Multiple sclerosis is a chronic progressive disease of the nervous system, which often affects young people. It is quite common, and in recent years there has been a tendency to increase morbidity even more. The disease does not always manifest itself immediately with expressed symptoms, besides it does not have clinical specific signs, which makes diagnostics very difficult. It is important not to miss the initial manifestations of multiple sclerosis, because the treatment started in time allows you to remain able to work for a long time and prevents disability. Let's talk about the first signs of the disease.
- 1When do the first symptoms appear?
- 2The first signs of multiple sclerosis
- 3Defeat of cranial nerves
- 4Cerebellar disorders
- 5Sensitivity disorders
- 6Pelvic anomalies
- 7Movement disorders
- 8Emotional and mental disorders
- 9Complaints about everything at once
When do the first symptoms appear?
Multiple sclerosis is an autoimmune disease. In this state, the body "sees" some of its own tissues, like foreign ones (in particular myelin sheath, covering most of the nerve fibers) and fights them with antibodies. Antibodies attack myelin and destroy it, nerve fibers are "bared". This condition is clinically already manifested by initial symptoms. For a while, nerves can still perform their functions, but eventually the unprotected fibers themselves are destroyed. If the destroyed myelin sheath can still be "repaired," the destruction of the fiber is irreversible. Therefore, while myelin is not completely destroyed, and partial recovery occurs, the clinical symptoms can then appear, then disappear. When the process reaches the fiber, the symptoms do not disappear anywhere, but remain with the patient forever.
The fact that the first manifestations of multiple sclerosis can disappear, contributes to late diagnosis. After all, when something bothered, and then passed on its own (as the patient thinks), there is no point in going for medical help. This is the cunning of this disease. Symptoms may disappear for a while, but the process of destruction of nerve structures will continue (and at this time it is already necessary to receive specific treatment). It is believed that at the time of treatment of the patient with the debut of multiple sclerosis, the autoimmune process already exists on average about 5 years. Just a person does not connect the previous complaints with complaints at the time of treatment, does not see a connection between these events. Sometimes people seek medical help on time, but medical personnel can ignore minor symptoms and not even think about the possible multiple sclerosis.
Since the attack on myelin and fibers is carried out throughout the body, and there is no pattern of lesion of nerve wires in different parts of the central nervous system, then the destruction is scattered by localization. On the site of the destroyed structures, connective tissue scars are formed. Hence the name of the disease: diffuse means location, sclerosis is a scar. This unpredictable location of pathological changes leads to a huge variety of clinical symptoms, including the very first ones, since it is not known which of the patients which part of the nervous system will be affected first. This is another aspect that hampers the diagnosis of early manifestations of multiple sclerosis.
The first signs of multiple sclerosis
The first signs mean that the patient is not yet aware of the possible development of multiple sclerosis. Let's get acquainted with those symptoms and situations, the emergence of which can be the "first bell" of multiple sclerosis. They can be divided into several groups, depending on which functional part of the nervous system is affected.
Defeat of cranial nerves
To one of the most common debuts of multiple sclerosis is the damage to the optic nerve. It can have the following manifestations:
- there is a sudden impairment of vision to one eye (visual acuity is reduced);
- turbidity, a veil before the eye or a black dot that do not pass as a result of blinking;
- change in the visual fields (the space seen by the eye with a fixed head and look): constriction (looking like a tube), falling out of the outer or inner halves of the fields of vision;
- disappearance of color vision or non-perception of a single color;
- foreign body sensation in the eye;
- vagueness of contours.
Most often these symptoms indicate the development of retrobulbar neuritis. Disturbances of vision can last more than a week, and then everything gradually passes. Sometimes the recovery is incomplete. Retrobulbaric neuritis can be accompanied by pain in the eyeball, which increases with eye movements. Pain can last for several days. Sometimes pain precedes a decrease in visual acuity. With pressure on the eyes, the pain intensifies. Characterized by increased sensitivity to bright light, loss of contrast. There may be a flashing of objects before your eyes. The defeat of the optic nerve can be accompanied by a headache from the same side in the fronto-parietal or frontal-occipital region. Violated the reaction of the pupil to light: it is either too lax, or even paradoxical (narrowing). When examining the ocular fundus, the following changes can be detected by the ophthalmologist: there is edema of the optic nerve disk, its borders are erased, blanching of the temporal halves, narrowing of the arteries. Retrobulbaric neuritis can recur, and more than once.
Retrobulbaric neuritis may be a harbinger of multiple sclerosis, and may be an independent disease, but its development is always is an indication for the MRI of the brain for the diagnosis of foci of demyelination (characteristic of multiple sclerosis). Statistics show that in 15 years after the development of retrobulbar neuritis, 60% of people who have had this disease develop multiple sclerosis.
The initial signs of multiple sclerosis can be double vision, slight strabismus, insignificant ptosis (omission century), the unfamiliarity of the eyes outside when looking to the side (arise when the oculomotor and defecating nerves are affected). All these symptoms can pass independently, be perceived by the patient as a consequence of fatigue. Strabismus can be imperceptible when viewed directly, and only when the outermost eyeballs are detected. For multiple sclerosis, a breakdown in the coordinated eye movement is characteristic: when looking upward, to the side. In this case, individually, each eye can perform movements in all directions.
Of the other lesions of the cranial nerves, which are alarming for multiple sclerosis, neuralgia of the trigeminal nerve and neuritis of the facial nerve can be noted. When identifying the symptoms of these diseases, the patient should be subjected to a thorough neurological examination in order to search for symptoms of damage to other functional parts of the nervous system. The appearance of neuralgia in the human trigeminal nerve or neuritis of the facial nerve does not at all indicate the presence of multiple sclerosis. Just such a variant of the debut of the disease is possible.
Cerebellar manifestations also often become the first in the development of multiple sclerosis. These include:
- episodic dizziness;
- insignificant shakiness when walking: sometimes it is described by patients as "just led to the side". Day or two and the symptom passes by itself, a person connects this symptom with the change in weather and meteorolubility, a drop in blood pressure, etc., although this may be the initial sign of multiple sclerosis;
- sudden imbalances: when attempting to perform complex motor acts that previously did not present complexity (for example, a person Excellent riding a bicycle, and now can not; or a good skate, and now can not even just stand on them on the ice);
- a sudden change in the handwriting: it becomes uneven, clumsy. This is especially noticeable in people with calligraphic handwriting. Others may notice that "you started writing like a chicken with your paw". Usually this is not seen as a medical background;
- the appearance of the trembling of objects, the feeling of double vision before your eyes can also be a sign of damage to the cerebellum and its connections, and not just the cranial nerves;
- nystagmus: uncontrolled oscillatory movement of the eyeballs. Nystagmus is usually invisible to others and to the patient himself. It is detected with an extreme degree of eye-opening, upwards.
Very frequent initial manifestation of multiple sclerosis. Paresthesia is especially characteristic - any unpleasant sensations arising without external influence. They include: a feeling of creeping, a burning sensation, itching, tightening of the skin, numbness, tingling, "cotton feet", etc. And the area of sensation can be very small, for example, a brush of one hand or the big toe, cheek, wings of the nose. A person can quite connect their occurrence with a concrete situation, for example, "stayed" a leg, "lain" the arm. Since in most cases such feelings disappear on their own, the person is convinced of his correctness and does not bother at all. Even when the diagnosis of multiple sclerosis may be made over time, the question: "A did you have any previous sensations of numbness, tingling in the limbs, etc.? ", often answer:" No ". Of course, not all cases of such feelings should be considered as the initial manifestation of multiple sclerosis. The reasons for such violations are great. But if they are repeated regularly for no apparent reason, you should pay attention and consult a doctor so that you do not miss something important.
It happens that a person complains that he "ceased to feel the ground under his feet," in the truest sense of this expression. In order not to stumble or stumble, he has to look at his feet all the time. This sensation can arise as a result of the defeat of the fibers of the joint-muscular sensitivity, which is often the case with multiple sclerosis.
Another early sign of the onset of multiple sclerosis may be a decrease in vibration sensitivity. Check it can be using a special device, tuning fork, with a normal neurologic examination.
Sometimes multiple sclerosis begins with impaired pain or temperature sensitivity. There are uncaused pains (in a variety of places), there may be areas with a lack of sensitivity, a violation in the recognition of cold and heat. Even the first-time headache can be regarded as a sign of possible multiple sclerosis, although this is rare.
They can also be the initial sign of multiple sclerosis. It should be alarmed by frequent urination (it is often associated with the presence of a urological infection), delayed urination (additional effort is required to carry out the act), impossibility urinate completely (a feeling of residual urine, which can no longer be extinguished), imperative urge to urinate (sudden, demanding urges, requiring immediate satisfaction). Like other initial signs of multiple sclerosis, they can suddenly appear and also suddenly disappear. Such situations require a compulsory examination, however delicate the problem might seem.
To the disorders of pelvic functions is the decrease in potency.
Very frequent initial symptom of multiple sclerosis. The spectrum is quite extensive: the awkwardness of movements (it is difficult to fasten the buttons, it is impossible to get into the lock with the key the first time, pointing the computer mouse on the icon on the screen, etc.), insignificant muscle weakness (may remain unnoticed for the patient, as it is regarded as a manifestation of fatigue, and after rest is no longer noted), a feeling of tension in the muscles. Various household "trifles" may be the first sign of multiple sclerosis: everything falls from the hands, dishes fall (and the person remains in perplexity, as he tried to keep the object, and the hands "did not obey").
One of the most characteristic signs is the decrease or loss of abdominal reflexes (they are checked by a neurologist with the help of a dashed irritation of the skin of the abdomen). All other reflexes in humans can be normal. Such dissociation is suspicious of multiple sclerosis. Also one of the first signs can be general hyperreflexion, i.e., increase of all tendon reflexes (especially from the lower limbs), the appearance of pathological foot symptoms (Babinsky). Naturally, these violations can be detected only by a neuropathologist.
Another sign that combines motor and sensory disturbances is the night cramp. It is a painful involuntary muscle cramp, lasting a few seconds or even minutes at night.
From all of the above, it becomes clear that all the initial manifestations of multiple sclerosis are very nonspecific. Many symptoms may be a sign of another disease (for example, an increase in reflexes in neurotic states or krumpi in violation of calcium metabolism) or even a variant of the norm (muscle weakness after work). Of course, such difficulties do not contribute to the early diagnosis of multiple sclerosis. All complaints must be evaluated carefully, so as not to miss anything.
Emotional and mental disorders
Emotional lability, irritability, bad mood, difficulty with remembering or reproducing information, depression or, conversely, euphoria, constant fatigue, in no way changing after rest, lack of desire to do anything can be the first symptoms of multiple sclerosis.
More often these signs are display of other diseases, and the diagnosis at all is not exposed only for these disorders, but in some cases they may be the first symptoms of multiple sclerosis.
Complaints about everything at once
Sometimes the patient turns to the doctor with a lot of complaints, scattered in time: the day before yesterday he doubled in the eyes, yesterday my hands were numb, today my head is spinning, and a month ago I was worried about frequent urination. Such a list is very suspicious of multiple sclerosis, although it may be a trivial coincidence of a number of reasons (it was twofold, because on the eve of overdone with alcohol; my hands were numb, because I slept uncomfortably; dizzy, because blood pressure has dropped; and frequent urination was associated with an exacerbation of the urological infection). Therefore, for an adequate assessment of symptoms, a competent doctor is required.
Multiple sclerosis is a disease with many clinical "masks", so its first symptoms can be so different. Being attentive to one's health, being suspicious of every violation that arose, a person must adhere to the "golden mean", so as not to miss the disease, but not to "invent" it for yourself. In the case of multiple sclerosis it is very difficult even for a practicing doctor. "It is better to perebdet than not to have," - this formulation is very useful in the early manifestations of multiple sclerosis. If you are worried about anything, it's best to visit a competent specialist who can understand your situation, that if necessary, modern MRI diagnostics helps to confirm or disprove the diagnosis of multiple sclerosis.
Video version of the article:
Watch this video on YouTube
Watch this video on YouTube