How to diagnose multiple sclerosis? Oligoclonal bonds of IgG.

Until recently, the diagnosis of multiple sclerosis, as well as the diagnosis of early stage multiple sclerosis, was based only on clinical features. The first attempts, like the first definition of MS, were given by J.M. Charcot back in the 19th century. Since then, many attempts and formulas have been formulated to diagnose multiple sclerosis. However, only recently, 20-30 years ago, among the “primitive” tools for diagnosing the disease, new methods of formulating criteria began to be used in order to make a diagnosis.

To make a diagnosis of multiple sclerosis

The studies of MS described by the classics are currently insufficient for the clinical characterization of MS patients. The picture of this disease allows us to define 2 groups of symptoms: classic and rare. The classics include the most common symptoms, which are a direct manifestation of damage to the functioning of brain systems. This group also includes multifocal demyelinating processes. The second group of rare symptoms includes such manifestations of the disease that may cause difficulties in making a diagnosis.

Diagnosis of multiple sclerosis at an early stage

Diagnosis of MS is still based on the clinical characteristics of the manifestation of the pathological process in the central nervous system.

attention

Diagnosis of multiple sclerosis must be carried out directly by a neurologist at the stage of outpatient examination.

Except in cases where there are contraindications to hospitalization, with the participation of a specialist dealing with the problem of multiple sclerosis. These could be neurologists from multiple sclerosis centers.

Diagnose MS

Typically, the diagnosis includes the following:

• Identifying symptoms to suspect deimilinating disease
• Clarification of compliance of the condition with MS criteria
• Exclusion of other diseases and other forms of inflammatory processes that have a similar clinical picture
• determination of the type of disease
• staging
• determining the degree of damage and degree of disability of the patient

Signs of brain damage

There are signs of damage to various parts of the brain that allow one to suspect a demyelinating disease:

Optic nerve damage: unilateral retrobulbar neuritis in combination with pain when moving the eye and a partial decrease in the predominantly central visual field, lasting from 2 to 4 weeks, less typical is bilateral retrobulbar neuritis without pain or with constant pain, complete and persistent loss of vision, papilledema, presence of uveitis.

Damage to the cerebellum and its pathways: cerebellar ataxia (instability when walking, dysmetria, megalography), cerebellar dysarthria (scanned speech), less typical: characteristic vestibular ataxia.
Damage to the brain stem: bilateral internuclear ophthalmoplegia, multiple central nystagmus, abducens nerve paresis, prosohyposthesia, less typical: deafness, trigeminal neuralgia, central or peripheral paresis of the facial nerve.

Spinal cord lesion: spastic asymmetrical lower paraplegia, conduction-type sensory loss, Lhermitte's symptom, urinary urgency, urinary incontinence, less typical: complete transverse myelitis, segmental sensory disorders, radiculopathies, sensitive ataxia, fecal incontinence, symmetry of spinal cord lesions.

Damage to the cerebral hemispheres of the forebrain: subcortical cognitive deficit (decreased memory and attention), central hemiparesis, less typical are hemianopsia and partial epileptic seizures.

Neuropsychological symptoms: fatigue, fatigue, cognitive disorders (impaired memory, thinking), depression, less often anxiety, euphoria.

Necessary signs of a chronic process

To clinically substantiate the diagnosis of MS, it is necessary to identify signs of a wave-like chronic process involving several conductive systems of the central nervous system. Currently, two main types of criteria are used: clinical and paraclinical, obtained using neurophysiological methods, tomographic studies, analyzes of cerebrospinal fluid and peripheral blood.

Currently, the scale compiled by J. Kurtzke is used for clinical assessment in the world. It contains 7 groups of symptoms, characterized by different degrees of impairment.

• Symptoms of damage to the pyramidal tract
• Coordination problems
• Disorders of cranial nerves (except II pair)
• Sensory disorders
• Disorders of the pelvic organs
• Optic nerve lesions
• Changes in intelligence

Based on the sections of this scale, it is convenient to briefly list the typical clinical manifestations of the disease, which can be established during anamnesis or neurological examination, and to evaluate the effectiveness of treatment.

Below is the frequency of typical clinical manifestations of MS (including medical history and neurological examination) according to sections of the FS scale according to Kurtzke J.F.

Frequency of typical clinical manifestations of MS:

• Symptoms of pyramidal tract lesions - average 92%
• Coordination problems - average 80,5%
• Disorders of cranial nerves (except II pair) - on average 69,5%
• Sensory impairment - average 71%
• Pelvic organ dysfunction - average 61,5%
• Optic nerve damage - average 46%
• Neuropsychological impairment - average 41%

If we consider the minimized version of the diagnosis, we will see the following picture:

1. Young age of onset
2. Multifocal lesions of the central nervous system (mainly a combination of pyramidal and cerebellar disorders with pelvic disorders)
3. Progressive-remitting course
4. Detection of foci of demyelination on MRI of the brain
5. Immunologically detectable sensitization to myelin basic protein

This pentad is sufficient to diagnose the disease, but not the diagnosis of the patient.

Based on these methods, a specialist is able to make a diagnosis of MS.

Complaints from MS patients

Among the complaints of the initial manifestations of multiple sclerosis:

• Weakness, fatigue - 17-48%
• Decreased visual acuity - 25-45%
• Feeling of numbness, tightness, “pins and needles” - 25-35%
• Dizziness with nausea - 15-25%
• Urgency or urinary retention - 3-11%

Multiple sclerosis is a dangerous, severe, currently incurable disease of the nervous system, which cannot be detected immediately. With it, nervous tissue is gradually destroyed, which is replaced by connective tissue. As a result, pathological foci do not fully participate in the functioning of the nervous system, which externally manifests itself in the form of symptoms characteristic of the disease. According to statistics, sclerosis can be detected in average age in approximately 20 people out of 100,000. Diagnosis of multiple atherosclerosis at an early stage is of great importance, since the earlier the diagnosis is made, the more favorable the prognosis for health and life.

Clinical symptoms

MS often manifests at a young age

The disease occurs more often in women under 45 years of age living in cool climates. After 55 years, pathology is diagnosed less frequently. If you pay attention to race, sclerosis affects more Europeans.

It is impossible to determine the disease at the beginning without conducting additional examination. This is due to the absence of symptoms at an early stage. In three out of 9 patients the disease has a benign course. Less commonly, the disease leads to disability in the next five years.

Why is it not possible to recognize sclerosis at the very beginning? This is due to the fact that healthy tissue of the nervous system replenishes the lost function of the replaced areas with connective tissue. The presence of the first signs indicates damage to approximately 40-50% of the nerve fibers. How to recognize multiple sclerosis by clinical symptoms?

1. Early signs are causeless pain in the eyeballs, double vision, and noticeable blurred vision.
2. Simultaneously with the above symptoms, hypoesthesia occurs, that is, a violation (or rather) a decrease in skin sensitivity. In particular, a person may experience numbness in the fingers (or mild tingling).
3. Another characteristic symptom is muscle weakness, and with it a change in gait, which is associated with poor coordination.

Clinical symptoms may occur simultaneously or may appear sequentially. An increase in external temperature (hot shower, insolation, stuffy room, etc.) worsens the patient's condition. It is these signs that help a specialist differentiate the disease.

How was the disease previously diagnosed?

Timely diagnosis will ensure the patient many years of active life

How was multiple sclerosis diagnosed before and what has changed to date?

In the absence of additional diagnostic methods that reliably confirm the diagnosis, the doctor was guided by the presence in the anamnesis of typical symptoms of “dispersion”, which either arose or disappeared - thus, the undulating course of the disease manifested itself. Only in the 80s of the last century, the study of brain potentials was added to the clinical signs, confirming damage to parts of the nervous system. In the late 80s, MRI was used for the first time in diagnostics. During the procedure, a contrast agent was injected. In patients, foci of damaged nervous tissue with the absence of myelin substance were detected. However, at the beginning of the introduction of this method, there were repeated errors in diagnosis. Detecting the disease using MRI diagnostics became possible after the method was improved in 2005.

The order of medical actions in the process of identifying a disease

In the process of determining multiple sclerosis, early diagnosis includes the following criteria:

1. Mandatory differential diagnosis, followed by exclusion of other pathologies associated with damage to the central and/or peripheral parts of the nervous system.
2. Carrying out not only instrumental research methods, special tests, but also taking tests.

In the process of detailed differential diagnosis, the specialist pays attention to visual deterioration. As a rule, one eye sees worse. This is due to damage to the optic nerve. The hands often go numb, and there is a feeling of crawling goosebumps. Legs or arms become like cotton wool. It is not possible to actively move them. Often there is a feeling of nausea, the gait becomes unsteady. Differential diagnosis is carried out with the following diseases: cerebellar damage, osteochondrosis, radiculitis, etc.

MRI allows visualization of pathological foci in the central nervous system

The next step in clarifying the diagnosis is MRI, which can be used to check the affected areas of nervous tissue.

In 2010, amendments were made to the table of criteria, based on which a diagnosis can be made using additional research methods.

• A history of several attacks characteristic of the disease, as well as the presence of two foci.
• A history of more than 2 attacks, confirmation of one or more pathological foci in the central nervous system.
• A history of attack, more than 2 lesions, expectation of relapse of the disease according to MRI results.
• Confirmation in the anamnesis of the attack, as well as the spread of the pathological focus involving areas of the central nervous system previously untouched by the disease.

Before making a diagnosis of “progressive type of sclerosis,” the specialist pays attention to the presence of the following components: identification of characteristic symptoms that are more clearly manifested; spread of the pathological process in tissues beyond the boundaries of the first detected lesion using MRI; When taking cerebrospinal fluid (fluid circulating in the spinal canal and ventricles of the brain) positive results are found for oligoclonal IgG.

Signs of the disease manifest themselves in different ways. One symptom may accompany the disease for several months with periods of remission.

Magnetic resonance imaging in the diagnosis of pathology

How is multiple sclerosis diagnosed based on MRI results? A modern device must have a power of at least 1.5 Tesla. If the indicator is lower, then it will not be possible to determine pathological foci, as well as the structures of parts of the nervous system. When the disease occurs, lesions are located in the following parts of the brain:

1. Temporal lobes.
2. Cerebellum.
3. Lateral sections of the ventricles.
4. Corpus callosum.
5. Brain stem.
6. White matter of the brain.

MRI can show not only the shape, but also the size of pathological lesions (in mm or cm). There are usually few of them in the gray matter - only 10%. When the spinal cord is damaged, the lesions are located along. They can be distinguished by their oblong shape, up to 2 cm in size. Large diameter areas predispose to the emergence of new ones. Over time, the number of foci increases - large zones up to 8 cm are formed. Sometimes this indicator has to be differentiated from benign or malignant formations. MRI of the brain helps to identify at what stage of the disease. Using this method, examination of the spinal cord is not a mandatory procedure, but desirable, and is an absolute indication if there are pathological areas in it.

Cerebrospinal fluid examination

CSF analysis for multiple sclerosis

Using this immunological method, the following indicators can be determined:

• Increased level of immunoglobulins G.
• Detect the content of oligoclonal immunoglobulins of class G.
• Determine the increase in myelin levels during periods of exacerbation.

Cerebrospinal fluid examination is the most accurate analysis, allowing one to determine the duration of the disease and helping to make a diagnosis, eliminating suspected pathologies.

Determining the disease using the evoked potential technique

This technique (abbreviated as EP of the brain) is carried out using a special device that records the brain’s response to any irritations (for example, visual, auditory), in addition, peripheral nerves are irritated. Irritation of individual zones is indicated in specific cases, for example, the visual zone is subjected to irritation when diagnosing complex variants of the course of the disease, when only one area of ​​the central nervous system is affected.

Diagnosis of the disease based on blood test results

Among the existing tests for multiple sclerosis, a blood test is taken into account. The diagnostic criterion is biochemical analysis of markers of inflammatory activity - circulating adhesion molecules. There is a certain relationship between the amount of markers independently circulating in the blood and cerebrospinal fluid, which are responsible for inflammation and the degree of pathological progress. This pattern is true for all types (primary and secondary progressive) of the disease. Thus, the diagnosis of multiple sclerosis by blood is taken into account.

In MS, oligoclonal IgG can be detected in blood serum

Differential diagnosis of the disease

Due to the great similarity with other diseases, and at first the symptoms are sparse, the doctor conducts a differential diagnosis. For sclerosis, there is no specific diagnostic criterion that would absolutely allow a specialist to exclude other ailments. At the same time, with sclerosis there may be rare symptoms that are not characteristic of the disease (lack of speech, hand tremors, coma, parkinsonism, etc.). A doctor may question the diagnosis if:

1. The patient complains of increased fatigue, but no neurological changes are detected.
2. Only one lesion is detected. Very often the lesion is confused with a tumor or altered blood vessels.
3. The patient has predominant spinal symptoms, but there are no disorders of the pelvic organs.
4. There are no significant abnormalities in the cerebrospinal fluid, as well as peripheral blood, as described above.
5. The leading symptom of the disease is pain. (In multiple sclerosis, pain is not the main symptom).
6. The patient's tendon reflexes are weakly expressed (with the disease they disappear only in the later stages).

The diagnosis remains in doubt if, 5-7 years after the disease was suspected, the patient has no oculomotor changes, no disorders of the pelvic organs, and no other characteristic symptoms.

MS must be differentiated from many other diseases due to the variety of symptoms

Some diseases with similar symptoms:

• Systemic lupus erythematosus affects the nervous and immune systems. When it occurs, the ESR increases and antibodies are detected in the blood.
• Behçet's disease is accompanied by damage to the nervous system. Distinguishes the disease from sclerosis - ulcerative lesions of the genital organs, accelerated ESR, aphthous stomatitis.
• Sarcoidosis is accompanied by damage to the cranial nerves, atrophy of the optic nerve is possible, enlargement of the lymph nodes, etc. is noted.

Thus, in diagnosing the disease, the specialist is guided by the data obtained during the examination, as well as with the help of instrumental and laboratory research methods.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Which doctor diagnoses and treats multiple sclerosis?

Diagnosis and treatment multiple sclerosis is engaged neurologist or neuropathologist, who specializes in diseases of the nervous system. At the same time, it is worth noting that in the process of diagnosis and treatment, a neurologist can send the patient for consultations with doctors from other fields of medicine. This is due to the fact that the symptoms of multiple sclerosis are very diverse and can often mask the signs of other diseases.

When diagnosing and treating multiple sclerosis, consultation may be necessary:

• infectious disease specialist– if you suspect the presence of viral or bacterial infections that could provoke an exacerbation of the disease.
• Ophthalmologist– if there are signs of visual impairment.
• Immunologist– if there is a suspicion of severe dysfunction of the patient’s immune system.
• Psychiatrist– if the patient has mental disorders and deviations.
• Urologist– for urinary disorders.
• Genetics– when planning a family ( to identify the likelihood of transmitting genetic predisposition to children).

Patient interview

The first thing a doctor should do when making a diagnosis is talk with the patient. The purpose of the survey is to identify possible risk factors for multiple sclerosis, as well as to identify symptoms that could indicate this disease.

When interviewing a patient, the doctor may ask:

• What ( what are the specific symptoms) is bothering the patient at the moment?
• How long ago did the symptoms appear and what preceded it? viral or bacterial infection, hypothermia, stress, injury and so on)?
• Have you had similar symptoms before?
• How often has the patient suffered from viral or bacterial infectious diseases?
• Does the patient have any chronic infections ( for example, herpes)?
• Did any of the patient's relatives suffer from multiple sclerosis?
• Does the patient smoke?
• How ( how) has the patient been eating lately?
• Does the patient have allergic diseases ( allergies to medications, food, pollen, etc.)?

The answers to these and some other questions will help the doctor suggest a particular diagnosis. If a patient is at increased risk of having multiple sclerosis ( for example, when several risk factors are identified at once), the doctor can conduct a more detailed examination.

Examination of a patient with multiple sclerosis and testing of reflexes

The initial examination of the patient sometimes reveals symptoms and signs that may indicate the presence of multiple sclerosis. A routine examination does not provide any valuable diagnostic information, since in the initial stages of development, multiple sclerosis may not have any external manifestations. At the same time, a more detailed examination of the patient can help identify characteristic signs of the disease.

During diagnosis, the doctor determines:

• Skin sensitivity. To test sensitivity, the doctor can touch various parts of the patient’s body with the pointed handle of a neurological hammer or a hand one ( who must close his eyes). When the patient feels the touch, he should inform the doctor about it. As a rule, tactile sensitivity disappears first ( touch sensation), then temperature and vibration. Much less often, loss of pain sensitivity may occur.
• Muscle strength. The doctor may use a subjective or objective method to assess muscle strength. In the first case, he himself takes the patient’s hand and asks him to bend it, while offering him resistance. As a result of such a simple test, the doctor assesses how strongly the patient can contract a particular muscle group. An objective assessment is carried out using a special device ( dynamometer). The patient is asked to squeeze the working part of the device as hard as possible, as a result of which the arrow displays a certain value on the dial. The results are assessed by the doctor depending on the age, gender and level of physical fitness of the patient.
• Muscle tone. The doctor can subjectively assess the tone of the flexor and extensor muscles in the patient's limbs. When assessing the muscle tone of the upper extremities, he takes the patient's hand in his own and asks him to completely relax it. Next, he bends and straightens the patient’s arm at the elbow joint several times, while assessing the state of muscle tone. Under normal conditions, the patient's arm should flex and extend equally easily, while with multiple sclerosis, the doctor may feel more or less pronounced resistance during extension ( which is associated with increased tone of the flexor muscles). The doctor can conduct a similar check with the lower limbs, bending and straightening the patient’s legs at the knee joints.
• Presence of signs of cerebellar damage. If the cerebellum is involved in the pathological process ( normally responsible for coordination of movements), the patient will experience certain disturbances. For example, even in the early stages of the disease, he will not be able to maintain a state of balance for a long time, especially standing on 1 leg or with his eyes closed. The doctor may also detect mild or moderate tremor ( trembling) in the arms and legs, especially when trying to stretch them in front of you and hold them in that position.
• Presence or absence of nystagmus. Nystagmus is a pathological twitching of the eye when the eyeballs are moved to the side. To detect nystagmus, the doctor places a hammer or pen in front of the patient’s eyes and asks him to follow it with his eyes, while he moves it left and right, up and down.
• Intensity of tendon reflexes. The essence of tendon reflexes is that if you hit the tendon of a muscle with a hammer, it will sharply contract. With multiple sclerosis, there is increased muscle tone, as a result of which tendon reflexes will be more pronounced ( so-called hyperreflexia will be observed). The most common tendon reflexes are the heel, knee, and elbow. To test the heel reflex, the patient should bend one leg at the knee and rest his knee on a chair. At the same time, the doctor gently hits the heel with a hammer ( Achilles) tendon, which causes extension of the foot. To test the knee reflex, the patient sits on a chair and crosses his legs, and the doctor hits with a hammer just below the kneecap of the upper leg, which causes it to sharply extend at the knee joint. To test the elbow reflex, the doctor takes the patient's arm and slightly bends it at the elbow joint, and then hits the biceps brachii tendon with a hammer ( in the area of ​​the cubital fossa). This leads to a sharp bending of the arm at the elbow joint.

Lhermitte's sign

This is a pathological symptom that is absent in a healthy person, but appears in a number of diseases of the cervical spine, as well as in multiple sclerosis. To identify this symptom, the patient must stand or sit on a chair with a straight back and look straight ahead. The doctor asks the patient to bend his neck sharply and as strongly as possible, tilting his head forward, and then turn his head left and right several times. With a positive Lhermitte's sign, while performing any of these movements, the patient may feel a sharp “electric shock” that will spread along the spinal column and into both legs, less often into the arms. Sometimes, instead of an “electric shock,” the patient may experience pain or a tingling sensation from needles. This indicates damage to the cervical spinal cord, which is especially characteristic of the spinal form of multiple sclerosis.

Laboratory diagnosis of multiple sclerosis

In the diagnostic process, the doctor can use a number of laboratory and instrumental studies that would identify signs of damage to the central nervous system and confirm the diagnosis. This is necessary in order to promptly identify the disease and prescribe the necessary treatment to prevent or slow down further progression of the pathology.

It is important to note that confirming a diagnosis of multiple sclerosis can sometimes be extremely difficult. This is due to the fact that the first symptoms and signs are extremely diverse and nonspecific, that is, they can manifest themselves in a number of other diseases.
That is why it may take a doctor a lot of time and many different studies to confirm the diagnosis.

When diagnosing multiple sclerosis, you may need:

• general blood analysis ;
• determination of ESR ( ) ;
• determination of the level of uric acid in the blood;
• lumbar puncture and cerebrospinal fluid analysis;
• serum protein electrophoresis;
• detection of antibodies to myelin;
• immunoglobulin analysis;
• tests for viral infections;
• examination of the fundus vessels;

Complete blood count and ESR

A complete blood count is a standard test that is performed on all patients with an unclear diagnosis. It is immediately worth noting that it will not be possible to obtain any characteristic data to confirm the presence of multiple sclerosis using this analysis. At the same time, certain changes will allow one to suspect that the patient has this disease.

A patient with multiple sclerosis may experience:

• Increase in the total number of lymphocytes. Lymphocytes are the main cells of the immune system that regulate the activity of the entire immune system. It is lymphocytes that are responsible for the development of autoimmune reactions, that is, for damage to the myelin sheath of nerve fibers of the central nervous system. With an exacerbation of multiple sclerosis, the production of lymphocytes increases significantly, as a result of which their number in the blood will increase to 40% or more.
• Decrease in the total number of leukocytes. Leukocytes are cells of the immune system that protect the body from foreign infections ( predominantly bacterial). The number of leukocytes decreases during viral infections, as well as during autoimmune diseases, including exacerbation of multiple sclerosis.
• Increase in ESR ( erythrocyte sedimentation rate). This indicator indicates the possible presence of a pronounced inflammatory process in the body. The fact is that under normal conditions, blood placed in a test tube eventually divides into two parts - it sinks to the bottom of the test tube ( settle down) heavier blood cells ( red blood cells), while the liquid part of the blood ( plasma) remains on the surface. The speed of this process is determined by the number of red blood cells in the blood, as well as some other factors. For example, when an inflammatory or autoimmune process develops in the body, a large number of so-called acute phase proteins of inflammation are released into the systemic bloodstream ( fibrinogen, C-reactive protein and others). These proteins attach to the surfaces of red blood cells and promote their approach to each other, as a result of which the rate of their settling to the bottom of the test tube during the study increases significantly. Normally, ESR in men ranges from 2 to 10 millimeters per hour, and in women – from 2 to 15 mm per hour. At the same time, with exacerbation of multiple sclerosis, this figure can reach 40 mm per hour or more.

Blood Sugar Level

With multiple sclerosis, blood sugar levels do not change, as a result of which this test will not help in making or confirming the diagnosis. At the same time, it is worth remembering that there is an autoimmune form of diabetes, when the cause of an increase in blood sugar levels is a lack of the hormone insulin, which develops as a result of damage to the pancreatic cells that produce it by the body’s own immune system. It has been found that antibodies secreted against pancreatic cells can also damage the myelin sheaths of the nerves of the central nervous system. Therefore, if during the diagnostic process a patient is diagnosed with diabetes mellitus ( that is, a persistent increase in blood sugar levels of more than 5.5 mmol/liter), the likelihood of having multiple sclerosis will be considered increased.

Lumbar puncture and cerebrospinal fluid analysis ( analysis for immunoglobulins, antibodies to myelin)

Lumbar ( spinal) puncture ( puncture) allows you to confirm the presence of an autoimmune process in the central nervous system, which is necessary for making a diagnosis. The fact is that during the development of the immune process, many active components of the immune system are formed ( immunoglobulins). In addition, during the destruction of myelin, its breakdown products are released into the surrounding space. All these substances accumulate predominantly in the central nervous system, which is separated from the systemic bloodstream by the so-called blood-brain barrier. Consequently, they can be detected in high concentrations in the cerebrospinal fluid ( CSF) - a substance that bathes and nourishes the brain and spinal cord.

Cerebrospinal fluid is easier and safer to obtain by lumbar puncture. To understand the meaning and essence of this procedure, you need to know some features of the anatomy of the spine and spinal cord.

The human spine consists of many vertebrae that overlap each other. In the center of the vertebrae there is a round hole that forms the spinal canal. It is through these openings that the spinal cord passes, around which the cerebrospinal fluid is located. Also, normally, an intervertebral disc is located between two adjacent vertebrae, as a result of which they ( vertebrae) are located at a certain distance from each other.

The essence of a spinal puncture is that the doctor inserts a special needle between two adjacent vertebrae and pierces the spinal canal with it, after which he takes cerebrospinal fluid from it. It is easiest and safest to do this in the area of ​​the lumbar vertebrae, since the risk of damage to the spinal cord is minimal. No special preparation is required before performing the procedure, however, the day before the test, it is recommended to take a warm shower and thoroughly wash the skin in the back area. Also, the procedure will be performed under local anesthesia, as a result of which the patient must inform the doctor in advance if he is allergic to any medications.

The procedure itself is performed under conditions of strict sterility, since the penetration of even a small number of microorganisms into the spinal canal can lead to the development of life-threatening complications. Before the procedure, the doctor asks the patient to bare his upper body, sit on a chair backwards and rest his hands on the back of it ( in some cases, the procedure can be performed with the patient lying on his side). Next, wearing sterile gloves, the doctor treats the site of the upcoming puncture several times ( puncture) alcohol solution to destroy all bacteria present on the skin. After treating the skin, the doctor injects a solution of a local anesthetic into it, and then uses a special needle to pierce the spinal canal. As soon as the needle is in it, it will begin to flow through it ( drip slowly) cerebrospinal fluid, about 2 milliliters of which the doctor collects in a sterile tube. It is extremely important that during the procedure ( especially during cerebrospinal fluid sampling) the patient sat absolutely still, since any movement could lead to displacement of the needle, as a result of which the procedure would have to be repeated again.

After collecting the material, the doctor removes the needle and applies a sterile bandage to the puncture site, which the patient can remove independently after 4 to 6 hours. The cerebrospinal fluid is sent to a laboratory where it is further examined. The patient can go home immediately after the procedure is completed.

The presence of multiple sclerosis may be indicated by:

• The presence of immunoglobulins G in the CSF ( IgG). Immunoglobulins are special antibody proteins that are secreted by cells of the immune system ( lymphocytes) and are directly involved in the development of inflammatory as well as autoimmune reactions. Their role is that they attach to antigens ( specific structures) myelin, which further contributes to its destruction. During exacerbation of the disease, as well as during its chronic course ( even in remission) the concentration of IgG in the cerebrospinal fluid will be increased.
• Increased concentration of lymphocytes. It may also indicate the presence of an autoimmune process in the central nervous system. At the same time, such a change can be observed in a number of other pathologies ( for example, with a viral infection of the spinal cord), so the results of the analysis must be assessed in conjunction with other data.

It is also worth noting that when examining cerebrospinal fluid, the doctor also evaluates its other indicators ( glucose concentration, the presence of pathological cells, proteins, and so on). This is necessary in order to exclude the presence of any other spinal cord diseases in the patient ( for example, tumors, viral infections and so on), which could mimic the symptoms of multiple sclerosis.

Performing a spinal tap is contraindicated:

• If there is a skin infection at the puncture site– infectious particles can enter deeper tissues or the spinal canal.
• In case of a violation of the blood coagulation system– this may cause bleeding, which will be extremely difficult to stop.
• – an inadequate person will not be able to sit still during the procedure.
• With high intracranial pressure– Permanent brain damage may occur.

Immunogram

An immunogram is a special analysis that allows you to assess in detail the state and activity of the body’s immune system. The material for the study is venous blood, which is collected in a special laboratory. Having studied the concentrations of certain types of cells of the immune system, as well as its other components ( including immunoglobulins), the doctor can guess whether the patient has an autoimmune disease or whether the cause of the symptoms lies in something else.

It is also worth noting that control immunograms during treatment for multiple sclerosis can provide the doctor with information about the effectiveness or ineffectiveness of therapy.

Tests for viral infections

These are nonspecific tests that cannot by themselves confirm or refute the presence of multiple sclerosis, but help the doctor rule out other diseases that could cause similar symptoms in the patient. For the study, the patient’s venous blood is usually taken, in which the presence of antibodies to certain viruses is determined ( if a patient is infected with a certain virus, the concentration of antiviral antibodies in his blood will be increased).

If multiple sclerosis is suspected, testing may be required to identify:

• herpes virus type 1;
• measles virus;
• rubella virus;
• retroviruses;
• cytomegalovirus and others.

Examination of fundus vessels

If the optic nerve is damaged ( that is, with the development of retrobulbar neuritis) certain changes in the fundus may be detected, which is associated with damage to the structures located there.

The fundus of the eye is the posterior inner surface of the eyeball, to which the retina is attached ( structure consisting of photosensitive nerve cells and responsible for the perception of light). From the retinal nerve cells, nerve fibers gather together in the posterior region of the fundus of the eye, forming the so-called optic disc. Then, as part of the optic nerve itself, they enter the brain.

To examine the fundus of the eye, an ophthalmologist uses a special device - an ophthalmoscope, which is a magnifying glass with a built-in light source. The research procedure is extremely simple, safe and does not require special preparation. The doctor asks the patient to open his eye and brings the ophthalmoscope as close as possible to his pupil, while he looks through the working opening of the instrument at the retina and fundus of the eye. The study is then repeated with the second eye.

With multiple sclerosis, you may experience:

• Papilledema. This is due to autoimmune damage to the optic nerve, which develops when the myelin sheath is destroyed. The edges of the optic disc swell and protrude into the cavity of the eyeball.
• Optic disc atrophy. Due to edema, the blood supply to the nerve fibers of the optic disc is disrupted, which is manifested by narrowing and destruction of blood vessels in its edges. The marginal zones of the disc become pale and thinner, which is accompanied by a narrowing of the visual fields ( a person sees worse in peripheral vision, and visual acuity also decreases).
• Damage to the fundus vessels. There may be inflammation of the tissue around the small veins of the retina.

Are lesions of multiple sclerosis visible on MRI?

MRI ( Magnetic resonance imaging) is one of the most informative methods in identifying and diagnosing multiple sclerosis, with which you can identify foci of pathological changes in the tissues of the brain and/or spinal cord ( so-called "plaques"). The essence of the method is that the part of the human body being studied is placed in a strong electromagnetic field. Under the influence of this field, the atoms that make up various tissues begin to release a certain energy. The key point of the study is the fact that each tissue contains a different number of different atoms. As a result, when conducting research, a strictly defined signal will emanate from each tissue of the human body. Since in multiple sclerosis, the normal myelin sheath and even the nerve fiber tissue itself is destroyed and replaced by sclerotic ( cicatricial) tissue, these changes will be noticeable during an MRI. Since this study is very sensitive, it can detect the smallest changes in the central nervous system even in the early stages of the disease.

To improve the efficiency of the study, MRI with contrast is sometimes used. The essence of the method is that a substance is injected into the patient’s bloodstream, which accumulates in well-supplied tissues ( for example, in normal brain tissue) and is clearly visible on MRI. Since sclerosed ( destroyed) zones of nerve fibers ( plaques) have virtually no blood supply ( and therefore do not accumulate contrast agent), this study allows us to identify them with maximum accuracy.

The MRI procedure itself is safe, painless and does not require special preparation. First, the patient must hand over absolutely all metal objects ( including credit cards, mobile phone and so on), since when approaching the tomograph they can interact with the magnet, which can cause unpleasant incidents. Next, the patient lies down on a special sliding table of the computed tomograph, which is then moved inside the device. Then a strong electromagnetic field is created around the patient, and the energy released by the atoms is recorded by special sensors and presented on a computer monitor in the form of a layer-by-layer image of the tissue being examined. During the procedure ( which can last from several tens of minutes to 1 – 2 hours) the patient must lie absolutely still, since any movement can distort the quality of the data obtained.

MRI is contraindicated:

• If there are metal objects in the body ( bone implants, splinters, dentures and so on) – when exposed to a strong electromagnetic field, the metal in the patient’s body can heat up to extremely high temperatures.
• For claustrophobia ( fear of confined spaces) – during the study, the patient will have to stay in a relatively narrow compartment of the device for a long time.
• If you are allergic to contrast media– in this case, you can perform a regular MRI or use another contrast.
• For mental disorders– if the patient is inadequate, he will not be able to remain motionless during the entire study.

Will a CT scan show multiple sclerosis?

CT ( CT scan) is a highly accurate research method, which, however, has limited value in multiple sclerosis. The essence of the procedure is similar to MRI, however, with CT, information about the state of the central nervous system is obtained not using an electromagnetic field, but through many x-rays taken by a special apparatus ( computed tomograph). The procedure for performing a CT scan is similar to that for an MRI - the patient is placed in a special compartment of the machine, after which a small X-ray machine begins to rotate around the part of the body being examined, taking a whole series of images. Next, the received information is processed by a special computer and presented as an image on the monitor.

The disadvantages of the method include the fact that it does not allow identifying small foci of damage to nerve fibers. That is why, if multiple sclerosis is suspected, CT is prescribed only as an auxiliary research method ( for example, to identify

Multiple sclerosis is a disease of the nervous system that occurs in young and middle age (15-40 years).

A feature of the disease is the simultaneous damage to several different parts of the nervous system, which leads to the appearance of a variety of neurological symptoms in patients. Another feature of the disease is its remitting course. This means alternating periods of deterioration (exacerbation) and improvement (remission).

The basis of the disease is the formation of foci of destruction of the nerve sheath (myelin) in the brain and spinal cord. These lesions are called multiple sclerosis plaques.

The size of the plaques is usually small, from a few millimeters to several centimeters, but as the disease progresses, the formation of large confluent plaques is possible.

Causes

The exact cause of multiple sclerosis is not clearly understood. Today, the most generally accepted opinion is that multiple sclerosis can arise as a result of a random combination of a number of unfavorable external and internal factors in a given person.

Unfavorable external factors include

• frequent viral and bacterial infections;
• influence of toxic substances and radiation;
• nutritional features;
• geo-ecological place of residence, its influence on the body of children is especially great;
• injuries;
• frequent stressful situations;
• genetic predisposition, probably associated with a combination of several genes that cause disturbances primarily in the immunoregulatory system.

In each person, several genes simultaneously participate in the regulation of the immune response. In this case, the number of interacting genes can be large.

Recent studies have confirmed the mandatory participation of the immune system - primary or secondary - in the development of multiple sclerosis. Disorders in the immune system are associated with the characteristics of the set of genes that control the immune response.

The most widespread is the autoimmune theory of the occurrence of multiple sclerosis (recognition of nerve cells by the immune system as “foreign” and their destruction).

Considering the leading role of immunological disorders, treatment of this disease is primarily based on the correction of immune disorders.

In multiple sclerosis, the NTU-1 virus (or a related unknown pathogen) is considered as the causative agent. It is believed that a virus or a group of viruses causes serious disturbances in immune regulation in the patient’s body with the development of an inflammatory process and the breakdown of the myelin structures of the nervous system.

Manifestations of multiple sclerosis

Multiple sclerosis symptoms involve damage to several different parts of the brain and spinal cord.

Signs of damage to the pyramidal tract can be expressed by an increase in pyramidal reflexes without a decrease or with a slight decrease in muscle strength or the appearance of fatigue in the muscles when performing movements, but while maintaining basic functions.

Signs of damage to the cerebellum and its conductors are manifested by tremors and impaired coordination of movements.

The severity of these signs can vary from minimal to the inability to perform any movements.

Typical for cerebellar damage is a decrease in muscle tone.

In patients with multiple sclerosis, lesions of the cranial nerves may be detected, most often the oculomotor, trigeminal, facial, and hypoglossal nerves.

Signs of impairment of deep and superficial sensitivity are detected in 60% of patients. Along with this, a feeling of tingling and burning in the fingers and toes may be detected.

Frequent signs of multiple sclerosis are dysfunctions of the pelvic organs: urgent urges, increased frequency, retention of urine and stool, and in later stages - incontinence.

Possible incomplete emptying of the bladder, which is often the cause of genitourinary infection. Some patients may experience problems associated with sexual function, which may coincide with dysfunction of the pelvic organs or be an independent symptom.

In 70% of patients, symptoms of visual impairment are detected: decreased visual acuity in one or both eyes, changes in visual fields, blurred images of objects, loss of vision brightness, color distortion, and contrast disturbance.

Neuropsychological changes in multiple sclerosis include decreased intelligence and behavioral disturbances. More often, depression predominates in patients with multiple sclerosis. In multiple sclerosis, euphoria is often combined with decreased intelligence, underestimation of the severity of one’s condition, and disinhibition of behavior.

About 80% of patients with multiple sclerosis in the early stages of the disease have signs of emotional instability with repeated sudden changes in mood in a short period of time.

The deterioration of the patient's condition with increasing ambient temperature is associated with increased sensitivity of the affected nerve cells to changes in electrolyte balance.

Some patients may experience pain:

• pain along the spine and intercostal spaces in the form of a “belt”,
• muscle pain caused by increased tone.

In typical cases, multiple sclerosis occurs as follows: the sudden appearance of signs of the disease in the midst of complete health.

They can be visual, motor or any other disorders, the severity of which ranges from barely noticeable to grossly disrupting the functions of the body.

The general condition remains good. Following an exacerbation, a remission occurs, during which the patient feels almost healthy, then an exacerbation occurs again.

It becomes more severe, leaving behind a neurological defect, and this is repeated until disability occurs.

Diagnostics

Diagnosis of multiple sclerosis is based on data from a patient interview, neurological examination and the results of additional examination methods.

Today, magnetic resonance imaging of the brain and spinal cord and the presence of oligoclonal immunoglobulins in the cerebrospinal fluid are considered to be the most informative.

Considering the leading role of immunological reactions in the development of multiple sclerosis, regular blood testing in patients—the so-called immunological monitoring—is especially important for monitoring the disease.

It is necessary to compare immunity indicators with previous indicators of the same patient, but not healthy people.

Treatment of multiple sclerosis

Antiviral drugs are used in treatment. The basis for their use is the assumption of the viral nature of the disease.

The most effective drug for multiple sclerosis is betaferon. The total duration of treatment is up to 2 years; has strict indications: it is prescribed to patients with a relapsing-remitting form of the course and mild neurological deficit.

Experience with the use of betaferon has shown a significant reduction in the number of exacerbations, their milder course, and a decrease in the total area of ​​inflammatory foci according to magnetic resonance imaging.

Reaferon-A has a similar effect. Reaferon is prescribed 1.0 IM 4 times a day for 10 days, then 1.0 IM once a week for 6 months.

Interferon inducers are also used:

• proper-mil (proper myl),
• prodigiosan,
• zymosan,
• dipyridamole,
• non-steroidal anti-inflammatory drugs (indomethacin, voltaren).

Ribonuclease, an enzyme preparation obtained from the pancreas of cattle, inhibits the reproduction of a number of RNA-containing viruses.

Ribonuclease is administered 25 mg intramuscularly 4-6 times a day for 10 days.

The drug is used after the test: a working solution of RNase in a dose of 0.1 is injected subcutaneously on the inner surface of the forearm. 0.1 ml of saline solution is injected into the symmetrical area in the same way (control). The reaction is read after 24 hours. Negative - in the absence of local manifestations.

If there is redness or swelling at the site of RNase injection, the drug should not be used.

Dibazol has an antiviral and immunomodulatory effect. It is prescribed in microdoses of 5-8 mg (0.005-0.008) in the form of pills every 2 hours for 5-10 days.

Hormone therapy

For multiple sclerosis, hormones - glucocorticoids - are used. There are many schemes for the use of glucocorticoids in multiple sclerosis.

Synacthen-depot is a synthetic analogue of the hormone corticotropin, consisting of its first 24 amino acids, and is a very effective drug for the treatment of multiple sclerosis.

Can be used as an independent remedy and in combination with glucocorticoids. The action of synacthen depot continues after a single administration for 48 hours.

There are several options for its use: the drug is administered 1 mg once a day for a week, then at the same dose after 2-3 days 3-4 times, then once a week 3-4 times or administered 1 mg 3 days, then 2 days later on the 3rd course of treatment of 20 injections.

Complications when taking drugs of this group are Itsenko-Cushing syndrome, increased blood sugar, edema, asthenia, bacterial infections, gastric bleeding, cataracts, cardiac failure, hirsutism, vegetative-vascular disorders.

When taking large doses of glucocorticoids, it is necessary to simultaneously prescribe almagel, a diet low in sodium and carbohydrates, rich in potassium and protein, and potassium supplements.

Ascorbic acid takes part in the synthesis of glucocorticoids. Its dosage varies widely and depends on the patient's condition.

Etimizole activates the hormonal function of the pituitary gland, which leads to an increase in the level of glucocorticosteroids in the blood, and has anti-inflammatory and antiallergic effects. Prescribe 0.1 g 3-4 times a day.

Additional Treatments

Nootropil (piracetam) is prescribed orally, 1 capsule 3 times a day and the dose is adjusted to 2 capsules 3 times a day; when a therapeutic effect is achieved, the dose is reduced to 1 capsule 3 times a day.

When treated with piracetam, complications in the form of allergic reactions are possible, which is largely due to the presence of sugar in the drug. Therefore, when carrying out the course, it is necessary to limit the amount of sugar in food and exclude sweets from the diet. The course of treatment with nootropil is 1-3 months.

Glutamic acid - up to 1 g 3 times a day.

Actovegin is indicated to improve metabolic processes in the brain. The drug is administered intravenously in the amount of 1 ampoule with glucose at a rate of 2 ml/min.

Solcoseryl, which is prescribed intravenously, has a similar effect. Improves metabolic processes and tissue regeneration.

Plasma transfusion is a very effective treatment method. Native and fresh frozen plasma is used, 150-200 ml IV 2-3 times with intervals between infusions of 5-6 days.

Desensitizing therapy: calcium gluconate intravenously or in tablets, suprastin, tavegil, etc. are widely used.

Decongestants are used relatively rarely.

Of the diuretics, preference is given to furosemide - 1 tablet (40 mg) once a day in the morning. If the effect is insufficient, the dose is repeated the next day or the following course of treatment is carried out: 1 tablet for 3 days, then a 4-day break and then taken for another 3 days according to the same regimen.

Hemodez can be added to drugs that increase urination. This drug also has an anti-intoxication effect. Hemodez is administered intravenously at 200-500 (adults) in a warm form (at a temperature of 35-36 ° C, 40-80 drops per minute, a total of 5 injections with an interval of 24 hours. In some cases, it is useful to alternate hemodez injections with the administration of rheopolyglucin.

In addition to its detoxification effect, Reopolyglucin improves blood counts and restores blood flow in the capillaries.

Dalargin normalizes regulatory proteins, is an immunomodulator, and affects the functional state of cell membranes and nerve conduction. It is recommended to take 1 mg IM 2 times a day for 20 days.

T-activin is used at a dose of 100 mcg daily for 5 days, then after a 10-day break, another 100 mcg for 2 days.

Plasmapheresis in the treatment of multiple sclerosis

This method is used in especially severe cases during exacerbation. Recommended from 3 to 5 sessions.

There are a lot of options for using plasmapheresis: from 700 ml to 3 liters of plasma during each session (at the rate of 40 ml per 1 kg of body weight), on average 1000 ml. The removed fluid is replaced with albumin, polyionic solutions, and rheopolyglucin. Course 5-10 sessions.

Method of using plasmapheresis: after 2 days for the 3rd 5 times or every other day.

Typically, plasmapheresis is combined with the administration of metypred (after a plasmapheresis session, 500-1000 mg is administered intravenously per 500 ml of saline solution) 5 times, followed by switching to taking prednisolone every other day at the rate of 1 mg/kg with a dose reduction of 5 mg each subsequent take up to a maintenance dose (10 mg 2 times a week).

Cytochrome-C is an enzyme obtained from bovine heart tissue. It is prescribed 4-8 ml of a 0.25% solution 1-2 times a day intramuscularly. Before starting to use cytochrome, individual sensitivity to it is determined: 0.1 ml of the drug is administered intravenously. If facial redness, itching, and urticaria are not observed within 30 minutes, then treatment can begin.

Means to improve blood circulation

Nicotinic acid has a pronounced vasodilating effect. The drug is administered in increasing doses from 0.5 (1.0) to 7.0 ml IM and from 7.0 to 1.0.

Xanthinol nicotinate has a similar effect. Synonyms: teonicol, complamin. The drug combines the properties of substances from the theophylline and nicotinic acid groups, acts on peripheral blood circulation, and enhances cerebral circulation.

Cinnarizine has a multifaceted effect: improves cerebral and coronary circulation, microcirculation, has a positive effect on the state of the blood, relieves vasospasm, etc.

Cavinton is used in the treatment of multiple sclerosis. If there are no contraindications (pregnancy, arrhythmias), it is prescribed orally 1-2 tablets (0.02) 3 times a day. It selectively dilates the blood vessels of the brain, improves the supply of oxygen to the brain, and promotes the absorption of glucose by the brain.

There is information about the possibility of using Cavinton in the form of intravenous injections (drips). It is administered in a dose of 10-20 mg (1-2) ampoules in 500 ml of isotonic solution.

Trental, chimes, pentamer, and agapurin have similar effects to Cavinton. Trental is prescribed in a dose of 0.2 (2 tablets) 3 times a day after meals. After the therapeutic effect occurs, the dose is reduced to 1 tablet 3 times a day. 0.1 mg (1 ampoule) is administered intravenously in 250-500 ml of isotonic solution over 90-180 minutes. In the future, the dose may be increased.

A remedy that improves cerebral and coronary circulation is chimes. It is well tolerated and should not be prescribed only for severe forms of coronary atherosclerosis and precollaptoid conditions. It is usually taken in a dose of 25 mg for several months, 1-2 tablets an hour before meals, 3 times a day.

A tonic that improves brain function is phytin, a complex organic phosphorus preparation containing a mixture of calcium and magnesium salts of various inositol phosphoric acids. For multiple sclerosis, take 1-2 tablets 3 times a day.

Tocopherol acetate (vitamin E) is an antioxidant, protects various tissues from oxidative changes, participates in protein biosynthesis, cell division, and tissue respiration. Has the ability to inhibit lipid peroxidation. Daily intake - 50-100 mg for 1-2 months (one drop of 5%, 10% or 30% solution of the drug from an eye pipette contains 1, 2, 6.5 mg of tocopherol acetate, respectively).

Folk remedies in the treatment of multiple sclerosis

Sprouted wheat seeds: 1 tablespoon of wheat is washed with warm water, placed between layers of canvas or other fabric, and placed in a warm place. After 1-2 days, sprouts 1-2 mm in size appear.

Sprouted wheat is passed through a meat grinder, poured with hot milk, and a paste is prepared. Should be eaten in the morning, on an empty stomach. Take daily for a month, then 2 times a week. Course - 3 months. Sprouted wheat seeds contain B vitamins, hormonal substances, and microelements.

Propolis is a waste product of bees. A 10% solution is prepared: 10.0 propolis is crushed, mixed with 90.0 butter heated to 90 °, mixed thoroughly. Take 1/2 teaspoon with honey (if tolerated) 3 times a day. Gradually, the intake can be increased to 1 teaspoon 3 times a day. The course of treatment is 1 month.

Multiple sclerosis is a chronic disease that affects the spinal cord and brain. It occurs as a result of the occurrence of inflammatory foci on the myelin. This is fatty tissue located around the spine and brain that protects them like the insulation of electrical wires. Damage to the myelin sheath leads to further spread of inflammatory foci throughout the central nervous system.

This disease should not be confused with the word “scattered” contained in its name means nothing more than the presence of small foci of the disease, which seem to be scattered throughout the nervous system. But “sclerosis” indicates the nature of the disorders. This is scar tissue that looks like a plaque. In medicine it is called sclerotized.

Prevalence of pathology

Patients with multiple sclerosis are, as a rule, young people aged between fifteen and forty years. But the disease has exceptions. Sometimes it is observed both in childhood and in adulthood. However, when a person has crossed his fifty-year mark, the risk of this pathology decreases significantly.

Multiple sclerosis occurs three times more often in women than in men. But at the same time they tolerate the disease more easily.

Geographical and ethnic factors influence the prevalence of the disease. Thus, people from North America and Northern Europe suffer most from multiple sclerosis. This is due to a lack of vitamin D, which is produced in the human body under the influence of sunlight. But Koreans, Chinese and Japanese practically do not know about this pathology.

Who else is affected by multiple sclerosis? The risk group is people living in large cities. In rural areas, pathology occurs less frequently. All these facts indicate that the development of multiple sclerosis is influenced by an unfavorable environment.

The disease is quite common. This is from 20 to 30 cases for every hundred thousand people in the population. Moreover, many young people diagnosed with multiple sclerosis become disabled after injuries they have sustained.

Why does the disease occur?

The reason why multiple sclerosis occurs is still not clear. But in recent years, scientists have associated the development of this pathology with disturbances in the functioning of genetics and the immune system.

In a normal state, our “body defense” reacts sharply to the penetration of an unknown object into the body, which can be any virus or microorganism. She first attacks the “invader” and then removes him. The speed of this process is influenced by the speed of connection between the links of immunity, as well as the production of cells designed to eliminate danger.

What happens with multiple sclerosis? Scientists believe that the immune system is altered by the virus. She begins to perceive myelin as a dangerous object and attacks the cells of this fatty tissue. This phenomenon is called “autoimmunity.”

4. Mental and emotional disorders. The reason for contacting a doctor may be a feeling of fatigue after a long rest. This is an early sign of multiple sclerosis. The disease also manifests itself in cases where it is difficult for a person to remember or retell information. Signs of pathology are also constant irritability and dissatisfaction, lack of former ambitions and depression, as well as excessive “playing to the public.” Of course, after 40-45 years, any person will attribute all these signs to impending old age. However, young people in this case should consult a doctor.

5. Feeling constantly tired. Of course, it is familiar to workaholics, young mothers and students. However, if it persists, you should consult a doctor. A feeling of constant fatigue overtakes patients with multiple sclerosis already in the morning hours. While still lying in bed, they have a feeling of heaviness, like after working a triple shift. Sometimes a similar feeling comes over the patient right on the street.

6. Failure of the menstrual cycle in women. The presence of foci of pathology on nerve fibers leads to hormonal imbalance and general disorder of the reproductive system.

7. Intestinal dysfunction. A person’s digestive system can tell them about the first signs of multiple sclerosis. If, despite eating little flour products, he rarely goes to the toilet for a long time and constipation has become more frequent, then this should be a cause for concern. Of course, such symptoms often occur during sudden weight gain, when changing a diet to lose weight, or during pregnancy. And here it is necessary to analyze whether you have any other signs of multiple sclerosis.

8. Hand trembling. If a person notices that he has difficulty fastening buttons or threading a needle, this may be the first sign of multiple sclerosis. After all, one of the symptoms of pathology is hand trembling.

Multiple sclerosis is an insidious disease due to the variability of symptoms.

Today a person may have a sore eye, but tomorrow he will feel only dizziness and weakness. Then everything may stop, and the patient will begin to feel quite normal.

Diagnostics

In order to determine the presence of the disease, a specialist conducts a neurological examination of the patient and an oral interview. Additional research methods are also used.

The most informative of them today is considered to be magnetic resonance imaging of the spinal cord and brain. In addition, while monitoring the patient, the doctor refers him to immunological monitoring, that is, regular blood tests.

Treatment of multiple sclerosis

To date, scientists have not yet found a cure to save people from this disease. Doctors for patients diagnosed with multiple sclerosis prescribe medications during the course of therapy that relieve the symptoms of the disease, alleviate the condition, and also prolong the period of remission and prevent the occurrence of various complications.

Treatment for exacerbations

Today, two types of therapy are used to eliminate multiple sclerosis. The first of them is taking medications for exacerbations and deterioration of the patient’s condition. The second type of therapy is interval therapy. It is used for those patients who experience long-term improvement in their condition after being diagnosed with multiple sclerosis. In this case, patients take the medicine for a long time.

An exacerbation is a deterioration in health that lasts more than a day. In this case, the patient is prescribed adrenocorticotropic hormone and cortisone in the form of injections or tablets. This allows not only to relieve inflammation, but also to prevent the occurrence of functional disorders. The greatest effect with this therapy is provided by a combination of drugs such as Cortisone and Cyclophosphamide. The doctor will also individually select medications to eliminate the patient’s symptoms.

Integral treatment

The goal of this therapy is to restore nerve cells in the period between exacerbations. At the same time, medications prescribed by a doctor protect the spinal cord and brain from attacks by the immune system.

During this period and when multiple sclerosis is in remission, treatment is carried out using drugs such as Cyclosporin A, Azathioprine, Mitoxatron and others.

Sometimes the patient is offered surgical treatment. In order to reduce the immune attack, his spleen may be removed or sometimes such patients undergo a bone marrow transplant.

You can also support the patient at home. How, then, is multiple sclerosis treated? Folk remedies recommended by healers:

1. Garlic oil. To prepare it, the chopped head of the vegetable is infused in sunflower oil. Consume with lemon juice.
2. Honey with onions. This remedy strengthens the blood vessels of the extremities and resolves blood clots. To prepare it, squeezed onion juice is mixed with honey.
3. Alcohol tincture of garlic. This remedy fights sclerotic formations and helps relieve vascular spasms.

In addition, traditional medicine recommends that all patients with multiple sclerosis not include sweets in their daily diet. The menu should include foods with low cholesterol levels, as well as those that do not cause high blood pressure. In this case, it is advisable to season the dishes with vegetable oils. Frequent drinking of green tea and natural juices is also recommended.

Life expectancy of people with multiple sclerosis

How many years are measured for patients suffering from this neurological disease? It depends on the:

Timely diagnosis;
- age at which the disease began;
- effectiveness of treatment;
- development of various complications;
- presence of other pathologies.

How long do people live with multiple sclerosis? At the beginning of the 20th century, patients with this diagnosis were given a maximum of thirty years. And this is only if the course of the disease was favorable.

How many people live with multiple sclerosis today? In the 21st century, due to the development of medicine, these people receive more comprehensive treatment. On average, their lives are seven years shorter than their peers. However, every rule has its exceptions, so it is very difficult to reliably predict the development of events.