Multiple sclerosis

Multiple sclerosis: general information

Multiple sclerosis is usually diagnosed in people in their 20s and 40s. In about 5-10% of cases, the first symptoms of the disease occur in children and adolescents. Pathology is one of the most common chronic autoimmune diseases. The incidence of the disease is estimated at 33 cases per 100,000 people.

The pathology is based on a malfunction of the immune system, which begins to mistakenly attack the myelin sheath that protects nerve fibers. Inflammation occurs at the site of injury, which affects the conduction of electrical impulses that transmit signals from the brain to various tissues and organs of the human body. After inflammation, sclerotic scars or so-called plaques form in the lesion site, foci of demyelination, where the destroyed nerve tissue is replaced by connective tissue. Plaques dissipate as the disease progresses, meaning they affect new areas of the central nervous system.

A distinctive feature of pathology is a remitting course with periods of acute exacerbation, which are interspersed with periods of remission lasting sometimes up to several years or decades.

Causes of the disease

Multiple sclerosis has a combined nature. It is a genetic predisposition that has developed into an autoimmune pathology due to unfavorable external and internal factors. The main causes of multiple sclerosis:

1. Genetics. The contribution of the hereditary factor to the risk of developing the disease is approximately 30%, but the probability of transmission by inheritance (with the exception of family cases) is not more than 2%.
2. Infectious diseases. Certain viruses, especially the Epstein-Barr virus, have an increased risk of developing multiple sclerosis in people with a genetic predisposition. Some scientists believe that MS is caused by a neurotropic filtering virus identical to the multiple encephalomyelitis virus. However, transmission of infection from the patient to healthy people is excluded.
3. Lifestyle. The disease occurs significantly more often in residents of the northern territories, who are characterized by vitamin D deficiency. There is also a link between the development and faster progression of the disease with factors such as smoking or a diet high in animal fats.

Symptoms

The symptoms of the disease largely depend on the location of the plaque and the degree of damage to the nerve fibers. That is why the signs of multiple sclerosis are very diverse. At an early stage, there may be:

• from the side of the motor system: seizures, weakness, tremor of the hands, impaired coordination and motor skills;

• from the organs of vision: nystagmus, double vision, optic neuritis, decreased visual acuity, color distortion or loss of vision brightness;

• from the nervous system: pain, numbness, decreased sensitivity;

• from the gastrointestinal tract: constipation, diarrhea, fecal incontinence;

• from the urinary system: frequent urge to urinate or urinary retention, urinary incontinence;

• increased fatigue, constant fatigue, cognitive impairment.

As the disease progresses, the symptoms worsen. At a later stage, the patient loses the ability to move independently, is forced to use a wheelchair, and loses the functions of household self-service.

Classification

The disease is classified according to the types of course and stages:

1. Remitting MS has periods of exacerbations interspersed with periods of remission, during which the symptoms of the pathology disappear, and the patient's well-being is restored to a normal level. There is no increase in disability.
2. Secondary progressive MS continues to have periods of remission, but beyond periods of exacerbation and unrelated to them, disability increases, and the patient's condition gradually worsens.
3. Primary progressive MS is a form of pathology that does not begin with exacerbations, but with progression, which occurs steadily, although periods of stabilization of the condition are possible.

Taking into account the peculiarities of the course, some severe forms of multiple sclerosis are also distinguished, which quickly lead to disability of the patient: Marburg's disease (malignant MS), rapidly progressive MS, highly active MS.

Diagnostics

Due to the variety of manifestations of multiple sclerosis, no single symptom or laboratory test can serve as a sign of pathology in itself. The doctor should conduct a survey of the patient, clarifying complaints, symptoms, the presence in the past of signs indicating a possible diagnosis, or periods of exacerbation. Differential diagnosis is performed with other diseases (mental disorders, encephalopathy, systemic autoimmune diseases, etc.).

The assessment of the clinical status of patients is based on the EDSS scale (extended Disability Assessment Scale). This system allows you to objectively assess the signs of the disease, predict its course, and choose treatment methods. The severity of symptoms is assessed on a scale from 1 to 10 in increments of 0.5 units.

The main method of instrumental diagnosis in multiple sclerosis is MRI of the brain and spinal cord. At the same time, foci of demyelination should be found in at least two different areas of the central nervous system. Tomography is performed with an interval of 6 months to identify the formation of new foci.

Additional diagnostic methods:

• analysis of cerebrospinal fluid (reveals the breakdown products of myelin, indicates the presence of autoimmune inflammation in the central nervous system);

• the study of evoked potentials (shows a violation of the conduction of nerve impulses along certain pathways).

Treatment of autoimmune disease of the central nervous system

It is impossible to completely cure multiple sclerosis, but the latest treatment methods allow many patients to achieve stable and long-term remission without disability. Based on a modern treatment protocol, drugs that alter the course of MS (PITRS). This group includes medicines of various effects:

• Monoclonal antibodies for the treatment of multiple sclerosis (MS)natalizumab and its analogues, several drugs against the anti-CD20 receptor drugs (ocrelizumab, rituximab, ofatumumab, ublituximab) and alemtuzumab. These drugs are highly effective. They are preferable for patients with a more active course of the disease, as well as patients for whom the issue of effectiveness is more important than certain risks.

• Oral PITRS include fumarates (dimethyl fumarate, diroximel fumarate, monomethyl fumarate), sphingosine-1-phosphate (S1PR) receptor modulators (fingolimod, ciponymod, ozanimod, and nimod), cladribine, and teriflunomide. These PITRS may be preferable for patients with MS who prefer self-administration of tablets instead of injections and infusions.

• Basic injectable PITRS that appeared earlier than other injectable PITRS (intramuscular and subcutaneous) include interferon beta preparations (recombinant human interferon beta-1b and recombinant human interferon beta-1a) and glatiramer acetate. These PITRS may be preferable for patients who place the highest importance on safety and are willing to accept potentially lower efficacy.

• Other immunomodulatory agents Based on limited research data, some immunosuppressive agents, including azathioprine, cyclophosphamide, glucocorticoids, intravenous immunoglobulin, and mitoxantrone, were used to treat MS before the introduction of the above-described PITRS. However, now that PITRS with proven efficacy have appeared, these drugs are used less frequently to treat MS.

• Stem cell therapy with hematopoietic and mesenchymal stem cells is a promising method of treating MS, but research to evaluate the effectiveness and safety of these techniques is currently ongoing.

During periods of exacerbation, patients are prescribed glucocorticoids. For patients with severe exacerbations who do not respond well to treatment with high doses of glucocorticoids, plasma exchange treatment is performed. Symptomatic therapy is also used to improve the patient's quality of life, which can help with movement disorders, spasticity, fatigue, pelvic disorders, cognitive and emotional disorders, paroxysmal states and pain.

During periods of remission, rehabilitation measures, spa treatment, physiotherapy, physical therapy, massage are carried out to improve functionality.

Frequently Asked Questions

How fast does multiple sclerosis develop?

In each person, the disease progresses at a different rate depending on the form of pathology, predisposing factors, and individual health characteristics. Sometimes mobility impairment develops in just 1-2 years, in other cases the patient retains his ability to work and move independently for decades. On average, every second patient faces difficulties in performing work duties 10 years after the onset of the first symptoms, and after 15 years there are problems with independent movement. Studies show that patients achieve a score of 3 on the EDSS scale in an average of 17 years, and a score of 6 after 24 years of illness. It is believed that with the primary progressive form, disability is faster on average: according to one study, approximately 25% of patients needed walking support 7.5 years after diagnosis, however, 25% could still walk without a cane after 25; years after the appearance of the first signs of the disease.

What not to do with multiple sclerosis?

To reduce the severity of symptoms, the following factors can help patients with MS:

• stress;

• overheating (including in the sun, in hot tubs or baths);

• monotonous work that causes rapid fatigue;

• infections;

• wearing tight and tight clothes;

• lack of sleep;

• foods that provoke inflammation;

• bad habits (smoking, alcohol);

• taking medications without consulting your doctor.

What are the pains of multiple sclerosis?

Pain syndrome in multiple sclerosis may be related to:

• with neuropathic pain, chronic, paroxysmal, or acute pain, including Lhermitte's syndrome, trigeminal or glossopharyngeal neuralgia, and optic neuritis;

• with muscle spasticity or imbalance of their relaxation and tension, cramps or chronic pain in the extremities, back, neck, which may occur during movement or at night.

Also, patients with multiple sclerosis are twice as likely to suffer from migraines and tension headaches.

How many people with multiple sclerosis live on average?

PC has a negligible effect on average life expectancy. According to modern concepts, the life expectancy for patients from the older groups is about 5 to 10 years less than in the general population. However, thanks to the latest methods of support and treatment, younger patients are expected to have almost no difference in life expectancy from the average.

How do patients with multiple sclerosis behave?

The disease provokes psychoemotional changes, which can be a neurological symptom of the disease itself, or a response to inevitable life changes. People with multiple sclerosis often suffer from depression, increased anxiety, and cognitive impairments (problems with memory and thinking). Emotional instability, suicidal tendencies, panic disorders, fear of open spaces, social phobias and other disorders are noted.