Otosclerosis: treatment, surgery, symptoms, forms. Surgical treatment of temporal forms of epilepsy Is it possible to do surgery for multiple sclerosis

In this disease, certain features are observed in the conduct of various types of anesthesia.

General characteristics of the disease

In multiple sclerosis (MS), the myelin sheath of nerve fibers is destroyed. This disease is considered an autoimmune disease, since it is the body itself that produces antibodies that destroy myelin.

Multiple sclerosis is an autoimmune disease

Peripheral nerves, brain and spinal cord are usually affected. There are many foci of destruction. This disease can be manifested by such symptoms:

• violation of the pelvic organs, urinary incontinence, violation of sexual functions can be observed;
• cranial nerve damage;
• isolated paralysis or paresis;
• speech disorders, aphasia;
• nystagmus;
• violation of the sensitivity of the skin.

Treatment is ongoing. Usually, basic therapy is used, which cannot be interrupted. It may consist of corticosteroids and cytostatics.

Features of general anesthesia

Multiple sclerosis is not a contraindication to general anesthesia. Patients tolerate it well. With multiple sclerosis, there are some features that must be considered when conducting anesthesia in such patients. These include:

1. Systemic administration of corticosteroids. Corticosteroids are included in the basic therapy of multiple sclerosis. Their intake can slow down the progression of this destructive disease. It is forbidden to stop taking corticosteroids before surgery using general anesthesia! Their introduction continues during the operation itself. There is no need to increase their dose.
2. Refusal to administer Ditilin. Ditilin is a muscle relaxant, a drug that is widely used for anesthesia. It relaxes muscle tissue. In multiple sclerosis, it causes a sharp increase in the level of potassium in the blood. Potassium causes an acute disturbance of the heart rhythm and leads to ventricular fibrillation.
3. Doses of other muscle relaxants should be at least half the standard. It is more difficult for such patients to recover from anesthesia.

Before general anesthesia, it is necessary to take into account some features of the use of anesthesia

Patients with this autoimmune disease are prone to a strong increase in body temperature during the course of surgery under general anesthesia. It is necessary to monitor body temperature and have antipyretic drugs in reserve.

Patients with multiple sclerosis can be given general anesthesia, both mask and intravenous. Their postoperative period may differ slightly. The differences in the postoperative period are presented below:

1. MS patients are prone to emotional distress and stress, which can trigger the progression of the disease. That is why after general anesthesia it is necessary to prescribe them tranquilizers.
2. In such patients, the function of independent breathing and the work of the pelvic organs may take longer to recover.

Use of other types of pain relief in MS

Local anesthesia in patients with MS is performed frequently. Multiple sclerosis is not a contraindication to the use of local anesthetics in dentistry, surgery or other medical fields.

Spinal anesthesia may also be used. But when it is carried out, there is a risk of toxic effects of the anesthetic on the spinal cord and peripheral nerves. The anesthetic for spinal anesthesia is injected directly into the spinal canal, which is highly undesirable in MS.

An alternative to spinal anesthesia in these patients is an epidural. When it is carried out, the anesthetic is injected exclusively into the epidural space and affects in isolation the nerve roots that exit at this level of the spinal cord.

The local anesthetic used in patients with MS should not contain epinephrine. Adrenaline promotes vasospasm and disrupts blood supply, including nervous tissue. Usually, adrenaline is added to the anesthetic to prolong its action. In MS, it is undesirable to add this drug, since the work of the nervous system is disrupted, and circulatory disorders can contribute to the progression of the disease.

Multiple sclerosis is not a contraindication to surgical interventions using general, local or regional anesthesia. The only method that is not desirable to use is spinal anesthesia. When conducting general anesthesia, it is necessary to remember the need for the introduction of corticosteroids, and the restriction on the use of Ditilin. When performing local and epidural anesthesia, it is necessary to use anesthetics that do not include adrenaline, since this substance can provoke the progression of the disease.

Can multiple sclerosis be permanently cured?

Multiple sclerosis is a chronic autoimmune disease that affects 5 people in the population. The disease is called disseminated due to multiple demyelinating foci that occur unevenly in the brain and spinal cord. Treatment for multiple sclerosis is a long process that helps slow down the course of the disease.

The mechanism of the onset and development of the disease

Multiple sclerosis is a disease of a polyetiological nature, but in the development of pathology, the main link is occupied by a person's own immunity. In the presence of a genetic predisposition, the damaging component penetrates the blood-brain barrier, where it disrupts the correct synthesis of glial tissues. These tissues serve as a support link for neurons, oligodendroglia takes part in myelination.

During the synthesis of antigenic nucleic acids, immunity is activated and begins to form antibodies, which, in addition to defective proteins, begin to destroy normal myelin fibers, the demyelination process begins, due to which multiple sclerosis develops. In the early stages of the disease, autoallergy is observed, and in the later stages - a distortion of immune processes and immunodeficiency.

Symptoms of the disease

The age group for the manifestation of the disease is people from 15 to 40 years old; MS rarely occurs in childhood and old age. The development of the disease occurs gradually, the symptoms of multiple sclerosis appear in isolation, less often the course of the disease is acute, with multiple lesions of the nervous system.

The optic nerve is one of the first to be affected in multiple sclerosis. The patient feels blurry images, decreased visual acuity, transient blindness and scotoma (dark spot in the field of view). When the oculomotor neurons are damaged, diplopia (doubling of the image) and strabismus occur.

Among motor disorders, unstable paresis of a central nature predominates, with muscle hypertonicity, pathological reflexes and convulsions. Abdominal reflexes disappear, vegetative functions are disturbed, trembling occurs, unsteadiness of walking associated with damage to the cerebellum.

The loss of higher brain functions occurs in the terminal phase of the disease, in the absence of treatment for MS, there is emotional lability, depression and a decrease in intelligence to dementia.

The most common clinical variants of the disease

The most dangerous form of the disease is the stem form. When the brain stem is damaged, the general hemodynamics in the body is disrupted, sudden respiratory arrest, severe headache may occur, the temperature rises to high numbers, almost every vegetative function suffers, which can quickly lead to the death of the patient

The most common form is cerebrospinal, it presents symptoms from different parts of the brain and spinal cord. Manifested by violations of movement, sensitivity, coordination and optical disorders.

The remaining clinical forms of multiple sclerosis are rarely found separately and are found against the background of a dominant syndrome. The cerebral and optical form refers to similar variants of the manifestation of the disease.

Modern approaches to the diagnosis of MS

For patients with multiple sclerosis, MRI of the spinal cord and brain is used as a diagnostic method. In the study in T2 mode, a large number of scattered demyelination plaques are detected, especially near the ventricles of the brain. To detect a newly formed plaque, a contrast agent should be used. The diagnosis of MS is based on the detection of more than 4 demyelinating areas larger than 3 mm, or 3 foci located near the bodies of the lateral ventricles, in the brainstem, cerebellum or spinal cord. Unlike other modern methods of examination, MRI in multiple sclerosis allows you to see the smallest soft structures, and for diseases of the nervous system is an important diagnostic study.

Methods of treatment of multiple sclerosis

In the treatment of multiple sclerosis, there are certain difficulties due to the influence of the etiological signs of the disease. Accordingly, the question of how to defeat multiple sclerosis forever remains open to science. When scientists from all over the world will be able to completely rid mankind of it is not known.

Treatment of MS is based on pathogenetic mechanisms of intervention in the structure of the disease. Given that autoimmune processes are the basis of the disease, it is necessary to use drugs for multiple sclerosis that suppress the aggressive reaction of the immune system to myelin fibers and change the course of the disease.

Thus, the treatment includes the following components:

• removal of exacerbations;
• changing the course of the disease with the help of MDMS (drugs that change the course of multiple sclerosis);
• lifestyle changes (gymnastics, proper nutrition, diet);
• psychological help.

"Pulse therapy" for patients with multiple sclerosis

Hormones are the drugs of choice for diseases with an immune mechanism of development. Curing in this way is problematic, but you can significantly slow down or even stop the course of multiple sclerosis and restore lost functions. The appointment of high doses of hormones from the group of glucocorticosteroids in a short course is called "Pulse therapy".

Treatment regimen: Methylprednisolone in the amount of 1-2 grams is prescribed for 5-6 days or prednisolone 1.5 mg per kilogram of body weight per day, in the morning in 1-2 doses with 4 hour intervals, every other day or daily (for a course of treatment 1000 mg). After ten days of therapy, the maximum dose is reduced by 5 mg every 2 days. The general course of treatment lasts 6 weeks.

With damage to the optic nerve, the drugs are injected into the retrobulbar fatty tissue, behind the eye. At the end of the therapy, injections with adenocorticotropic hormone are prescribed.

Hemosorption and plasmapheresis in multiple sclerosis is carried out in the case of an acute course of the disease that threatens human life.

Side effects of hormonal drugs

Therapy with hormonal drugs and the autoimmune nature of multiple sclerosis prompts patients to question which doctor treats multiple sclerosis. A neurologist takes care of patients with multiple sclerosis and prescribes the necessary doses of drugs. Self-administration of hormones is not safe for health due to the large number of dose-dependent side effects.

Glucocorticoids retain sodium and water in the body, which leads to edema, the loss of potassium leads to arterial hypertension, and the loss of a large amount of calcium provokes the development of osteoporosis, the blood glucose level rises, with prolonged use, the face becomes moon-shaped, obesity occurs according to the upper type.

Decreased immunity caused by the use of glucocorticosteroids leads to the activation of pathogenic microorganisms. To combat bacterial infections that manifest themselves due to the side effects of drugs, courses of antibiotics are prescribed. To combat urinary tract infections, antimicrobial agents from the nitrofuran group are used. To correct the immunological activity of the body during the treatment period, antiallergic drugs are used - diphenhydramine, suprastin, lymphocytic globulin.

Immunomodulating therapy

To combat exacerbations in relapsing-remitting form of MS, the achievements of scientists in immunomodulation are used. Means used to gently and naturally activate the immune system reduce the likelihood of multiple sclerosis recurrence by 1/3.

Among the drugs used for this purpose are betaferon and rebif. The drugs are prescribed for young patients with less than 2 exacerbations in the last 2 years.

The use of cytostatics

An alternative to treatment with immunomodulators is the use of cytostatics. The immunosuppressive drug methotrexate 7.5 mg once a week, azathioprine 2 mg/kg per day, both drugs are taken orally.

Cytostatics are not first-line drugs, since their side effects are more pronounced than any immunomodulatory agent. The use of drugs inhibits the hematopoietic function of the bone marrow and causes metabolic disorders.

Treatment with tissue metabolites

The treatment of multiple sclerosis in Russia includes the use of agents that improve tissue metabolism: amino acids (glutamic acid, actovegin, cortexin), B vitamins, nootropics, drugs that stimulate energy metabolism (ATP) and co-carboxylase. The use of drugs is based on their ability to protect cells from the destructive effects of the external environment and their own immunity, the effect of drugs is nonspecific and is a complementary therapy.

Symptomatic and physiotherapeutic treatment

Symptomatic treatment for patients with multiple sclerosis is selected in accordance with clinical manifestations:

• With paresis of a central nature, muscle relaxants are prescribed, which reduce the increased muscle tone.
• Physiotherapy for the disease includes exchange plasmapheresis, acupuncture, stimulation of muscle biopotentials by the Myoton apparatus.
• Acupressure for multiple sclerosis is indicated for muscle twitches and cramps. The combination of physiotherapy and massage greatly facilitates the transmission of impulses along the neuromuscular fibers, has a beneficial effect on metabolism, and reduces the manifestation of symptoms associated with multiple sclerosis.

Prevention of exacerbations of the disease

Secondary prevention of multiple sclerosis is used to relieve exacerbations and prevent the emergence of new foci of demyelination. Patients need to avoid cold and hot irritants, contact with infectious agents, it is necessary to limit physical activity.

Pregnancy and childbirth in MS provoke an exacerbation of the pathology, new foci of fiber demyelination appear, and there is a restriction on the use of drugs. Rehabilitation in multiple sclerosis occurs in conditions of complete neurological unloading. Sanatoriums for the sick provide a long remission. Spa treatment is a good way to support patients even after severe manifestations of the disease.

Whether multiple sclerosis can be cured remains an open topic for medicine, and spontaneous recovery cases are rare today. But proper treatment using all modern methods will help a person live a long life. Leave your opinions in the comments, take part in the discussions.

Pavlenkov Sergey Pavlovich,

Sviridov Alexey Gennadievich,

Medical portal "About sclerosis.RU"

The information presented on the site is not intended for self-treatment and is provided for review. To draw up a treatment plan and establish a diagnosis, it is necessary to consult a doctor.

Partial or complete copying of materials is allowed only with an active link to the site page.

We invite specialists to consult patients and prepare materials for the site.

An Experimental Treatment for Multiple Sclerosis: Stem Cell Transplantation

Multiple sclerosis is a disease of the nervous system that leads to disability, disability and the need for the help of other people. Pathology causes irreversible phenomena in the form of muscle paralysis, blindness, deafness. Medicines will not be able to eliminate these effects. Therefore, new technologies come to the rescue - rebooting the immune system with the help of stem cells. The cost of such a transplant operation, of course, is high, but justifies its price with a successful development of events.

How does stem therapy help with MS?

Multiple sclerosis is a disease characterized by damage to the nerve fibers, their inflammation and scarring. In this regard, the function of the pathways is disturbed, pain, muscle paralysis, autonomic disorders occur.

The main symptoms of multiple sclerosis include:

1. Immobilization of individual muscles or their entire groups. Paralysis is both spastic and flaccid.
2. Loss of hearing and vision.
3. Dizziness, imbalance.
4. Pain in joints and muscles.
5. The appearance of a feeling of numbness of the skin, goosebumps.
6. Double vision.
7. Urinary incontinence, feces.
8. Memory disorder.

Many violations are irreversible and cannot be restored. Therefore, there is a need for new methods of treatment, since:

1. Medicines used for multiple sclerosis (immunosuppressants, glucocorticoids) have serious side effects, sometimes life-threatening. For example, septic complications.
2. Drug treatment only slows down the development of the disease, stops it, but does not lead to the restoration of the affected, healed nerve fibers.

However, medical science does not stand still, therefore, in multiple sclerosis, stem cell transplantation is now being carried out. This procedure gives hope for the restoration of the working capacity of seriously ill people.

Results of stem cell transplantation in multiple sclerosis

Stem cells are biological material that can transform into any tissue under the influence of certain substances and conditions. Thanks to this ability, they are used to grow new tissues. No exception and brain neurons with new processes. However, their recovery is rare and takes a very long time. Therefore, the main target of stem therapy is immunity.

The technology for restoring the normal functioning of the immune system is not easy. Stem cell treatment for multiple sclerosis requires a lot of money and patience. But this method gives great hope to paralyzed patients.

How stem technologies work:

1. Damaged nerve fibers are restored along with cells (in rare cases).
2. The immune system is reprogrammed to attack its own tissues - this is the main goal of therapy.

Thus, stem therapy allows you to protect the body from its own overly aggressive immunity.

How is a stem cell transplant performed?

The patient's own materials are used, taken from his venous blood, which is filtered by a separator in order to capture exactly the stem cells. The stem cell collection process can take up to three days to get enough. They are then frozen with liquid nitrogen.

Treatment is carried out in two stages:

1. Destruction of all immunity.
2. The introduction of stem material intravenously.

The immune system of patients with multiple sclerosis is impaired. Perhaps the viruses provoked auto-aggression. Therefore, first, the “killing” of the immune system is carried out with immunosuppressants: Azathioprine, Cyclophosphamide, glucocorticoids.

At the same time, anti-inflammatory therapy with interferons is used to suppress the viruses that may have provoked the attack. Thus, various infections are also prevented.

Since the immune system is suppressed, it is necessary that the patient be in a completely sterile environment. This is provided in special protected chambers.

Then the patient is injected intravenously with his own stem cells, which are designed to build a new immunity, designed to protect his body, and not attack it. The new material is converted and differentiated into healthy white blood cells.

Then the patient undergoes general rehabilitation. At an early stage of the disease, it occurs faster, since drug therapy is almost not needed. In more serious cases, the immune system reboots, but residual manifestations (paralysis, paresthesia) require medical correction. The tissue of the brain, spinal cord and pathways regenerate for a long time and poorly, almost never recover due to their complex structure.

The cost of stem cell treatment

When autotransplantation was first used, its cost reached about a million rubles and was not so affordable, the poet had to go to Israel and other countries.

The price of stem cell transplantation in multiple sclerosis is about 250-300 thousand rubles in Russian clinics. However, the cost depends on the medical institution itself, it can vary greatly and reach 2 million rubles.

How effective is stem therapy

The effectiveness of the procedure depends on the severity and neglect of the disease. Doctors who practice this method of therapy warn that it is better to start treatment as early as possible. In this case, the immune system does not have time to hit a large amount of nervous tissue in the brain and pathways.

Judging by the reviews about the use of stem cells in multiple sclerosis, some patients lost hand trembling, the progression of the disease stopped, but the disability persisted. Rebooting the immune system is an easier task than repairing nerve tissue affected by sclerotic plaques.

It is important to find out how Neuromidin helps in injections for multiple sclerosis: who is shown how to use analogues.

Conclusion

With the steady progression of multiple sclerosis, drugs that slow down the course of the pathology do not always help. One way or another, the patient is waiting for disability. A new method with stem cell transplantation gives hope to sick people. The clinic in which treatment is carried out must have a license for this type of activity. The chance of being cured is higher in people in the early stages of the disease. This method allows you to stop damage to the nervous tissue forever.

Multiple Sclerosis Treatment: Deep Brain Stimulation Method

Deep brain stimulation (DBS) is a variant of a long-established surgical technique used to correct tremor in people with multiple sclerosis, Parkinson's disease, and essential tremor. In the 60s of the last century, such an operation was performed to destroy a small area deep in the brain - the thalamus (thalamotomy) or another part of the brain known as the "pallid globe" (pallidotomy).

These operations are still performed today, although less frequently due to the advent of deep brain stimulation. Such an operation is associated with significant risks: both thalamotomy and pallidotomy are associated with the targeted destruction of certain brain tissues.

It is worth the surgeon to “miss” by a fraction of a centimeter, and the operation, instead of the expected effect, can lead to serious consequences - for example, paralysis, loss of vision or speech.

Deep brain stimulation is a method that allows you to deactivate certain areas of the brain without intentionally destroying its tissues. Thus, the risk during such an operation is significantly reduced. With deep brain stimulation, an electrode is implanted into it in such a way that its working (contact) end is located in the thalamus (for multiple sclerosis and essential tremor) or the "pale globe" or subthalamic nucleus (for the treatment of Parkinson's disease). The implanted electrode remains in the brain, with the help of wires it is connected to a device like a pacemaker, sewn under the skin above the chest. This device generates electrical discharges.

What are the benefits of deep brain stimulation?

Deep brain stimulation provides many benefits. The process of electrical stimulation can be regulated, while this is not possible with the surgical destruction of brain tissue. The implantable electrode has 4 metal contacts that can be used in many different combinations. Even if any of the electrode contacts are not exactly where they should be, there is a fair chance that one of the other three, or some combination of them, will be closer to the target. Since the patient's response to electrical impulses changes over time, electrical stimulation can be adjusted without reoperation.

Another significant benefit of deep brain stimulation relates to the possibility of other treatments in the future. Destructive surgery (thalamo or pallidotomy) may reduce the patient's chances of taking advantage of new treatments that may be developed in the near future. With deep brain stimulation, when trying to apply another method of treatment, the pacemaker can simply be turned off.

What does deep brain stimulation do for people with multiple sclerosis?

The main purpose of using the method of deep brain stimulation in patients with multiple sclerosis is to correct the tremor caused by this disease. In the case of multiple sclerosis, other disorders (impaired vision and sensation or muscle weakness) cannot be treated with this method.

Can multiple sclerosis be cured with deep brain stimulation?

No. Deep brain stimulation does not cure multiple sclerosis or prevent the disease from getting worse. It is only effective in correcting tremor associated with multiple sclerosis.

Is deep brain stimulation considered experimental?

The deep brain stimulation method is not experimental. The FDA (Federal Drug Administration) has approved it as a treatment for Parkinson's disease, essential tremor and dystonia (a type of movement disorder in which the patient takes unnatural postures or makes involuntary rotational movements).

The FDA has not issued a separate decision regarding the use of deep thalamic stimulation in multiple sclerosis. However, this does not mean that this method is experimental or that its use is not covered by insurance. There are many treatments used in everyday practice as standard and accepted, but not officially approved by the FDA.

Who needs deep brain stimulation?

When prescribing deep brain stimulation, a number of important factors should be considered. These questions should be discussed with a qualified movement disorder specialist or a neurologist with special training in this area.

Before deciding on an operation, it is necessary to try medical methods of treatment. Surgery is not indicated if your symptoms can be corrected with medication. However, surgery should be considered if medical treatment does not give satisfactory results. If you are not sure if this method is right for you, consult a movement disorder specialist or a neurologist experienced in working with patients with movement disorders.

Where should such an operation take place?

The operation must be performed in a center with a team qualified to care for patients with multiple sclerosis. It should include neurologists and neurosurgeons with experience and special training to perform such operations.

When choosing a site for the operation, you should also clarify the nature of the location of the target area of ​​\u200b\u200bthe brain (that is, the thalamus). Different centers may use different techniques for performing this operation. Obviously, the chances of success and minimizing the risk of surgical intervention will directly depend on how close the electrode is to the target zone.

Topics

• Treatment of hemorrhoids Important!
• Treatment of prostatitis Important!

Top health guides

Online consultations of doctors

Endocrinologist's consultation

genetics consultation

Endocrinologist's consultation

Other services:

We are in social networks:

Our partners:

Trademark and trademark EUROLAB™ registered. All rights reserved.

Multiple sclerosis

Neurological deficits that persist for >6 months usually do not regress.

2. History of MS: Patient reports of symptoms (preferably confirmed by investigator) sufficient to localize an MS focus and which have no other explanation (i.e., cannot be associated with any other process)

3. clinical symptoms (complaints): neurological disorders recorded by a competent investigator

4. paraclinical confirmation: tests or studies that detect CNS lesions that do not cause symptoms; e.g. hot bath test, ASEP, neuroimaging (CT, MRI), qualified urological examination

5. Complaints and symptoms characteristic of MS: this allows to exclude lesions in the gray matter, peripheral nervous system, non-specific complaints such as H/B, depression, seizures, etc.

6. remission: significant improvement for >1 month of complaints and symptoms that have occurred for >24 hours

7. separate lesions: complaints and symptoms cannot be explained on the basis of a single focus (neuritis of both optic nerves occurring simultaneously or within 15 days is considered one focal lesion)

8. Laboratory confirmation: In this study, only oligoclonal bands on CSF electrophoresis (see below) (may not be present in plasma) or elevated CSF IgG production (may be normal plasma levels of IgG) were considered as evidence. These data make it possible to exclude syphilis, subacute sclerosing panencephalitis, sarcoidosis, etc.

Criteria for establishing a diagnosis of MS

A. 2 attacks separated by remission, affecting different parts of the CNS

B. And one of the following signs:

1) clinical signs of the presence of two separate lesions

2) clinical signs of one focus and anamnestic information about another

3) clinical signs of one focus and paraclinical signs of the presence of another

A. 2 attacks separated by remission involving different parts of the CNS AND clinical or paraclinical confirmation of a single lesion AND the presence of oligoclonal IgG in the CSF

B. one attack AND clinical signs of two different lesions AND the presence of oligoclonal IgG in the CSF

C. one attack AND clinical signs of one lesion and paraclinical signs of another separate lesion AND presence of oligoclonal IgG in CSF

A. 2 attacks, separated by remission, involving different parts of the CNS AND clinical confirmation of one lesion

B. one attack AND clinical signs of two different lesions

C. single attack AND clinical evidence of one lesion and paraclinical evidence of another separate lesion

A. 2 attacks separated by remission, with lesions of different parts of the CNS AND the presence of oligoclonal IgG in the CSF

MRI: MRI has become the neuroimaging technique of choice for diagnosing MS. In 80% of patients with a clinically clear diagnosis of MS, multiple lesions in the white matter are found (and only 29% on CT). Lesions have a high signal in T2 mode; fresh foci accumulate more gadolinium than old ones. On T2 examination, periventricular lesions may not be visible due to the signal from the CSF present in the ventricles. These foci are better seen on proton density images as being more intense than CSF. The specificity of MRI is ≈94%, however, encephalitis foci and indeterminate bright foci may mimic the presence of MS foci.

2. interferon β-1a (Avonex®)75,76: 33 µg injections weekly (9 million IU)

3. glatiramer (formerly copolymer-1, mixture of tetrametric oligopeptides) (Copaxone®): 20 mg s.c. reduces annual risk of recurrence by 30%

4. immunoglobulins: have some effect, but are very expensive

5. immunosuppression: methotrexate has been shown to have a moderate short-term positive effect

6. corticosteroids: commonly used, but research is controversial

A. corticotropin (ACTH): its use is decreasing

B. Major relapses: Treat with high doses of IV methylprednisolone or 1000 mg/d (given over 30 minutes) for 3 days or 500 mg/d for 5 days

C. mild-to-moderate relapse: often treated with low-dose oral prednisone tapering off gradually over ≈3 weeks

Fibromuscular dysplasia

Vasculitis and vasculopathy

Arteriovenous malformations (AVM)

Rheumatoid arthritis

Ear otosclerosis- This is a disease, a characteristic feature of which is the pathological proliferation of tissues of the bony labyrinth of the ear. The result of the disease is a progressive hearing loss. Otosclerosis of the ear occurs most often during puberty in women. The process in this disease is two-way.

Symptoms of otosclerosis

The first symptoms appear at the age of 16-20 years. Leading among them is the sensation of tinnitus and progressive hearing loss. Describing tinnitus, patients compare it with various phenomena of nature and everyday life (the rustle of leaves, the sound of the surf or the rumble of wires). In this case, the severity of noise is assessed in three degrees:

1. The first degree - the noise does not bother, this symptom is detected only with an active survey.
2. The second degree is the presence of noise in combination with other symptoms.
3. The third degree - the sensation of noise is the main complaint of the patient.

Hearing loss and tinnitus, most often, are slowly increasing in nature. Most patients have a history of indications of various factors that contributed to its occurrence - these are infectious diseases, and prolonged exposure to a noisy environment, and systemic diseases of the body, as well as pregnancy and childbirth.
Sometimes patients may be disturbed by balance disorders and short-term dizziness that occur when the head is thrown back, fast movements or tilts. The phenomenon is manifested by nausea and vomiting. In addition, patients often complain of ear pain, congestion and tingling sensation in them, memory loss and sleep disturbances.

Signs of otosclerosis

The severity of signs depends on the clinical form of the disease (tympanic, cochlear and mixed). This classification is based on the nature of the hearing loss, changes in the inner and middle ear, and computed tomography data.

1. Tympanal form: the lesion is located in the region of the oval window. Its symptom is progressive conductive hearing loss.
2. Mixed: the lesions are located in the cochlear capsule and the region of the oval window. The hallmark of this form is mixed progressive hearing loss.
3. Cochlear: only the cochlea is affected. The symptom is sensorineural progressive hearing loss.

In addition, the severity of signs of otosclerosis directly depends on the stage of the disease. It is customary to distinguish otospongiosus (active) and sclerotic (inactive) stages.

Also a characteristic sign of otosclerosis is an improvement in hearing acuity when the patient is in a noisy environment, a decrease in speech intelligibility during chewing and swallowing food, while talking to several people and with intense attention.

Otosclerosis treatment

otosclerosis treatment therapy can be both conservative and operational. The second is used more often.
Conservative treatment

The aim of this treatment is to influence bone turnover in order to reduce noise. Recent studies have shown that one of the causes contributing to the disease may be a lack of vitamins and minerals in the affected tissues. To compensate for the deficiency of essential substances, bromine, phosphorus and calcium preparations are prescribed. Depending on the indications, hormonal preparations and B vitamins can be used. Physiotherapeutic measures include electrophoresis with iodine or calcium and darsonvalization, which help reduce tinnitus.

Conservative therapy in most cases is ineffective and is used only at the beginning of the development of otosclerosis. Otosclerosis treatment can only be carried out when the hearing loss is less than 30 dB. If it is higher than this figure, only surgical intervention is indicated, the result of which is an improvement in hearing in 85-90% of patients.

Surgical treatment

The goal of this treatment is to restore hearing with the maximum use of the cochlea, even if after the treatment it will be necessary to use a hearing aid.
Contraindications are individual features of the structure of the ear or general medical contraindications.

Otosclerosis operation

Otosclerosis is an operation performed for otosclerosis, called stapedoplasty or calibrated stapedomy. It is done under local anesthesia using an operating microscope, under high magnification. During the operation, the pathological focus is removed and the head and arch of the stirrup are replaced with a prosthesis. At a certain stage of the operation, ringing in the ears, dizziness, a feeling of sinking, accompanied by nausea and vomiting, may occur. This is normal and passes quickly. After the end of the procedure, a hearing test and tamponation of the ear canal are performed for 1 week.
At the end of the period, the tampons are removed, the patient is discharged home. Hearing improvement occurs gradually and reaches its maximum after 3 months. Hearing tests are performed at 3, 6, 9 and 12 months after surgery. On the second ear, surgery can be done six months after the first. The result of the operation is the restoration of hearing in 90-95% of patients. The best results are observed in younger patients with good bone conduction and slight hearing loss.

Otosclerosis, surgery and prices

The operation, as mentioned above, gives a positive result in more than 90% of patients. However, it is necessary to know that in some cases, serious dangers to the inner ear may occur in the separated period. Given this fact, surgery is initially performed on one ear. In case of complications, the second ear will be able to perform its function with the help of a hearing aid.
Stapedoplasty is performed at stages I and II of otosclerosis, and very rarely - at stage III, when sensorineural hearing loss is pronounced.
After the operation, patients must adhere to some simple rules that will help to successfully pass the postoperative period and maintain restored hearing:

1. avoid noise and sudden pressure drops;
2. do not blow your nose for a month;
3. protect ears from cold;
4. avoid activities that can cause dizziness. Do not lift weights, do not bend over sharply, do not strain strongly;
5. watch out for upper respiratory tract infections.

Stapedoplasty is carried out both in public medical institutions and in private clinics. Prices do not depend on the degree of the disease, but may vary depending on the age of the patient and comorbidity. The cost of treatment includes the operation itself, postoperative care and supervision.

Multiple sclerosis can occur in people between the ages of 18 and 60, but it most often appears in youth. The female sex is more at risk of getting sick than the male. Multiple sclerosis is not a hereditary disease.

Reasons for the appearance

To date, there is a hypothesis that this disease may arise due to the action of autoimmune processes that are associated with the nervous system or with viral diseases that a person has in childhood. In the event of an exacerbation, inflammatory foci are formed, as a result of which the electrically insulating sheath swells, which covers the axons of many neurons. After some time, swelling and inflammation slowly subside, but scar marks or affected areas remain. All processes of nerve cells remain intact and unharmed. This provides an opportunity to comment on why people experience full or partial recovery. However, it is worth noting that if a new defeat occurs next to the old one, then there can be no talk of a full recovery.

Signs of multiple sclerosis

In almost half of the cases, these ailments are manifested by disturbances in the motor system: spasms, weakness during movement, impaired coordination. There may be colic in the hands and feet, or their numbness. Some people begin to have vision problems: double vision or blurry vision. Also, sexual function may be disturbed, control over urination is lost. In a small number of patients, mainly those who have been suffering from sclerosis for a long time, intelligence decreases.

Diagnosis of sclerosis

Such a disease is diagnosed with the help of a neurological examination, a conversation with a doctor and other methods. Today, in modern medicine, the most accurate way to diagnose multiple sclerosis is with the help of magnetic resonance imaging, and in an unhealthy person, the level of gamma and immunoglobulins in the cerebrospinal fluid increases. Considering that immunological reactions are the main ones in the progression of sclerosis, it is important to constantly check them in patients: take blood for immunological analysis. This is necessary in order to make a comparison of the parameters of the immune system of a sick person at different times.

Treatment and preventive measures

With mild exacerbations, this disease is treated with a large number of medications: drugs that improve tissue blood flow, general tonic, vitamins, sedatives, antioxidants, and, if necessary, antidepressants. In severe forms of exacerbation, hormonal agents are prescribed. In the period of five days you need to take large doses of hormones. This method in medicine is called pulse therapy. The use of drugs that depress the immune system and anti-inflammatory drugs makes it possible to quickly recover and reduce the period of exacerbation. Hormones, as a rule, are not taken for long courses, which does not allow side effects to develop, and therefore they are the smallest. Also, quite common medical procedures are massage, blood purification from harmful toxins, and so on.

Multiple sclerosis quite often it is expressed by exacerbations that contribute to the emergence of other serious ailments. To prevent them, it is necessary to carry out preventive measures, which consist in the use of immune modulators. These drugs contribute to the proper functioning of the immune system, which accordingly makes it possible to manifest exacerbations to a lesser extent, and also slows down the progression of the disease.

Traditional medicine treatment

First of all, people suffering from this disease should lead a correct lifestyle. The necessary complete rejection of smoking and drinking alcohol, in the summer you need to protect yourself from the sun and in no case should you swim in hot water. An effective remedy for the treatment of multiple sclerosis is mummy. It is strengthening and filling the body with vitamins and essential trace elements. Also, royal jelly is effective: it normalizes metabolism and increases the level of protection of the whole organism. People suffering from this disease should not be wiped with apple cider vinegar, which must first be diluted with water. Freshly squeezed juices and oatmeal will be very useful.

Actions, the type of swimming and sports training are pushed back multiple sclerosis to the background, and are excellent ways to treat it.

Otosclerosis is a disease that leads to a progressive hearing loss, ending, which is caused by the appearance of bone structures in the soft tissues of various parts of the middle and inner ear.

Loss of elasticity of soft tissues located in the capsule of the cochlea (the main organ of the inner ear), as well as connecting the small auditory ossicles with each other and with the tympanic membrane - reduces the transmission of the full range of oscillatory movements to sensory receptors, the nerve impulse from which forms sound sensations in the brain . The perception of sound at the previous level is lost, gradually leading the patient to deafness.

In varying degrees of severity, otosclerosis occurs in 1-2% of people. The rapid pace of hearing loss, sometimes taking on a one-sided character, allows only 10-15% of patients from the total number of patients to seek medical help on their own. The rest is diagnosed for the first time during a comprehensive medical examination.

Causes and predisposing factors

To date, several theories of the etiology of otosclerosis are known:

Symptoms of otosclerosis

What are the signs of otosclerosis?

Treatment of otosclerosis

Treatment depends entirely on the type of disease diagnosed.

Allocate:

• cochlear otosclerosis(changes occur in the capsule of the cochlea and semicircular canals, in the shells of the internal auditory canal);
• Tympanic otosclerosis(there is an immobilization of the joint of the stirrup and the eardrum).
• Mixed otosclerosis(a combination of cochlear and tympanic forms).

Treatment of otosclerosis without surgery is possible only with cochlear and mixed types of the disease.

Operations

Operations for otosclerosis are carried out in cases where there is no effect from conservative treatment for 4-5 months and in the tympanic form of the disease. Surgical treatment of the cochlear form is currently at the stage of theoretical development. Treatment of such patients is limited to the use of hearing aids.

Operations on the inner ear are aimed at restoring the transmission of sound vibrations from the auditory ossicles to the tympanic membrane.

Previously, two types of operations were quite common:

• Stirrup mobilization. Its essence was the mechanical loosening of the stirrup.
• Fenestration of the stirrup base. To improve the mobility of the auditory bones, a through hole was created at the base of the stirrup. As a variant of this operation, the labyrinth was also fenestrated by creating a hole in its vestibule to improve sound transmission.

But due to the short duration of the positive effect of these operations (a little more than 3-5 years), at the present stage stapedoplasty has been widely used. With it, a prosthesis is installed in place of the removed stirrup. The percentage of a stable effect from this type of surgical treatment is quite high - over 80%.

In addition, this technique allows, after 5-6 months after the first operation, to perform intervention on the second ear.

The ongoing development of methods of microsurgery for the pathology of the hearing organs, the improvement of stirrup prostheses, and the increase in their biocompatibility make it possible to achieve consistently high results in the treatment of osteosclerosis.

The average price of an operation (stapedoplasty) in Moscow is from 26,000 to 100,000 rubles.

The operation is included in the list of surgical treatment provided under the CHI policy.

With the development of multiple sclerosis, an uncontrolled rejection by the nervous system of the patient's body occurs.

This process is the most dangerous - both for the state of health and for human life.

Treatment of multiple sclerosis today

Until recently, this disease was considered incurable and doomed patients to long-term treatment and significant limitations in life.

However, relatively recently, scientists studying multiple sclerosis made a real revolutionary discovery, which made it possible to significantly improve the quality of life of patients with this disease.

We are talking about the use of stem cells. The first stem cell transplantation operations were successfully carried out - they were carried out in the USA, as well as in European countries.

Is there any evidence of any positive results of operations to treat this disease in Russia?

Multiple sclerosis is an autoimmune disease that is chronic in nature. Unfortunately, the disease is quite common at a young age.

Is pregnancy possible with multiple sclerosis? This question is asked by many women. Consider how realistic it is to give birth to a healthy child when making this diagnosis.

Read about traditional and non-traditional methods of treating intercostal neuralgia here.

Multiple sclerosis is a disease that is not so easy to immediately recognize. Here http://neuro-logia/zabolevaniya/rasseyannyj-skleroz/simptomy-i-trechenie.

html let's talk about the specific signs of this disease and possible long-term complications.

Russia - what's new in the treatment of multiple sclerosis?

According to a woman who underwent such an operation by Novik A.A.

Her life has changed significantly. There was no need to take treatment for multiple sclerosis, the manifestations of the disease disappeared.

The quality of life has increased significantly and almost approached a healthy state.

Another review of the operation, also carried out in Moscow. Woman, 39 years old, suffered from multiple sclerosis for 4 years.

The treatment used slightly eased the course of the disease, but the periods of time between exacerbations gradually began to decrease, and the remission became shorter and shorter.

Based on the data on the patient's health status and the severity of the current disease, the doctors decided that the operation was necessary.

And there is a significant amount of such evidence, for this reason, stem cell transplantation can be considered a real breakthrough in the treatment of this terrible disease.

Of course, the price of such an operation will be quite high. And for its appointment, it will require a comprehensive examination by the doctor of the patient, the establishment of the current stage of the disease, the severity of the course of multiple sclerosis, as well as the general condition of the patient.

The cost of stem cell transplantation in Russia is different, and in many respects its final amount depends on the level of the medical institution that performs this type of surgical intervention, the classification of doctors.

Moscow medical centers offer such an operation at the most expensive price - depending on the level of the institution, it ranges from 270,000 to 780,000 rubles.

The use of medical procedures and drug treatment, the goal of which is to stop the manifestations of the disease and the possible restoration of the myelin layer of nerve fibers.

The procedure for the introduction of stem cells to a patient - it is carried out with a certain stage for the successful survival of cells by the body.

The final cost of this operation is affected by the price of each of its stages - the isolation of stem cells from the material taken from the patient, and then the introduction of the resulting cells.

The effectiveness of treatment largely depends on the patient himself - be attentive to your health.

A disease such as multiple sclerosis tends to rejuvenate. Now the incidence is observed even among children. Multiple sclerosis in children: features of the course of the disease and methods of treatment. Let's try to understand who is at risk.

You can find out about the causes of neuralgia of the facial nerve in this block.

About twenty years ago, some hope was placed on the then considered very promising method of stem cell transplantation in multiple sclerosis.

Now it belongs only to the fourth line of treatment. The first line of treatment consists of immunomodulators (rebif, betaferon, copaxone), tecfidera and abagio, the second - gilenia, tysabri, lemtrada and ocrevus.

The third line includes human immunoglobulin, mitoxantrone, azathioprine. And in the absence of the effect of the first three lines of treatment, in the case of a malignant course of multiple sclerosis, stem cell transplantation is considered.

It is rather an experimental method, one might say, a therapy of despair. The essence of the method is as follows: blood is taken, from which stem cells are isolated.

By a special method they are cloned to a very large number. These cells do not secrete antibodies to myelin and are not trained to destroy it.

After that, massive chemotherapy is carried out, which kills all immune and hematopoietic cells in the body. Then the stem cells are injected into the patient's body and replenish the blood cells that died from chemotherapy.

Despite great expectations, this method is not actively used. First, sooner or later, the new immune cells are again trained to act against their own myelin, because despite chemotherapy, immune cells in the lymph nodes, dendritic cells, etc. remain. The disease is reactivated.

Secondly, such massive chemotherapy has various long-term consequences in the form of an increased risk of developing cancer.

Thirdly, in recent years, new highly effective drugs have been released - monoclonal antibodies (such as lemtrada, ocrevus, etc.), which, like an immunological knife, remove only "bad" immune cells, while maintaining immunity as a whole intact.

Such drugs have an order of magnitude fewer side effects, their action is predictable, protocols for their administration have been developed. An individualized approach to the selection of therapy for patients with multiple sclerosis allows in the vast majority of cases to achieve the effect of therapy as part of the first or second line of treatment for multiple sclerosis.

You can get more detailed information at a consultation by making an appointment by phone with a specialist in multiple sclerosis at the Yusupov Hospital.