Do they give disability with multiple sclerosis. Multiple sclerosis: is there a disability? Origin and development of the disease

Medico-social expertise and disability in multiple sclerosis

MULTIPLE SCLEROSIS
Definition
Multiple sclerosis (multiple sclerosis) is a demyelinating disease with multiple lesions nervous system occurring with exacerbations and remissions or steadily progressive, affecting mainly young people.

Epidemiology
Multiple sclerosis (MS) accounts for 4.7 to 10.5% of organic CNS diseases. Number of patients in different countries ranges from 5 to 70 per 100,000 population. A high incidence is clearly seen in the northern and western regions (25-50 cases per 100,000 in the European part of Russia, the Baltic states, Belarus). Women are 1.5-2 times more susceptible to MS than men. The frequency of PC among close relatives is 15-20 times higher than in the general population. It is considered to be the age limits of PC 20-40 years. When the first symptoms appear after 40 years, the diagnosis is most often doubtful. The lower limit is more labile: PC can begin at the age of 15-17 and earlier, and in these cases it often progresses rapidly.
The social significance of PC is determined by the relative frequency (2-3%) in the structure of primary disability due to neurological diseases. Disability, often severe, occurs early (in 30% of cases during the first two years from the onset of the disease), in young patients.

Etiopathogenesis
The etiology of PC is still unclear. The autoimmune theory of the occurrence of MS, the role of persistent viral agents, genetically determined inferiority are widely discussed. immune system in certain geographic conditions. From a clinical standpoint, the concepts of MS pathogenesis proposed by I. A. Zavalishin (1990) and Poser look logical.

PC pathogenesis
(after Poser, 1993; with some modifications)
Genetic susceptibility (presence of antigens of the histocompatibility system HLA-AZ, B7, DR2 - possible markers of the gene that determines sensitivity to PC)
I
Primary antigenic stimulus (non-specific viral infection, vaccination, injury, etc.)
I
Production of antibodies, particularly against myelin basic protein
I
Education immune complexes(contributes to deficiency of T-suppressors, possibly genetically determined)
I
Vasopathy and damage to the BBB
I
Edema and inflammation in the lesions of the nervous system
I
The formation of foci of demyelination

Some clinically significant features of pathogenesis and pathomorphology:
1. Complete and partial recovery functions can occur even before the formation of a demyelination zone due to the reversibility of edema and inflammation in the focus, which explains the rapid and complete early remissions).
2. The possibility of asymptomatic MS in the presence of foci of demyelination, detected, in particular, by CT and MRI, if the minimum conduction of impulses necessary for the implementation of a specific function is maintained.
3. The possibility of manifestation or exacerbation of the disease under the influence of additional factors (infections, anatomical damage, the impact of physiological active substances, metabolic and endocrine dysfunctions).
4. As a result of demyelination - a decrease in the speed and a violation of the strictly isolated conduction of excitation through the neuron, the possibility of its transition from one nerve structure to another (ephaptic transmission). Clinically - the phenomenon of dissociation.
5. Influence of the temperature factor: deterioration in the condition of patients, an increase in paresis, coordinating and other disorders after hot bath, often when taking hot food. The phenomenon, apparently, is based on a partial blockade of neuromuscular transmission under conditions of demyelination, temporary disturbances in the permeability of the BBB.
6. Nested foci of demyelination (PC plaques) in various departments brain ( white matter hemispheres, as a rule - the periventricular zone, trunk, cerebellum), mainly the thoracic spinal cord, in the intracerebral part of the cranial and less often spinal nerves. Possibility of detecting foci and edema zones around them, as well as brain atrophy by imaging methods.

Risk factors for occurrence, progression
1. Age up to 40 years.
2. Frequent viral and bacterial infections history (measles, chicken pox, hepatitis, etc.).
3. Hereditary (genetically determined) predisposition (close relatives of the patient, blood marriages).
4. Past retrobulbar neuritis.
5. The impact of adverse factors in the process of work and at home ( physical stress, insolation, overheating, allergization, exposure to neurotropic poisons, etc.).
6. Pregnancy is one of the likely risk factors for exacerbation of the disease, especially in patients with severe spinal and cerebral symptoms.

Classification
MS refers to proper demyelinating diseases, in which, unlike myelinopathy, the destruction of correctly formed myelin occurs. It belongs to the group of predominantly central demyelination along with acute primary disseminated encephalomyelitis, para- and post-infectious encephalomyelitis, leukoencephalitis and some other diseases.
The PC classification is based on a topical attribute, reflects
clinical features and dynamics of the process (Zavalishin I. A., 1987). There are 3 forms: 1) cerebrospinal; 2) cerebral; 3) spinal.
Regardless of the primary localization, the lesion spreads to other parts of the nervous system, forming a cerebrospinal form.

Forms characterizing the course of PC: 1) remitting; 2) primary progressive (without clear exacerbations from the onset of the disease); 3) secondarily progressive (after previous exacerbations).

1. Anamnesis. Data on the first symptoms (debut of the disease): double vision, blurred vision, staggering when walking, weakness or paresthesia in the limbs, dizziness attacks, paresis of the facial nerve, imperative urge to urinate, etc. They can be isolated (in 60% of patients) or multiple. The duration of the first attack is from one day to several weeks. In 16% of patients, the first manifestation of MS is retrobulbar neuritis, in 5% - acute transverse myelopathy.
2. Analysis of medical documents. Important information about previous diseases, the nature of the course, the features of neurological symptoms.
3. In the advanced stage of the disease, clinical manifestations are very polymorphic. The most typical combination of symptoms caused by damage to the pyramidal, cerebellar, sensory pathways, individual cranial nerves:
- movement disorders(occur in 60-80% of patients), in typical cases they are manifested by paraparesis or paraplegia lower extremities, less often than the upper ones. Tendon and periosteal reflexes are usually high, especially on the legs, occasionally low. Characteristically early decline or loss of superficial abdominal reflexes, and pathological reflexes are typical. The phenomenon of clinical dissociation in the motor sphere: severe muscle weakness without increased reflexes, clear pathological signs without a convincing change in muscle tone and strength in the limbs, muscle hypotension against the background of high reflexes;
- coordination disorders (in 60% of patients): ataxia in the extremities with asynergy, dysmetria, atactic gait, intentional trembling, scrambled speech, change in handwriting (megalography);
- damage to the cranial nerves. In the foreground, visual disturbances due to retrobulbar neuritis (diagnosed in 50% of patients during the course of the disease): decreased visual acuity, central and peripheral scotomas, concentric narrowing of the visual fields, atrophy (blanching of the optic discs, often temporal halves). The phenomenon of dissociation: blanching of the discs with normal visual acuity and, conversely, a drop in visual acuity in the absence of changes in the fundus. Vestibular and auditory disorders: dizziness, vestibular hyperreflexia, unsteadiness, feeling of sinking, nystagmus, rarely hearing loss. Dissociation is manifested in normal tuning fork hearing and impaired perception of whispered speech. There is paresis of the facial, oculomotor and abducens nerves, the latter are characterized by transient diplopia;
- disturbances of sensitivity. Meet often, but usually subjective: paresthesia of various localization. Actually
vibration sensitivity decreases early and constantly, especially on the legs, less often musculo-articular;
Disorders of sphincter function are more often manifested in the form of urinary retention, imperative urge, constipation. Severe violations - only in the final stage of the disease;
- violations mental functions(in 93% of patients): neurosis-like (asthenia, hysteroform syndrome, sometimes obsessive states); affective (most typical is euphoria with inadequate assessment by patients of their physical and intellectual capabilities), depression, psychoorganic syndrome, dementia;
- rare and atypical manifestations PC: epileptic seizures in 1.5% of patients, usually generalized convulsive with an exacerbation of the disease; paroxysms of dysarthria and ataxia; paresthesia in the form of Lermitte's electric discharge phenomenon; chronic pain syndrome and paroxysmal trigeminal pain; extrapyramidal hyperkinesis (in reality, only dentorubral hyperkinesis is observed - a large-scale intentional tremor when trying to purposefully move); vegetative and endocrine (amenorrhea, impotence) disorders.
4. Data from additional studies:
- lumbar puncture (with diagnostic purpose, to clarify the degree of activity of the process). In the CSF during exacerbation, slight hyperproteinorachia (0.4-0.6 g / l) with a more pronounced increase in the amount of gamma globulin, in 95% of patients the content of oligoclonal immunoglobulins of group G is constantly increased. The determination of the basic myelin protein (its content in 2-3 times higher than in other organic diseases of the nervous system);
- Immunological studies (determination of indicators of cellular and humoral immunity in the blood). A marker of PC activity can be: depression cellular immunity(decrease in the number of T-suppressors), an increase in the content of immune complexes in the blood serum;
- electrophysiological study: visual and auditory evoked potentials in the cerebral form of MS and somatosensory in spinal and cerebrospinal. It is possible to determine the presence and localization of the pathological process along the corresponding paths, subclinical lesions. EEG - mainly for the purpose of differential diagnosis, detection of an epileptic focus, and oculography - initial (subclinical) oculomotor disorders;
- Brain imaging techniques (CT and MRI) have the greatest diagnostic value. Contrast-enhanced CT can reveal lesions in the brain (mainly located periventricularly). At the same time, an expansion of the ventricular system and furrows of the hemispheres is detected ( indirect signs PC). However, the possibilities of CT are limited in the study of the trunk, posterior cranial fossa, and especially the spinal cord. The MRI method makes it possible to detect hyperintense foci on Tg-weighted tomograms characteristic localization, as well as changes in the optic nerve, trunk, cerebellum. An increase in their number with a high activity of the process is shown. Foci of demyelination are also identified in the spinal cord (increased signal intensity on T2-weighted sagittal tomograms against the background of its swelling or atrophy). In general, the MRI method visualizes PC lesions in the brain in 95%, and in the spinal cord in 75% of cases. MRI makes it possible to judge the dynamics of the pathological process, to control the effectiveness of disease therapy.

Imaging techniques are also successfully used in the differential diagnosis of PC. Clinical limitations: 1) the possibility of asymptomatic PC in the presence of characteristic changes on MRI; 2) a frequent discrepancy between the localization and volume of foci of the severity of clinical symptoms;
- ophthalmological and otolaryngological examinations.
5. Criteria for the reliability of the diagnosis, depending on the nature of the lesion of the nervous system and the course of the disease (Zavalishin I.A., Nevskaya O.M., 1991):
1) undoubted PC - multiple damage to the nervous system (including according to anamnestic data) with a relapsing or progressive course with a fractional onset of symptoms and instability of some of them, without clear age restrictions;
2) doubtful PC: a) the first attack of the disease with several lesions (including isolated retrobulbar neuritis) and a regressive course; b) patients with multiple lesions of the nervous system without distinct progression or signs of remission; c) patients with one lesion, relapsing or progressive course.

Clinically reliable diagnosis according to Poser (1983):
1) two exacerbations and clinical signs of at least two isolated lesions;
2) two exacerbations and clinical signs of one focus in the presence of typical changes on MRI and positive results studies of evoked potentials. In addition, an important diagnostic test is the detection of oligoclonal antibodies of the IgG group in the cerebrospinal fluid.

Differential Diagnosis
The range of differentiable diseases depends on the stage of development, the characteristics of the clinical picture and the course of MS. Required thorough examination using additional methods sometimes long-term observation.
1. Acute disseminated encephalomyelitis (primary encephalomyelitis). Represents significant difficulties for differentiation from PC. Some authors consider the boundary between these diseases conditional. However detailed analysis wedge-
clinical picture and follow-up of patients in dynamics, as a rule. allow to clarify the diagnosis, which is essential for resolving issues medical and social expertise. Unlike MS, primary encephalomyelitis is characterized by an acute infectious onset with the development of focal cerebral, sometimes meningeal symptoms within 1-4 weeks. Frequent disturbances of consciousness, epileptic seizures, damage to the nuclei of cranial nerves, chiasmatic syndrome, pelvic and conduction sensory disorders. The absence of the phenomenon of clinical dissociation is characteristic. Lesions detected by CT are more often of cortical localization. In the future, long recovery period(from 3-4 months to 1-2 years), it is shorter at rapid development process. Residual manifestations (as a rule, persistent): sensory, motor, mental disorders, epileptic seizures, etc. Rarely occurring progressive course, exacerbations make us reconsider the diagnosis in favor of MS.
2. Cerebral or spinal (craniospinal) tumor, cranio-vertebral anomalies with neurological manifestations. Particular difficulties in tumors of the trunk (pons) and cerebellum, neurinoma auditory nerve, intramedullary spinal tumor. Often crucial have a lumbar puncture, contrast methods of research, CT, and with spinal localization - MRI.
3. Cervical ischemic myelopathy.
4. Progressive spinocerebellar degenerations, especially hereditary cerebellar ataxias, spastic paraplegia Strumpell, Friedreich's ataxia in the case of cerebellar or spinal variant of the onset of PC.
5. Hepatocerebral dystrophy ( shaking form) in the hyperkinetic variant of PC.
6. Retrobulbar neuritis (differentiation is especially difficult due to the possibility of PC debut), hereditary atrophy Leber's optic nerves and other types of degenerative diseases of the optic nerve (with an optical variant of PC).
7. Tick-borne borreliosis(later neurological manifestations chronic encephalitis). Difficulties, in particular, due to similar changes on MRI.
8. Some other diseases and syndromes (vestibulopathy, hysteria, consequences of craniocerebral and spinal trauma, optic-chiasmal arachnoiditis, neurosarcoidosis, drug addiction).
Course and forecast
In general, there are chronic and acute (subacute) course of MS. The latter - with a stem variant of the disease, deaths are frequent.

Chronic course options:
1) relapsing: a) a benign form with a relatively favorable slow course, long-term (often long-term and deep) remissions (10-20% of cases). More common with late start. A distinct violation of functions after 10-20 years, the ability to work remains for a long time, sometimes up to retirement age; b) a relatively favorable variant with short-term unstable remissions, multiple short attacks. A distinct dysfunction is detected after 5-10 years from the onset of the disease. Ability to work can be maintained for a long time, or limited; c) an unfavorable variant of the course (often at a young age) with rapid progression, severe exacerbations and incomplete remissions (malignant form). Severe functional impairment within 2-5 years. Remissions differ in degree (complete, partial) and duration: short (up to 3 months) and long;
2) progressive without remissions (in 15-20% of patients), often with slow progression. More characteristic of the late onset of the disease (after 30 years).

The clinical and labor prognosis is generally more favorable with a relapsing course, a late onset. However, an increase in the frequency and duration of exacerbations is an unfavorable prognostic sign. Approximately during the first two years of the disease, 20-30% of patients become disabled, after 5-6 years, about 70%, and 30% remain able to work for 10-20 years or more. The duration of the disease ranges from 2 to 30-40 years. The prognosis for life is uncertain. Death comes to late stage diseases from intercurrent diseases (with the exception of acute table form of PC).

PC severity criteria(according to Leonovich A. A., Kazakova O. V., 1996; with changes). It should be evaluated taking into account the variant of the course of the disease.
1. First degree. clear signs organic damage nervous system (more often in the reflex sphere), without dysfunction. Ability to work is usually preserved.
2. Second degree. Moderate insufficiency of motor, coordinating, visual functions. Employability is often limited.
3. Third degree. Persistent pronounced motor, coordinator and other disorders that significantly limit the patient's life activity, leading to the impossibility of professional activity.
4. Fourth degree. Pronounced motor, visual, pelvic, mental disorders, causing the need for constant extraneous care, assistance.
MS, spinal form (I degree of severity), stage of prolonged remission, favorable course.
MS, cerebrospinal form (II degree of severity), fast
progressive course, exacerbation.
MS, cerebrospinal form ( III degree severity), progressive course.

Principles of treatment
At the first manifestations of MS, patients need to be hospitalized in a neurological hospital. In the future, inpatient treatment is desirable in a situation of exacerbation, with a clear progression.
1. Pathogenetic therapy(based on the immune-mediated nature of the process). The main goal is to stop or slow down demyelination, and therefore, the stabilization of a neurological defect.
1) Immunosuppression. Corticosteroids: prednisolone, preferably methylprednisolone (metipred), with almost no side effects. In tablets at a dose of 1 mg / kg of body weight, according to the scheme daily or every other day. Maximum daily dose during
2 weeks, from gradual decline for 4-6 weeks. Metipred can also be used according to the method of pulse therapy: intravenous drip - large doses(up to 1000 mg daily for 3-7 days). The main indication for corticosteroid therapy is a relapsing form of MS (exacerbation), a clear progression.
ACTH and its synacthen depot fragment are less effective and are usually used in progressive cases. Cyclophosphamide (together with ACTH) can be used in patients with severe MS, and dexamethasone in isolated retrobulbar neuritis (retrobulbar).
2) Immunomodulation. It is promising to use interferons-beta (rebif, betaferon), which can enhance the activity of T-suppressors, which is reduced during an exacerbation of MS, which have antiproliferative and antiviral effects. They are used at an early stage of MS, in patients with a relapsing course of the disease, capable of independent movement. It is possible to stop exacerbations (in 50% of patients), inhibition of the progression of the disease. Continuous (at least a year) subcutaneous injections of the drug are required.
Plasmapheresis, enterosorption methods, UV irradiation of CSF are also used to activate immune processes.
The effectiveness of levamisole, taktivin and other immunostimulants is questionable.
2. Symptomatic therapy: muscle relaxants to reduce muscle tone - baclofen, mydocalm, sirdalud; Essentiale, nootropics, antioxidants to reduce metabolic
ic disorders, stimulation of the nervous system; correction mental disorders- psychotherapy, antidepressants, sedatives.
3. Physiotherapy(carefully), prevention of joint contractures, skin care, catheterization if necessary.
4. Out of exacerbation (in remission) - maintenance therapy 2 times a year (biostimulants, nootropics, symptomatic remedies). Hormone therapy is not used.

Medical and social examination Criteria of VUT
1. At the first manifestations of the disease, especially acute or subacute, when patients need to be examined for the purpose of diagnosis and treatment (VN period is at least 3-4 weeks).
2. With a remitting course (during an exacerbation). The duration of VN depends on the severity of exacerbation, its duration (may be 2-3 months), in the case of repeated exacerbations, more often than not less than 1.5-2 months. lingering until
4 months exacerbation at 2nd-3rd degree of MS severity gives grounds for referral of the patient to BMSE. Continuation of treatment on sick leave is indicated only with a favorable labor prognosis (the patient will be able to return to work in full or with restrictions being disabled Group III). A slight improvement does not justify the continuation of VN.
3. Chronic progressive course. VN if necessary hospitalization for the purpose of treatment (including for disabled people of group III), as well as inpatient examination in order to clarify the diagnosis, nature and severity of dysfunction (terms of VN are determined by the time of stay in the hospital).

The main causes of disability
1. Movement disorders due to the combination central paresis and ataxia, most often lead to limitation of life:
1) a pronounced motor defect causes the possibility of movement only within the apartment or complete immobility of the patient. Violation of the ability to self-service of the third degree leads to severe social insufficiency, the need for constant care, assistance;
2) a pronounced defect - the patient moves independently, usually with the help of a crutch, a stick. Difficulty climbing and descending stairs, reduced ability to overcome other obstacles, use public transport, housekeeping, writing, personal care;
3) moderate motor defect - the patient can move over relatively long distances, but the gait is changed (spastic-atactic). Reduced ability to lift
carry weights, manual activity (performing subtle, precise movements). Due to ataxia, there may be difficulties in personal care, in daily activities;
4) mild motor disorders. Movement is free, difficulty only during physical exertion, carrying heavy loads. There may be difficulties in performing arbitrary operations, if necessary, writing (mainly due to coordination disorders);
5) pyramidal insufficiency syndrome (hyperreflexia, asymmetry of reflexes, pathological signs without limb paresis). Often occurs in patients with MS as a manifestation of the phenomenon of clinical dissociation. Causes the need to limit physical activity, in particular long walking, standing, carrying heavy loads, exposure to adverse domestic and industrial factors (insolation, overheating, etc.) due to the possibility of temporary and long-term deterioration of the patient's condition, the appearance of a motor defect.
2. Visual impairment leads to disability varying degrees due to a decrease in the ability to orientate, perform actions that require adequate visual acuity both during work and at home.
3. Disorders of mental functions can significantly limit life activity only at a late stage of MS. However, euphoria (rarely depression) requires an adequate assessment to determine the real labor opportunities of the patient (the phenomenon of clinical and labor dissociation).

Contraindicated types and working conditions
1. General: significant or moderate physical stress, impact toxic substances, general vibration, unfavorable meteorological factors (primarily insolation, overheating).
2. Due to the peculiarities of dysfunction and the course (progression) of the disease in a particular patient: the inaccessibility of professions that require a long stay on their feet, moving heavy objects, strictly coordinated movements, a certain rhythm, eye strain.

Able-bodied patients
In the stage of long-term remission with minimal or no organic symptomatic, rationally employed.
2. With MS of the first degree of severity (clear signs of organic damage without functional impairment): in the absence of general and individual contraindications to work in the main profession, prolonged remission, rare exacerbations or slow progression (taking into account the effectiveness of therapy). In some cases, it is necessary to exclude adverse factors labor activity on the recommendation of the KEC.
3. Patients with the second degree of MS severity (moderate motor, visual defect), with rare exacerbations, generally favorable course of the disease and rationally employed in professions of the humanitarian, administrative type.

Indications for referral to BMSE
1. Persistent and severe dysfunctions that significantly limit the patient's life.
2. Progressive course with repeated exacerbations, incomplete remissions or steady progression.
3. Long-term temporary disability (at least
4 months) due to exacerbation of the disease.
4. Loss of profession or the need for a significant reduction in the amount of work (depending on the features of dysfunction).

Required minimum examination when referring to BMSE
1. Data lumbar puncture(if possible - determination of oligoclonal globulins).
2. Results immunological research blood (indicators of cellular and humoral immunity).
3. CT and (or) MRI data of the brain and spinal cord.
4. Results of the study of evoked potentials of various modalities (visual, etc.).
5. Data of the ophthalmologist, otolaryngologist.

Disability Criteria
Clinical and social features assessment of working capacity in patients with MS:
a) progressive course of the disease in general (despite the above options);
b) the frequency of exacerbations cannot be the only criterion - it is necessary to evaluate the duration, as well as the depth of remissions;
c) a frequent discrepancy between the severity of organic symptoms and the degree of dysfunction (the phenomenon of clinical dissociation);
d) young age and active labor orientation of patients. At the same time, it is necessary to keep in mind the lack of criticality and underestimation by many patients of their labor opportunities (the phenomenon of clinical and labor dissociation).

Group III: social insufficiency due to the second (rarely first) degree of severity of the disease, if dysfunction and (or) a rapid rate of progression leads to loss of profession, qualifications, a significant decrease in the amount of work (according to the criteria for limited mobility, first-degree labor activity ).
Group II: the third degree of severity, rapid progression, in particular in the stem form of the disease, leading to severe disability (according to the criteria for impaired mobility, orientation of the second degree, labor activity of the second, third degree).
Group I: the fourth degree of severity of MS due to the need for constant outside care and assistance (according to the criteria for limiting the ability to move, orientation, self-care of the third degree).

Persistent pronounced functional impairments with the impossibility of reducing social insufficiency after observing a disabled person for 5 years are the basis for establishing a disability group without a re-examination period.

Reasons for disability: general illness, sometimes disability due to an illness received during military service.

Disability Prevention and Rehabilitation
Only secondary and tertiary prevention, partial rehabilitation are possible.

1. Secondary prevention: a) timely diagnosis;
b) differentiated therapy (depending on the nature of the course, the age of the patient and other factors); c) compliance with the terms of VN, especially in the period of exacerbation; G) dispensary observation(according to the III group of accounting, with a frequency of inspections at least 2 times a year). In the case of an acute form and a malignant course, patients should be observed at least once a quarter; e) rational and timely employment at the initial stage of the disease and in complete remission (transfer to another job after the diagnosis has been clarified and the VL has ended).

2. Tertiary prevention, professional and social rehabilitation: a) modern Definition III disability groups, changes in working conditions or employment in new profession taking into account contraindicated factors; b) organizing the work of disabled people of group II in specially created conditions, including at home (advisory, literary, administrative and economic work of a small volume, and DR); c) in the case of stable remission, with a slight violation motor functions one can cautiously recommend training and retraining for some technical, humanitarian, administrative professions, taking into account contraindications and a real prospect of further labor activity; d) in case of severe disability, the following are important: psychological support patient, correction of emotional disturbances; symptomatic therapy in case of pelvic disorders, severe spasticity; supply of a bicycle carriage and other measures of social assistance and protection.

With multiple sclerosis, you can issue a disability group for certain lesions.

First, the patient is required to undergo an examination by doctors of a narrow specialization. Then get a health report. The attending physician writes out a referral in a special form indicating the main and concomitant diagnoses and the severity of the existing violations.

Further, the patient applies to the medical and labor expert commission (VTEC), where he provides all the documents and undergoes a consultation. If the severity of the condition meets certain criteria, then the patient is assigned a disability group.

You may also be interested in, in which we will talk about such a popular procedure as mesotherapy and tell you if it will help alleviate sclerosis.

How to get it?

The status of disability and its group is assigned after passing a medical and social examination (passing). VTEK experts and doctors conduct an additional examination of the patient in the clinic or at home (if the person cannot move independently).

According to the diagnosis of the patient and the conclusion of the examination, a decision is made to assign a group with an indication of its validity period, after which a re-examination is carried out. If the condition has worsened over the past period, then the group can be changed (for example, assign the second group instead of the third). With the improvement of the condition of a patient with multiple sclerosis, disability is removed. Usually VTEC draws up one of the groups for multiple sclerosis.

The basis for the decision is a common disease. Upon appointment, personal rehabilitation is established, which determines the needs, methods and means of transportation, hygiene products for the patient. They also conduct training courses to restore lost actions and abilities.

Criteria for awarding

The VTEK Commission uses the following criteria:

Before making a final decision on the group, the commission considers the following aspects:

inability of a person to self-service;
pathology of visual function and the level of its impairment;
pathology of motor function;
the health status of the patient.

The patient's ability to self-care

It is one of the evaluation criteria. The degree of autonomy in self-care ranges from complete self-care to loss of motor function and the need to:

in additional care;
full care from the side;
ability to orientation in space;
communication and interaction.

Vision, its impairment and lack

The score per group is based on the severity (scotoma) of one or both:

A small degree of low vision - up to 0.7.
The average degree is from 0.1 to 0.3.
The expressed degree is from 0.05 to 0.1.
Significantly pronounced - from 0 to 0.4.

The severity of damage to the nervous system

It is characterized by impaired speech function, cognitive abilities, sensitivity and perception. Also applies to memory and its safety, psychomotor functions.

What disability group is given?

The VTEK Commission establishes a group according to the criteria and aspects of the diagnosis.

Assigned following groups disability in multiple sclerosis:

Payment amounts for a given period of time

The pension benefit depends on the disability group received (since it depends on the degree of the citizen's ability to work).

Scale

The disability scale for multiple sclerosis is calculated in points (from 0.0 to 9.0) using a special calculator.

The scales are represented by the following parameters:

visual functions.
Condition of the spinal cord.
Functions of the pelvic organs.
pyramid system.
Sense organs.
Functions of the cerebellum.
Cognitive abilities.

Kurtzke scale 10-point

Reason for establishment

The general disease is the reason for the establishment of disability in multiple sclerosis. In this case, the patient is given rehabilitation program and training courses that aim to restore lost abilities.

Read about the causes of the disease in, and whether it is inherited, you will find out by clicking on.

Rehabilitation program

The program is designed for timely diagnosis and appointment, application and suspension from work. Appointed clinical examination for a period of three months to a year. After recovery courses, socialization, limited activity and rationalization of work are carried out.

For the second group of disability, restrictions on work or retraining for a light specialty are introduced. Some patients are prescribed psycho-emotional correction.

Terms of registration

According to the Federal Law "On the Social Protection of the Disabled in the Russian Federation", a group is drawn up and a cash allowance (pension) is assigned. The allowance is assigned as part of an insurance or social nature.

The final decision on disability and disability registration is made after the stages of treatment, recovery and re-exacerbation. It usually takes four months to a year. Certificate deadlines:

definite- is established for a period of two to four years with a positive prognosis for recovery, is subject to verification in the VTEK after the end of the medical report.
perpetual- is established in the absence of positive forecasts for rehabilitation and in the presence of severe incapacity.

How to live with such a disease, tell

Contrary to popular belief, multiple sclerosis (MS) is not associated with sclerotic changes in the walls of blood vessels, nor with age-related forgetfulness and problems with concentration. This is an autoimmune disease. The pathological process is expressed in the degradation of the nervous tissue and the destruction of the outer layer of nerve fibers, consisting of myelin. The result of the development of the disease is multiple lesions of the nervous system, manifested by decreased vision, fatigue, impaired coordination of movements, tremor, muscle weakness, decrease peripheral sensitivity, local paresis. In severe cases, there may be deterioration in functioning pelvic organs(stool and urination retention, urinary incontinence, etc.), the appearance of neurosis, depression, hysteria, or, conversely, euphoric states, combined with a decrease in intelligence.

Source: depositphotos.com

Multiple sclerosis is a fairly common pathology: there are more than 2 million people in the world who suffer from it. There are several described forms of MS, but the set of symptoms, severity and specificity of the course of the disease are individual for each patient.

Although MS is not considered a rare disease, most people are not familiar with its features. We will try to dispel some of the myths that have developed around the named disease.

Multiple sclerosis is a deadly disease

This is not true. Most severe forms sclerosis, accompanied by a serious lesion of the central nervous system, are relatively rare. In addition, modern medications able to significantly improve the condition of patients. Unfortunately, the situation is complicated by the fact that the clinical manifestations of MS often appear late, when about half of all nerve fibers are already damaged. In such cases, the start of treatment is delayed, which negatively affects its result.

The use of modern medicines and an increase in the standard of living have a beneficial effect on the condition of people suffering from MS. Despite the fact that cases of a complete cure are unknown, the progression of the pathological process can usually be slowed down. In general, the life expectancy of patients with multiple sclerosis in developed countries does not differ from that of their peers who have avoided this disease.

MS patients are doomed to immobility

It is believed that for every person with multiple sclerosis, in the future - movement with the help of a wheelchair and complete helplessness. In reality, forecasts can be much more optimistic: early diagnosis and the timely initiation of adequate treatment, disability may not occur. Of course, much depends on individual characteristics course of the disease, but the majority of MS patients manage to maintain the ability to move independently, serve themselves and live in the usual mode.

Multiple sclerosis is a disease of old age

Rather, the opposite: the onset of the disease usually falls within the age interval between 10 and 50 years. Among the children of girls suffering from MS, three times more than boys, but in older age groups the number of men and women among patients is almost the same. In the fairer sex, the disease manifests itself on average 1.5-2 years earlier than in their male peers, but in the latter the disease is more active and takes on more severe forms.

The cause of multiple sclerosis is still unknown, only risk factors have been studied:

ethnic (racial) affiliation. Europeans get MS more often than Africans, and the Chinese, Japanese, Koreans are almost never diagnosed with the disease;
region of residence (the so-called "latitudinal gradient"). The risk of getting MS is highest for those people who live north of the 30th parallel. For the inhabitants of other regions of the Earth, this parameter gradually decreases in the direction from north to south. The minimum number of cases was recorded in the southern parts of the African and South American continents, as well as in Australia;
stress. There are observations confirming the increased incidence of multiple sclerosis among representatives of "nervous" professions (air traffic controllers, firefighters, pilots, etc.);
smoking;
genetics. Having a family history of MS increases the risk of developing the disease tenfold. However, the disease is not considered hereditary, since its appearance is usually due to many factors.

Women with MS shouldn't get pregnant

Multiple sclerosis is not an obstacle to bearing a child. On the contrary, many women with MS experience significant relief during pregnancy, and many years of remission may occur after the baby is born.

The disease of the expectant mother does not affect the development of the fetus and the health of the newborn. The only problem is the use of drugs prescribed for the treatment of MS, as some of them cannot be used during pregnancy and breastfeeding. Therefore, the patient must always consult with the attending physician before conception and be under his supervision for the entire period of gestation.

MS patients should avoid physical activity

For a long time, doctors really believed that exercise was bad for people with multiple sclerosis. Numerous studies have proven that this is not so: patients can and should exercise moderate physical activity (of course, dosed taking into account the manifestations of the disease). Specially selected complexes are very useful for MS patients aerobic exercise: in most cases, they reduce the severity of symptoms. Patients are also shown walking, swimming and just relaxing in the fresh air.

Source: depositphotos.com

MS patients cannot continue to work

Many people with MS, thanks to adequate treatment for decades, retain not only habitual image life, but also physical and mental activity, allowing them to successfully perform production duties. Even the onset of disability does not always become a reason for leaving work, especially since labor legislation obliges employers to provide such employees with working conditions that take into account the peculiarities of their condition. Therefore, the majority of MS patients who are of working age are not in danger of being thrown to the sidelines of life.

Multiple sclerosis is a severe progressive disease, but not a death sentence. Following the instructions of the attending physician, the patient may well remain an active, self-sufficient and successful person. It is important not to give up, to keep an optimistic view of the world, and maintaining a normal standard of living will be a completely solvable task.

Video from YouTube on the topic of the article:

Found a mistake in the text? Select it and press Ctrl + Enter.

Comments on the material (17):

I'm just quoting my wife:

Thanks

I quote Sidorenkova Ekaterina Valerievna:

I'm just quoting my wife:
I write because beginners can read. My husband has at least 10 years of experience - the first exacerbation was about 15 years ago, the diagnosis was incorrectly made. The symptoms went away on their own serious treatment, diagnosis, etc. Everything is individual. The husband stopped taking drugs (not a guide to action - he was on them for 8 years, he was just tired of the side effects), he lives ordinary life. When there is a financial opportunity, he eats food where there is less gluten, drinks alcohol not on wheat, but on grapes. If possible, eats turkey or lamb, but not chicken. Smokes. And it is no different from peers under 50 - the same lifestyle, etc. Again, I am writing to support newcomers. When I came across pessimistic articles at the beginning, my hands dropped. This is the worst thing for those who have just learned the diagnosis, and most importantly for those who are nearby! The main thing is for a person to move forward and set goals for at least 5 years ahead. Our daughter was born then, there was no time in wheelchair sits down (another son went to grade 1). Then they bought a dacha, and on the rise. The main thing is that a person should not fall out of the list of ordinary and living people. The disease has not been fully studied - with a remitting course, all functions are restored depending on age. It is advisable to adhere to a gluten-free diet for at least the first six months and master breathing exercises(Frolova, it seems) - removes headaches and spasms. GOOD LUCK! Maybe someone will support.

Thanks

I've been living with MS for 18 years, yes, in the first 10 years I felt noticeably better, but I don't give up either. I also recommend light yoga. She is also very helpful. The main thing is not to be buried alive. Yes, I don’t take any treatment, maybe in vain, but I don’t like to take pills. Yes, it’s better to refuse meat altogether, but it doesn’t always work out.

Quoting Elena:

My husband was diagnosed and he can still walk! Six months later - a stroller, and after 10 years - complete helplessness. And you say there modern medicines? And this is St. Petersburg and they diagnosed and prescribed treatment in 1 honey. There is no cure and no cure.

What was appointed?

I'm just quoting my wife:

I write because beginners can read. My husband has at least 10 years of experience - the first exacerbation was about 15 years ago, the diagnosis was incorrectly made. The symptoms went away on their own, after a serious treatment, diagnosis, etc. Everything is individual. The husband stopped taking drugs (not a guide to action - he was on them for 8 years, he was just tired of the side effects), he lives a normal life. When there is a financial opportunity, he eats food where there is less gluten, drinks alcohol not on wheat, but on grapes. If possible, eats turkey or lamb, but not chicken. Smokes. And it is no different from peers under 50 - the same lifestyle, etc. Again, I am writing to support newcomers. When I came across pessimistic articles at the beginning, my hands dropped. This is the worst thing for those who have just learned the diagnosis, and most importantly for those who are nearby! The main thing is for a person to move forward and set goals for at least 5 years ahead. Our daughter was born then, there was no time to sit in a wheelchair (another son went to 1st grade). Then they bought a dacha, and on the rise. The main thing is that a person should not fall out of the list of ordinary and living people. The disease has not been fully studied - with a remitting course, all functions are restored depending on age. It is advisable to adhere to a gluten-free diet for at least the first six months and master breathing exercises (Frolova, it seems) - it removes headaches and spasms. GOOD LUCK! Maybe someone will support.

Thank you!

Quoting Optimist:

Officially I have been sick for 11 years, unofficially for 13-14 years. I prick injections (glatirat). I don't lower my hands. Sports results are already better than healthy ones. I walk a lot. Approaching proper nutrition. I'm 45 years old. Don't be scared and don't despair. It may or may not be cured (I don’t know what was on the MRI, I didn’t do it for 3 years), but it’s quite possible to live a high-quality, ordinary life!) Minimize stress. Thirst for life and faith in yourself works wonders!!)) Good luck and health!!!)

In almost the same situation ... the diagnosis was not made on time, initially confused with a violation cerebral circulation. To date, for the sixth year on Glatiran, plus, if possible, protection from stress, i.e. if you can not heat and sun, then you can not! Well, food of course. Sport makes it possible to look better than those who are not sick with such a disease. When I went around the second round to find out the causes of my problems, at that moment there were already a lot of them, and the most serious one was severe headaches that prevented me from just living a full life, it’s not sleeping and not understanding ... a terrible feeling plus numbness of half of the body and dizziness, impaired speech, swallowing, some movements. I was lucky when I got to a competent doctor who immediately suspected such a diagnosis, especially since two relatives in the family had such a disease. Correctly write the most important thing is not to give up !!! Sports, yoga, walking and a positive attitude! Let's keep fighting!

With regular visits to the solarium, the chance of getting skin cancer increases by 60%.

Smiling just twice a day can lower blood pressure and reduce the risk of heart attacks and strokes.

Most women are able to get more pleasure from contemplating their beautiful body in the mirror than from sex. So, women, strive for harmony.

People who eat breakfast regularly are much less likely to be obese.

The rarest disease is Kuru disease. Only representatives of the Fur tribe in New Guinea are ill with it. The patient is dying of laughter. It is believed that the cause of the disease is the eating of the human brain.

During work, our brain expends an amount of energy equal to a 10-watt light bulb. So the image of a light bulb above your head at the moment an interesting thought arises is not so far from the truth.

The first vibrator was invented in the 19th century. He worked on a steam engine and was intended to treat female hysteria.

Millions of bacteria are born, live and die in our intestines. They can only be seen with strong increase, but if they came together, they would fit in an ordinary coffee cup.

Dentists have appeared relatively recently. Back in the 19th century, pulling out diseased teeth was part of the duties of an ordinary hairdresser.

An educated person is less prone to brain diseases. Intellectual activity contributes to the formation of additional tissue that compensates for the diseased.

Many drugs were originally marketed as medicines. Heroin, for example, was originally introduced to the market as a cure for baby cough. And cocaine was recommended by doctors as an anesthetic and as a means of increasing stamina.

Caries is the most common infectious disease in the world, which even the flu cannot compete with.

Four slices of dark chocolate contain about two hundred calories. So if you do not want to get better, it is better not to eat more than two slices a day.

In addition to people, only one living creature on planet Earth suffers from prostatitis - dogs. These are really our most faithful friends.

The liver is the most heavy organ in our body. Its average weight is 1.5 kg.

The term "occupational disease" refers to illnesses that a person is likely to get at work. And if with harmful industries and services ...

Multiple sclerosis is a primary demyelinating disease of the central nervous system. This means that there is a destruction of the already formed myelin. The main damage that the disease causes is a violation of the transmission of a nerve impulse. Damage to myelin leads to a sharp decrease in the transmission rate. In addition, an impulse intended for one group of nerves can be transferred to another. From this, a person loses his ability to work, sometimes the establishment of a disability group is required. The frequency of disability in Russia, the Baltic states and Belarus is approximately the same: from 25 to 50 cases per 100 thousand of the population.

Main criteria

Disability in multiple sclerosis is determined by three factors:

type of course of the disease and defect;
the number of days of temporary disability in a year;
the patient's profession.

The medical labor commission considers a combination of factors. Special attention is given to the severity of the process and the defect that has arisen as a result of it (loss of functions). They always try to preserve a person’s ability to work as much as possible, switching off from daily work immediately complicates social adaptation.

A disability group is given for multiple sclerosis for processing social benefits - pensions and subsidies.

The medical commission is based on the criteria for the severity of the course of the disease, developed in 1996 by Leonovich and Kazakova. According to them, 4 degrees of severity of the course of the disease are distinguished.

First - there are signs of organic damage to the nervous system, but all its functions are preserved. In this case, the person retains full working capacity, the disability group is not given, it is necessary intermittent treatment in the hospital.
The second - there is a lack of vision, movement or coordination. Depending on the type of flow, a temporary disability sheet can be extended or a 3rd disability group is established for 1 year, followed by re-examination.
Third - there are persistent violations various functions movement, coordination, vision, intelligence, which make the performance of professional skills impossible. Disability group 2 is established, with re-examination or indefinitely.
Fourth - there are pronounced violations vital functions, a person requires extraneous care. We are not talking about a profession at all, a person cannot independently serve himself. 1 group of disability is established, most often immediately indefinitely.

Temporary disability and disability

Timing inpatient treatment in Russia and Belarus are approximately the same. At the first degree of severity of the disease, the patient requires a thorough examination and quality treatment which can take 3 to 4 weeks. Represent the patient medical labor commission there is no need, the certificate of incapacity for work is extended in the usual way. At the end of treatment, the person returns to his former place of work, his ability to work is not impaired.

More attention is required to the remitting type of course, when an exacerbation can drag on up to 4 months once. Also, exacerbations can be repeated 2-3 times within one year, the duration of each can be from 1 to 2 months. For the medical and labor commission, not only the state of health is important, but also the total number of days of disability per year. The question of whether a person with existing disorders can generally return to work is being considered.

If by December the patient spent 2 months in the hospital, and he needs 1-2 weeks to complete the treatment, then the temporary disability sheet can be extended without establishing a disability group.

If the commission sees that the case is moving towards recovery, but the number of days of disability exceeds 4 months in 1 year, then a 3rd disability group is established. A person copes with the aggravation and returns to his previous place of work, but requires lighter working conditions - less work or a decrease in the number of hours. The difference in wages should theoretically be compensated by a disability pension.

A chronic progressive course is considered unfavorable in terms of labor prognosis. Such patients are almost immediately assigned a 3rd disability group, but they still have to spend a lot of time in the hospital. Subsequently, with an increase in disability, disability is aggravated. Sometimes there is a need to present such patients to MSEC ahead of schedule.

Disease and profession

There is a list of types and working conditions that are contraindicated in multiple sclerosis. it common factors and causes that harm this particular patient.

To general harmful factors relate:

Physical overexertion;
toxic substances;
Vibration;
Increased insolation;
General overheating.

According to the conclusion of the medical commission, a person can be transferred from the hot shop to another unit at the same enterprise.

The ratio of the symptoms of the disease and the profession of a person is always a very difficult question. The possibilities of retaining a profession depend on what actions this profession requires.

For example, a person works as a dispatcher transport company, is on duty throughout the day. Due to illness, he developed pyramidal insufficiency (asymmetry and increased tendon reflexes, expansion of reflexogenic zones, pathological signs, awkwardness when performing precise movements). In addition, there are visual impairments - the sharpness and ability to navigate have decreased. broke emotional sphere showed signs of depression. It is clear that further hard work as a dispatcher will worsen the state of health. It is best for such a patient to arrange a group, he can be transferred to a daily schedule to perform less responsible work (assistant, secretary, clerk).

The second patient has exactly the same clinical picture, but he works as a day watchman at a mothballed construction site, spends his working time in an equipped change house. There is no need to establish a group here (if the number of days of incapacity for work allows), since working conditions do not affect the course of the disease.

Which disability group will be established depends on the specific circumstances.

General indications for referral to MSEC

The indications are approximately the same throughout the post-Soviet space, in Russia and Belarus. These include:

persistent violations of the functions of movement, vision, coordination, mental activity, limiting human life;
progredient course of the disease, in which it is impossible to achieve complete remission, and exacerbations occur at least 2 times within one year;
duration of temporary disability exceeding 4 months within one year;
loss of profession or inability to perform previous work in full.

The disability group can be revised when a good quality remission is achieved.

The diagnosis of multiple sclerosis today is not a sentence. The life expectancy of patients reaches 30 years or more. Given the typical age of onset of the disease - from 20 to 40 years - a sick person has every chance of living full life, leave offspring and achieve the goal. Life still flows, and what it will be depends largely on the person himself.

To see a person with such an ailment on the street is possible only if the motor functions are preserved. But more often, only those who have had such a problem in their family recognize multiple sclerosis.

Multiple sclerosis is a chronic disease that leads to disability. With it, people rarely live to old age, especially in cases where there is a remitting form and constant treatment.

The main cause of death is the presence of infection or bulbar disorders (problem swallowing, chewing, etc.).

All information on the site is for informational purposes and is NOT a guide to action!
Give you an ACCURATE DIAGNOSIS only DOCTOR!
We kindly ask you DO NOT self-medicate, but book an appointment with a specialist!
Health to you and your loved ones!

Disability

In the presence of multiple sclerosis, patients receive a disability, the degree of which is determined by specialists of medical expert commissions. The nature of the course of seizures is taken into account.

Factors affecting life expectancy

Only a few manage to live long in the presence of multiple sclerosis.

The influencing factors are:

mental disorders;
the presence of bedsores and ulcers on the limbs, which cause infection of other organs.

Such causes lead to death gradually.

But there may be changes in which life ends immediately:

with a heart attack;
with lesions of the respiratory centers;
with renal failure;
with infection of the urinary system.

Life expectancy also depends on the stage at which pathological processes are detected. If the disease is diagnosed in a timely manner, then proper treatment disability does not occur.

Life expectancy in multiple sclerosis

It is rare to find a person with multiple sclerosis who has lived for more than 40 years. And in order to understand how advanced modern science has advanced in search of effective treatment, it is worth waiting for more than a dozen years. This is also difficult to do, for the reason that with atypical forms of MS, people die after 5-6 years.

But experts were able to ensure that life expectancy increased.

For comparison, here is a table:

After being diagnosed with multiple sclerosis, the average person still lives 35 years. If the disease is in acute form, then the person is given much less. The frequency of this type of pathology is every fourth patient.

Modern medicines increase the life expectancy of a person. Their particular effectiveness is noted in forty-year-old patients.

If there are problems with coordination of movements in a patient at the age of 50, it is likely that he will live no more than 70 years.

There are several groups of people with such a diagnosis, whose life has a different duration:

Consequences and complications

There may be such complications:

the sensitivity of the limbs is lost;
the brain is affected;
inability to control urination, defecation;
weakness in the legs;
paresis and paralysis;
the appearance of seizures;
the occurrence of dizziness;
feeling tired;
depression;
disorders in the sexual sphere.

Frequently asked Questions

Persons who have experienced such a disease themselves or observe its course in a member of their family are wondering: how to live on.

Can a person with MS study or work?

Since MS is not characterized common manifestation, severity and frequency of occurrence, it is difficult to answer such a question unambiguously. The degree of disability affects the ability to perform work duties or attend classes.

If a person has a 3rd disability group, he can continue to lead the lifestyle he is used to.

During remission, the patient must assess the level of his capabilities in a particular industry:

physical;
social;
cognitive abilities.

This will allow you to move towards the goal not only at this stage, but also in the future.

Do I need to talk about my illness to family and friends?

The patient has full right decide on your own - to hide the discovered ailment or tell loved ones.

If there are no visible signs, then you can not rush to inform your relatives.

But when you open a secret, you can take advantage of the benefits provided. For example, in educational institutions such patients are trained in special programs, can count on individual exams, etc.

How to live on after the diagnosis?

If the disease is detected early, treatment will be more effective. You need to take beta-interferons, which will help slow down the process of disability, reduce the severity and frequency of exacerbations.

The patient should adapt to disability (if it is not very pronounced) and continue to live the same life.

There is no general method of treatment. If there is a serious exacerbation, then the doctor will prescribe corticosteroids, methylprednisolone intravenously with a further transition to prednisolone.

Reduced severity and severity of exacerbation individual drugs, which were allowed for use more recently:

The patient should be in rehabilitation after an exacerbation.

With remissions, maintenance therapy is prescribed, as well as:

physical exercises (stretching and coordination);
speech therapy classes;
physiotherapy.

Which specialists to contact?

How to live without exacerbations or minimize them? It is worth seeing the experts. Multiple sclerosis is in the competence of a neurologist. A family doctor will help you and your loved ones to find out all the nuances about the course of the disease.

Many also apply to medical institutions for psychological support.

For special problems that may arise due to the disease, contact:

to the urologist;
psychologist;
nutritionist;
speech therapist;
physiotherapist;
therapist.

Will volunteers help if I'm lonely?

Lonely people can count on the support of social workers in housekeeping.

There are volunteer movements in the country that will support and help in solving problems.

These organizations have special literature on multiple sclerosis, which is provided to patients free of charge. Trust numbers and the address of such a society can be found on the RS International Portal.

Does MS differ in the elderly from the course of the disease in young people and children?

MS can debut in a person of any age, but is most often diagnosed in people 25-35 years old, and the female body is at a greater risk. In old age, as in the young, the disease rarely appears.

The course of multiple sclerosis two-year-old child is easy and complications are minimal.

In young people and children (unlike older patients), the disease is accompanied by:

convulsions;
loss of consciousness.

The rest of the symptoms are common. According to research, if a child falls ill before the age of 16, then the course of the disease will be more favorable. But there are cases when, after 20-30 years, such people have significant disability.

What are the predictions?

No one predicts how multiple sclerosis will develop. Partially it is possible to foresee, taking into account the type of course of the disease (remitting or progressive), the disability group that was obtained at this stage.

Most patients lead a normal life (45%), since the disease does not cause a strong deterioration in the condition. In 40% of patients, multiple sclerosis from a remitting type passes into a progressive one.

Those people with multiple sclerosis who work, during an exacerbation take steroid hormones and drugs prescribed by a neurologist to minimize them. AT rare cases the person must sit in a wheelchair.

In 15% of patients, there are no pronounced disorders for more than 25 years. Life expectancy with multiple sclerosis is different for everyone, but it is in your power to do everything possible to alleviate the condition and live a fulfilling lifestyle. The main thing is to identify the disease in a timely manner and not to avoid meeting with the doctor.