Multiple Sclerosis: Symptoms and Treatment

Multiple sclerosis is a chronic demyelinating disease of the nervous system. Has not fully studied the causes and autoimmune-inflammatory mechanism of development. It is a disease with a very diverse clinical picture, it is difficult to diagnose in the early stages, In this case, there is no specific clinical symptom characterizing exactly the absent sclerosis. Treatment consists in the use of immunomodulators and symptomatic agents. The action of immune preparations is aimed at stopping the process of destruction of nerve structures by antibodies. Symptomatic drugs eliminate the functional consequences of these disruptions.

You can learn about the initial signs of multiple sclerosis from the article of the same name. Now let's talk about the unfolded clinical picture, the methods of diagnosis and treatment of this disease.

Symptoms of Multiple Sclerosis

Manifestations of multiple sclerosis are very diverse, as the disease affects the entire nervous system. Foci of lesion are scattered in different departments, instead of nerve tissue in these places, connective tissue is formed, and the function performed by this site is lost, therefore all clinical manifestations are systematized at the place of lesion in the nervous system.

There are typical symptoms of multiple sclerosis and atypical, rare, which, however, should not be forgotten. Usually, one patient at the same time there are signs of damage to different functional systems (in connection with the absent-mindedness of the lesion).

Typical manifestations

Representation of a lesion of the conducting pathways of the nervous system. These are the so-called "classic" symptoms of multiple sclerosis.

Motor sphere

This group of symptoms includes the defeat of pyramidal pathways, which occurs in 85-97% of cases, i.e. almost every patient. It can be:

• paresis or paralysis - a decrease in muscle strength in the limbs. Most often affected are the lower limbs. As the disease progresses, pareses can spread up to the defeat of all four limbs;
• increased tendon reflexes (checked by a neurological hammer from the hands and feet) and a decrease and loss of surface (the latter is especially characteristic for abdominal reflexes);
• pathological symptoms - Babinsky, Gordon, Bekhterev, Zhukovsky, and others. They are always checked by a neurologist with an ordinary neurologic examination;
• the increase in muscle tone, the so-called spasticity of muscles. Muscles at rest become strained, hard to the touch. This symptom, along with muscle weakness, can impede the movement of patients (if it occurs in the legs) or interferes with the usual household devices of self-service (if occurs in the hands);
• the appearance of clones of the foot, hand and kneecap. This is the extreme degree of increase in reflexes. Clones are rhythmic movements of the foot, hand or kneecap. Are caused by stretching muscles or tendons. For example, the clone of the foot is caused by its maximum extension (by the doctor's hand) with the leg bent in the knee and hip joints. The foot is held in the unbending position and makes involuntary flexion-extension movements, as if tapping on the doctor's arm. Similarly, the presence of a clone of the hand and the patella is examined.

The coordination system (defeat of the cerebellum pathways)

Similar symptoms develop in 62-87% of patients:

• violation of gait - the patient "swings" from side to side, shaking even on a flat surface. In later stages, it is accompanied by falls or generally leads to the impossibility of movement;
• decrease in muscle tone - a characteristic symptom of cerebellar involvement. If the defeat of the motor system prevails, then the tonus will be increased if the cerebellar system is lowered;
• miss - any targeted movements do not reach their goal. If you ask the patient to hit the tip of his nose with his eyes closed, he pokes them on the cheek, nose or even eyes. Such violations interfere with the skills of self-service, food intake, etc .;
• speech disturbance - speech becomes jerky, chanting, words are divided into separate syllables, which are pronounced separately and with accent on each syllable;
• violation of the handwriting - it becomes uneven, gets out of the boundaries of lines;
• trembling of limbs, heads when performing movements;
• nystagmus - vibrational, rhythmic, involuntary movements of the eyes. It can be so pronounced that it gives the impression of "jumping" eyes. Because of this, vision can be impaired.

Damage to the trunk and cranial nerves

Occurs in 36-81% of cases:

• limiting mobility of the eyes when looking at the sides, up, down;
• strabismus, doubling of objects;
• violation of the combined movements of the eyeballs: for example, when looking up, one eye looks up, and the other deviates to the side. This is called internuclear ophthalmoplegia;
• weakness facial muscles of the face (paresis of the facial nerve) - the face is skewed, the eye on the affected side completely does not close, develops lachrymation from it, food and water pour out of the mouth, it is impossible to smile and etc .;
• pain in the face area by the type of neuralgia of the trigeminal nerve;
• fuzziness, blurred speech, choking with food, ingestion of food and water in the nose, violation of swallowing - the so-called bulbar symptoms (develop with damage to the nuclei of the medulla oblongata);
• the development of retrobulbar neuritis - is very common in multiple sclerosis (often the debut of the disease). It is manifested by a violation of visual acuity, the ability to distinguish colors. The difference in brightness and contrast of the image ceases to be captured. In the field of view the patient sees black dots, gray spots, sometimes there is a feeling, as if you look into the tube. Some half of the fields of vision may fall out. Pupillary reactions to light are disturbed. When examining the fundus, the blanching of the optic nerve disc (especially its temporal halves) is revealed, and the atrophy of the optic nerve develops.

Sensitivity impairment

Happens in 56-92% of cases:

• disorders of deep sensitivity - the body loses control over the perception of its muscles, tendons, joints, i.e. The brain does not receive impulses from these structures. How is this manifested? For example, the doctor asks the patient to close his eyes. It touches one of the fingers or toes and makes a slight movement with this finger (bends, unbends, points to the side). And the patient should tell, what under the bill the finger is touched by the doctor, and in what party movement is made. If the patient can not correctly determine this, then it means that he has violations of deep sensitivity. Because of such violations, walking worsens even more, as the patient ceases to sense the surface through which it moves;
• the presence of paresthesias (a feeling of crawling, chills, itching, burning, numbness, etc.);
• areas of pain and temperature sensitivity dropout - when the patient does not feel the difference between hot and cold, between touching and pricking the skin with a needle;
• pain in the muscles, spine.

Violation of the function of the pelvic organs

Occurs in 26-53% of cases:

• disorders of urination - urinary retention or incontinence (there may be a constant discharge of urine drop by drop, and may be periodic emptying as it is filled only without feeling a urge);
• violation of the act of defecation - is typical for later stages of the disease. By analogy with disorders of urination, constipation or incontinence of feces is possible;
• violations of sexual function - erectile dysfunction (impotence), lack of orgasm, decreased libido. In women, the menstrual cycle is disrupted.

Neuropsychological symptoms

Similar violations are detected in 65-95% of cases:

• asthenic syndrome - increased fatigue, rapid exhaustion in mental and physical exertion;
• violation of memory, thinking, attention;
• depression or euphoria;
• irritability, dissatisfaction, hysterical fits;
• chronic fatigue syndrome.

Atypical manifestations

It is defined only in 5-20% of patients with multiple sclerosis:

• vegetative disorders (attacks of dizziness with nausea and vomiting, sympathetic adrenal crises, attacks of slowing heart rate and lowering blood pressure);
• epileptic seizures;
• attacks of hiccough, coughing, yawning, muscle spasms;
• episodes of acute speech loss with dizziness, hearing loss;
• Lermitt's symptom is the feeling of an electric current passing along the spine with the head tilted forward.

The course of multiple sclerosis usually implies the presence of exacerbations and remissions. In a number of cases, it occurs without the moments of stabilization and improvement of the condition from the very beginning, and sometimes with a constant progression of symptoms.

Diagnostics

The diagnosis of multiple sclerosis is very complicated. This is facilitated by a variety of symptoms, and their ability to disappear (the "flickering" of symptoms) in the initial stages of the disease. For the diagnosis of multiple sclerosis use:

• neurologic examination for the detection of clinical symptoms;
• examination at the oculist with examination of the fundus and determination of the visual fields;
• MRI of the brain and spinal cord on a high-power apparatus using contrast agents (allows to detect foci of connective tissue - "plaques");
• exploring evoked potentials;
• oligoclonal antibodies in cerebrospinal fluid (cerebrospinal fluid), which confirm the immunopathological process in nervous system (may be noted in other infectious diseases of the nervous system, for example, neuropeptide).

To date, the McDonald et al., 2001 criteria are generally accepted for diagnosis. They provide for the recording of clinical symptoms and changes in MRI, evoked potentials, cerebrospinal fluid.

Treatment

To select effective treatment, it is necessary to take into account many aspects of the course of the disease in a particular patient. Treatment of multiple sclerosis is very individual, because the symptoms in all patients are different (or a combination of symptoms). But there are general provisions that are adhered to when prescribing therapy to all patients with multiple sclerosis:

• as early as possible treatment;
• constant medication (even during remission, to prevent the next aggravation and slow progression);
• use of drugs that suppress the autoimmune inflammatory process, which does not allow the formation of new lesions;
• combining different drugs to achieve greater efficiency.

All means for treatment are divided into two groups: agents for pathogenetic treatment (affect the mechanism of development of multiple sclerosis) and symptomatic drugs. In addition, the treatment is very different during the period of exacerbation and during remission.

Pathogenetic treatment

It is conducted both in the debut of the disease, with exacerbation, and in the stage of remission. The aim of such therapy is to stop the autoimmune inflammatory process, to prevent the destruction of myelin.

Exacerbation

In this stage apply:

• pulse-therapy with corticosteroids is a short course of large doses of hormones intravenously. Usually, methylprednisolone (Metipred, Solu-medrol) is used 500-1000 mg in 200-400 ml saline intravenously drip at a rate of 25-30 drops per minute 1 time per day (in the morning) during 3-7 days. The duration of the course and dosage depend on the severity of neurological disorders. To prevent the side effects of methylprednisolone, simultaneously prescribe potassium preparations (Asparcum, Panangin) and a diet rich in potassium salts (bananas, baked potatoes, apples, raisins); substances that protect the gastric mucosa (Ranitidine, Cimetidine, Almagel, Phosphalugel); antibiotics (because hormones reduce the defenses of the body, and can join infection). After pulse therapy continue to take methylprednisolone in tablets, starting at a dose of 24 mg, gradually canceling the drug;
• if pulse therapy can not be performed, then Dexamethasone is administered intravenously or intramuscularly once a day, starting with 128 mg (64 mg, 32 mg depending on of the severity of symptoms), gradually reducing the dose 2 times every two days (64 mg 2 days, 32 mg 2 days, 16 mg 2 days, etc., as if canceling the drug gradually);
• plasmapheresis - purification of blood plasma from circulating antibodies in it. It takes about 2 weeks: during this time 3-5 procedures are performed (with a break of several days). With the help of a special device, blood is drawn from the vein and passed through a filter system. In it, the blood is divided into cellular elements and plasma. Then, the cellular elements are mixed with the donor plasma (or with artificial plasma substitutes), and in this form they return to the patient through another vein. Sometimes plasmapheresis is combined with pulse-therapy with hormones;
• human immunoglobulin for intravenous administration (Sandoglobulin, Pentaglobulin) at a dose of 200-400 mg / kg per day at a rate of 20 drops per minute for 5 consecutive days;
• with ineffectiveness of hormones, with the steady progression of multiple sclerosis apply cytostatics (Azathioprine, Cyclophosphamide, Cyclosporine A, Methotrexate, etc.) that suppress autoimmune process. However, the use of cytostatics has the reverse side of the coin: they are very toxic. These drugs have many serious side effects. They lead to a sharp decrease in white blood cells, erythrocytes, platelets (which is accompanied by a decrease in the protective forces of the body, the development of anemia, a violation of blood clotting), cause drug-induced hepatitis, hair loss, lead to frequent nausea, vomiting, diarrhea;
• antiagreganty, drugs that improve blood supply - Dipiridamol, Kurantil, Pentoxifylline;
• if high titres of antibodies to the herpes virus are detected - Zovirax, Valtrex;
• interferon inducers - Cycloferon, Amiksin.

Remission

Multiple sclerosis is a disease that requires constant treatment, even during remission. Clinical symptoms may decrease, the condition - improve, but the process of destruction of myelin will continue. To suspend the autoimmune process, to prevent the progression of the disease, to slow downinvalidization, apply a special group of medicines: preparations of preventive (immunomodulating) therapy. International studies have proven their effectiveness in multiple sclerosis. These are preparations of β-interferon (Avonex, Betaferon, Rebif) and glatiramer acetate (Copaxone). The choice of the drug depends on the stage of the disease, the mechanism of action and, unfortunately, on the patient's material capabilities. Avonex used 6 million IU once a week intramuscularly, Rebif 6 or 12 million IU 3 times per week subcutaneously, Betaferon 8 million or 16 million IU every other day, subcutaneously, Copaxone 20 mg orally daily.

For this group of drugs, it is very important to start as early as possible: as soon as the diagnosis is made Multiple sclerosis will be exposed, you must immediately start taking, and take them continuously, without break. This helps to prevent the emergence of new exacerbations, and therefore, not to allow new functional disorders in the patient. After all, preventing destruction is easier and more effective than treating the consequences. Thus, a person keeps working capacity for a long time, remains socially active. And this is what they are striving for in the treatment of multiple sclerosis, since it is not possible to cure this disease completely.

Symptomatic treatment

This type of treatment involves the use of a variety of drugs to reduce the manifestation of symptoms that have already arisen in multiple sclerosis. Symptomatic treatment is used both in the period of exacerbation, and in the period of remission. Therapy is done asymptomatically:

• spasticity (increase in muscle tone) - Sirdalud (Tizanidin, Tizalud), Baclofen, Midokalm, Clonazepam, exercise therapy, acupressure, injections of botulinum toxin, sessions of hyperbaric oxygenation;
• muscle weakness - Neuromidine, Glycine, Cerebrolysin, Gliatilin, B vitamins;
• dizziness - Betaserk (Vestibo, Vestinorm), Fezam, Stugeron-Fort, Thiocetam, Nicotinamide, acupuncture;
• malfunction of urination - normalization of drinking regimen, elimination of caffeine and alcohol, magnetic and electrostimulation of the bladder, training of pelvic floor muscles. With urinary incontinence - Driptan, Adiuretin, Desmospray; with a delay in urination - Neuromidine, Gliatilin;
• impaired coordination - β-blockers (Propranolol, Anaprilin), small doses of antidepressants (Amitriptyline), vitamin B6, Magne-B6, Glycine, methods of physiotherapy for increasing vestibular adaptation;
• trembling - Carbamazepine (Tegretol, Finlepsin);
• metabolic therapy - Cerebrolysin, Nootropil, Encephabol, Glutamic acid, Methionine, B vitamins (Neurobex, Milgamma, Neurorubin), Vitamin C and E, Glycine, Essentiale, Lipoic acid;
• chronic fatigue - Semax, Fluoxetine (Prozac), Sertraline (Serlift, Zoloft), Stimol, Enerion, extracts of ginseng and Eleutherococcus, psychotherapy;
• headaches associated with increased intracranial pressure - Diacarb, Glycerin, Magne-B6, Magnesium sulfate, Lysine escinate, Cyclot 3 fort;
• paroxysmal pains and conditions (neuralgia of the trigeminal nerve, a symptom of Lermitt, paresthesia) - carbamazepine (Finlepsin), Diphenin, Convulsofin (Depakin), Gabapentin (Gabagamma, Neurontin), Pregabalin, Lamotrigine, Clonazepam;
• Depression - Coaxil, Amitriptyline, Lerivon, Fluxetin (Prozac).

Multiple sclerosis is a severe neurological disease that occurs mainly in young people. Has many symptoms that can serve as "masks" of other diseases. It flows with exacerbations and remissions. Diagnosed by clinical manifestations and data from additional research methods. It requires constant and long-term treatment, without which leads to loss of ability to work and disability.