuse
lesion of the white matter of the brain and spinal cord, in rare
cases in the pathological inflammatory process involved
peripheral nervous system. About multiple sclerosis, symptoms,
the main reasons for its occurrence, diagnostic methods we
will tell in this article.
Today, multiple sclerosis does not have a clear geographic,
age and sexual distribution, as was previously: disease
was typical for countries farthest from the equator, and the group
риска составляли женщины возрастной группы 20-four0 years old.
High prevalence geographic areas
sclerosis still exists today (countries of the north and center of Europe, south
Canada, northern United States, southern Australia and New Zealand), but
data from a retrospective epidemiological history, in recent
decade has seen an increase in the incidence of this
pathology in most regions of the globe.
More often women are ill, but men do not have this disease –
about a third of all cases accounted for them. Typical
age limits of the disease expand equally in both directions:
заболевание диагностируется и у детей до one5 лет, и у лиц старше 50
What is multiple sclerosis?
Under the influence of certain factors that we will talk about
further, in humans, the permeability of the blood-brain
a barrier that normally protects brain antigens from
actions of own immune cells. This leads to the penetration
in the brain tissue of a significant number of blood cells
(T-lymphocytes), which provokes the development of an inflammatory reaction.
When this occurs, the destruction of the myelin sheath, because
tolerance to myelin antigens (a substance that forms
nerve membrane) and they are perceived as alien.
Simply put, the disease is due to the fact that
immunity gradually begins to destroy neuroglia cells that
form the myelin sheath of neurons, so the transmission of nerve
impulses along neurons slows down, leading to dire consequences –
from falling vision to impaired memory, consciousness.
Important features in the pathogenesis of the disease have features
metabolic processes in the brain tissue, changes in the rate of blood flow,
violations of microelement metabolism, metabolism of polyunsaturated fatty acids,
amino acids and other factors.
The result of all these negative influences and autoimmune reactions
are irreversible degenerative changes in nerve fibers.
Such a long autoimmune process causes exhaustion.
the immune system develops secondary immunodeficiency and decreases
hormonal activity of the adrenal glands.
Causes and Risk Factors for Multiple Sclerosis
The causes of multiple sclerosis are numerous external and
internal (including hereditary) factors.
External factors, when exposed to the body with genetically
due to predisposition, can stimulate the development
demyelination of nervous tissue. The highest value is given
infectious agents of viral nature (measles viruses, infectious
mononucleosis, rubella, herpes).
Various causal factors, both external and internal,
capable of increasing the permeability of the blood-brain
- back and head injuries
- physical and mental stress
Significant effects on biochemical and immunological reactions in
CNS has nutritional characteristics, such as a large proportion of the diet.
animal fats and proteins, forming a risk factor in the development
- American researchers have concluded that in humans,
obese with 20 years of age (high content
fatty tissue hormone – leptin) increases the risk of disseminated
sclerosis 2 times.
- If a женщина принимает оральные контрацептивы, этот риск
increased by 35%.
- Another proven factor is the abuse of table salt.
(salted foods, convenience foods, cheeses, junk food,
sausage) leads to the pathological activation
the immune system against its own cells, increasing the risk
- The family members of the patient with multiple sclerosis risk of falling ill
увеличивается в four-20 раз. Child or adult in the presence of patients
relatives with autoimmune diseases can not be taken
no immunomodulators, otherwise it may end with a debut
any autoimmune process in the body.
- It has been established that the progression of multiple sclerosis
promotes elevated blood sugar levels.
Additional effects of other exotoxins (paints, products
refining, organic solvents) aggravates
Genetic factors for susceptibility to multiple sclerosis
proven to be involved in the development and spread of the disease to which
include changes in enzyme parameters, failure
T-suppressors, genotype features and others.
There are risk factors for developing multiple sclerosis:
- northern country of residence remote from the equator
- White race
- autoimmune pathologies
- violation of psycho-emotional state
- infectious and allergic diseases
- vascular diseases
These risk factors are conditional and are realized when
certain circumstances, proving multifactorial
природу multiple sclerosis.
Many scientists today are working to create an inexpensive,
painless, reliable and safe diagnostic method
multiple sclerosis, which gives a clear picture of the course of the disease,
The most informative diagnostic method to date –
lumbar puncture, that is, taking a sample of cerebrospinal fluid,
however, it is a difficult and painful method. MRI is also possible
use for diagnosis but it is quite expensive
study. One study group considers it possible
method of determining sclerosis will soon be recognized as a diagnostic method
on the patient’s breath.
Scientists from the American Southwest Medical Center
universities offer to diagnose this disease by
the nature of the pupillary reflex. Since in multiple sclerosis
there is a violation of the speed of transmission of nerve impulses and
multiple lesions of the nervous system, this is reflected in the reaction
pupil to the light.
Studies on 85 patients with multiple sclerosis
found that their pupil responds to light by narrowing to 25
milliseconds slower than healthy people.
This method of diagnosis will still be checked for
a greater number of patients and in the case of confirmation of its effectiveness,
It can be a great alternative to other methods.
Russian employees (Krasnoyarsk) of the Institute of Biophysics
have developed a completely new laboratory diagnostic method –
detection of antibodies to proteins of the myelin sheath in the blood
Since the appearance of autoantibodies that destroy myelin is
a sign of multiple sclerosis, their detection will be the most
highly sensitive way to diagnose MS. The essence of the discovery
is that scientists have synthesized a single-stranded RNA molecule,
which is able to bind to autoantibodies, and attached to it
obelin photoblog. That is, in the presence of such antibodies obelin
joins them and starts glowing. Maybe soon
In time, it will become the most common, safe and easy.
методом диагностики multiple sclerosis.
Symptoms, signs of disease
Symptoms of multiple sclerosis depend on the specific location.
localization of demyelination. Due to this flow
multiple sclerosis and its symptoms in each specific
patient will be different in their own diversity and
unpredictability. The following symptoms are scattered
sclerosis will almost never be detected
at the same time.
Symptoms of multiple sclerosis are classified into: primary,
secondary and tertiary. To understand what is multiple sclerosis,
should be considered symptoms of the disease that occur as
progression of the pathological process.
The primary symptoms are a direct consequence of demyelination,
leading to disruption of electrical impulses by
neuro-fibrous tissue. Secondary symptoms are due to
primary symptoms and occur on their background. Tertiary symptoms
are evidence of the scale of the disease – bright
An example is depression, which is very often diagnosed in
patients long suffering from the disease.
The first signs of multiple sclerosis can occur
quite violently, less often – to develop almost imperceptibly in
for many years. To the most common primary
manifestations of pathology include:
- tingling and numbness
- weakness in limbs, often one-sided
- double vision
- weakening and blurred vision
- pelvic disorders
Less common primary symptoms – paresis, change
speech function, impaired motor coordination and cognitive
functions (memory, attention, concentration).
The first signs of multiple sclerosis in frequency of manifestation
presented in the table.
|Symptoms||frequency%||Kind of Pelvic Disorder||frequency%|
|Mimic muscle paralysis||one||Intermittent urination||four2|
|Impotence||one||Feeling of incomplete emptying||four8|
|Myokimiya (twitching of the century)||one||Urinary incontinence||four8|
|Unsteadiness of gait, instability when walking||one||Difficulty urinating||four8|
|Decreased cognitive activity, dementia||2||Nocturia – the predominance of nocturnal urine over daytime||62|
|Symptom Lermitta – sudden pain when tilting the head, craking
passing current through the spine
|Ataxy – violation of movement coordination||oneone|
|Diplopia – the doubling of visible objects||one5|
|Paresthesia – goosebumps, skin numbness||2four|
It should be noted that from the beginning process disorders
urination is a constant sign in half of the patients,
and in one5% of patients they may be the only first symptom
multiple sclerosis. Moreover, even if the patient does not feel
no such violations during examination (cystometry) in 50%
patients registered incomplete emptying of the bladder. If a
sclerosis continues in a person over ten years, pelvic disorders
occur in almost every patient.
Research scientists confirm that creative hobbies,
music, painting, dancing, running on the spot, walking,
moderate physical activity, aerobic exercise contribute
improve the physical and psychological state of the patient with
multiple sclerosis. Proved (tests for in-depth diagnosis
memory and results of MRI), that if you perform light physical
exercise or run, walk for 30 minutes 3 p / week in
3 months – it improves brain function,
responsible for emotions and memory.
The progression of multiple sclerosis causes the following
- Sensory impairment occurs in 80-90% of cases.
Unusual sensations such as goosebumps, burning, numbness, itching
skin tingling, transient pain does not pose a threat to
life but worry patients. Sensitivity disorders
start from the distal parts (fingers) and gradually cover
whole limb. Most often affects only the limbs of one
side, but the transition of symptoms to the other side is also possible.
Weakness in the limbs initially disguised as simple
fatigue, then manifested by the difficulty of doing simple
movements. Hands or legs become like strangers, heavy
despite the remaining muscular strength (often affects the arm and
leg on one side).
- Visual impairment
in half of all cases are presented by optic neuritis
and are manifested by a sharp decline in vision, color perception and
more often diagnosed on one side. Often there are violations
friendly movement of the eyes during the abduction to the side, fuzziness
vision and double vision.
appears quite often and seriously complicates a person’s life.
Trembling of limbs or trunk resulting from
muscle contractions, deprives normal social and labor
A common symptom of multiple sclerosis is considered to be headache.
pain, the cause of which remains unclear,
it is believed that muscle disorders and depression provoke
pain in the head. It is noticed that headache with MS is 3 times
more often than with other neurological disorders. Sometimes she
is the first symptom of incipient sclerosis or as
harbinger of his aggravation.
- Swallowing and speaking disorders
symptoms accompanying each other. Impaired swallowing
half of the cases are not noticed by a sick person and
presented as complaints. Speech changes are manifested by confusion,
chanted, blurred words, slurred presentation.
- Gait disturbance
most often associated with signs of muscle weakness or spasm
muscle Difficulty walking may be due to impaired
balance or numbness of the feet.
- Muscle spasms
quite common in multiple sclerosis clinic and often
lead to disability of the patient. Muscle spasms
arms and legs, which prevents a person from being adequately controlled
- Heat hypersensitivity
occurs when overheating (in the bath, on the beach, etc.) and leads to
обострению уже имеющемся симптомам multiple sclerosis.
- Intellectual, cognitive impairment
relevant for half of all patients. Mostly they
manifested by a general inhibition of thinking, a decrease in the possibility
memorization and decreased attention span
the assimilation of information, difficulties in switching from one type
activities on the other. This symptom deprives a person
the ability to perform tasks encountered in everyday
often accompanied by multiple sclerosis. It may occur
feeling of own instability or “movement” of others
- Chronic fatigue
very often accompanied by multiple sclerosis and more characteristic
for the afternoon. The patient feels the increasing muscle
weakness, drowsiness, lethargy, and mental fatigue.
- Sexual dysfunction
most often manifested following urination disorders and
diagnosed in 90% of sick men and 705 women. Problem
may have a psychological basis and act as a secondary symptom
the disease itself, or develop directly due to the defeat
departments of the central nervous system responsible for the functioning of the reproductive system.
Libido decreases, erection and ejaculation are disturbed. However, almost
50% of men with impotence remains a morning erection, which is
evidence of its psychogenic nature. Women are sexy
dysfunction is characterized by the inability to get an orgasm,
painful intercourse, a violation of sensitivity in the area
- Vegetative disturbances
with a big probability indicates a long course
diseases, and rarely occur in the debut of the disease. Marked persistent
morning hypothermia, increased leg sweating, coupled with muscular
weakness, hypotension, dizziness, cardiac
- Sleep disturbance
diagnosed in half the cases and manifested difficulty
falling asleep against the background of muscle spasm of the legs and tactile sensations. Sleep
restless – patients often wake up and cannot fall asleep. Happy
there is a certain dullness of consciousness and stupidity.
- Depression and Anxiety Disorders
diagnosed in half of patients. Depression can speak
independent symptom of multiple sclerosis or becomes
reaction to the disease, often after making a diagnosis. Worth
note that such patients often make suicidal attempts,
many, on the contrary, find a way out in alcoholism. Evolving
social maladjustment of personality is ultimately the cause
disability of the patient and “overlaps” the available physical
- Disorders of urination may be incontinence, or
- Intestinal dysfunction may be manifested by fecal incontinence, or
Secondary symptoms of multiple sclerosis are complications.
available clinical manifestations of the disease. For example, infections
urinary tract are caused by bladder dysfunction,
pneumonia and pressure sores develop due to physical limitations
capabilities, thrombophlebitis of the lower extremity veins develops
due to their immobility.
Treatment of Multiple Sclerosis
When a person has monosymptomaticity (presence of one
characteristic symptom), as well as a late onset of the disease is
is a good prognostic sign. However, this disease
It is considered not curable, therefore it is most often prescribed.
symptomatic therapy that improves the quality of life, as well as
hormone therapy, immunotherapy, spa treatment,
- Hormone therapy is used as a pulse therapy – use
large doses in short courses, no more than 5 days.
- Since corticosteroids are used, they are also prescribed
magnesium and potassium preparations – Panangin, Asparkam
- Medicinal products that protect the gastric mucosa –
Omeprazole, Losek, Omez, Orthanol, Ultop
- Для лечения интенсивно прогрессирующего склероза
use immunosuppressant – Mitoxantrone.
- β-interferons are indicated for reducing the severity of exacerbations or for
relapse prevention – Avonex, Rebife
- The short-term effect is plasmapheresis; however, it is used
not always, because it has a number of contraindications
- Antidepressants – Cipramil, Amitriptyline,
иксел, флуоксетин, паксил, транквилизаторы – Фенозепам,
muscle relaxants – Baklosan.
- For pelvic disorders – prozerin, detruzitol,
- Vitamin therapy (especially B vitamins, vitamin E),
nootropics, antioxidants, enterosbrbents (Polysorb, Enterosgel,
Polyphepan, filtrum STI), amino acids.
- When pains are shown antiepileptic drugs –
габапентин, финлепсин, лирика.
- To mitigate the symptoms of the disease, reduce the number of exacerbations
shows an immunomodulator that stops myelin destruction
Glatiramer Acetate – Copaxone.
Complications of multiple sclerosis
In some cases, with initially severe disease with
impaired respiratory function and cardiac activity is possible
The cause of death can be pneumonia, which are characterized by
heavy and can develop one by one. Bedsores can
lead to the development of severe sepsis, which ends
death of the patient.
Multiple sclerosis is not completely curable and leads to
disability. Most often, disability occurs with prolonged
many years of illness, when there are no periods of subsidence
Автор: врач-гигиенист, эпидемиолог