Multiple sclerosis is a disease of the nervous system that occurs in young and middle age (15–40 years old).
A feature of the disease is the simultaneous damage of several different parts of the nervous system, which leads to the emergence in patients of various neurological symptoms. Another feature of the disease – remitting course. This means the alternation of periods of deterioration (exacerbation) and improvement (remission).
The basis of the disease is the formation of foci of destruction of the sheath of nerves (myelin) in the brain and spinal cord. These foci are called multiple sclerosis plaques.
The size of the plaques is usually small, from a few millimeters to a few centimeters, but with the progression of the disease, the formation of large confluent plaques is possible.
The cause of multiple sclerosis is not precisely understood. Today the most common is the opinion that multiple sclerosis can result from a random combination of a number of unfavorable external and internal factors in a given person.
Adverse external factors include
- frequent viral and bacterial infections;
- influence of toxic substances and radiation;
- food features;
- geoecological place of residence, especially its influence on the body of children;
- frequent stressful situations;
- genetic predisposition, probably associated with a combination of several genes, causing violations primarily in the system of immunoregulation.
Each person in the regulation of the immune response takes part simultaneously several genes. In this case, the number of interacting genes can be large.
Research in recent years has confirmed the mandatory participation of the immune system, primary or secondary, in the development of multiple sclerosis. Disturbances in the immune system are associated with features of a set of genes that control the immune response.
The most widespread autoimmune theory of multiple sclerosis (recognition of nerve cells by the immune system as “alien” and their destruction).
Given the leading role of immunological disorders, the treatment of this disease is primarily based on the correction of immune disorders.
In multiple sclerosis, NTU-1 virus (or a related unknown pathogen) is considered as the causative agent. It is believed that a virus or group of viruses causes serious impaired immune regulation in the patient’s body with the development of the inflammatory process and the breakdown of the myelin structures of the nervous system.
Symptoms of multiple sclerosis are associated with lesions of several different parts of the brain and spinal cord.
Symptoms of damage to the pyramidal path can be expressed by an increase in pyramidal reflexes without reducing or with a slight decrease in muscle strength or the appearance of fatigue in muscles when performing movements, but while maintaining basic functions.
Signs of damage to the cerebellum and its conductors are manifested by trembling, incoordination of movements.
The severity of these signs can vary from minimal to the impossibility of performing any movements.
Typical of a cerebellar lesion is a reduction in muscle tone.
In patients with multiple sclerosis, lesions of the cranial nerves can be detected, most often – oculomotor, trigeminal, facial, hypoglossal nerves.
Signs of impaired deep and superficial sensitivity are detected in 60% of patients. Along with this, a tingling and burning sensation may appear in the fingers and toes.
Disturbances of the functions of the pelvic organs are frequent signs of multiple sclerosis: urgent urge to increase, urine and stool retention, and incontinence at later stages.
Perhaps incomplete emptying of the bladder, which is often the cause of urogenital infection. Some patients may have problems related to sexual function, which may coincide with dysfunction of the pelvic organs or be an independent symptom.
In 70% of patients, symptoms of visual function impairment are identified: reduced visual acuity in one or both eyes, a change in visual fields, blurred images of objects, loss of brightness of vision, color distortion, impaired contrast.
Neuropsychological changes in multiple sclerosis include decreased intelligence, behavioral disturbances. More common in patients with multiple sclerosis prevails depression. In multiple sclerosis, euphoria is often combined with a decrease in intelligence, an 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 multiple sharp mood changes in a short period of time.
The deterioration of the patient’s condition when the ambient temperature rises is associated with an increased sensitivity of the affected nerve cells to changes in the electrolyte balance.
In some patients, pain may occur:
- pain along the spine and intercostal spaces in the form of a “belt”,
- muscle pain caused by increased tone.
In typical cases, multiple sclerosis proceeds as follows: a sudden onset of signs of disease among full health.
They can be visual, motor or any other disorders, the severity of which varies from subtle to grossly impairing the functions of the body.
The general condition remains safe. Following an exacerbation, remission occurs, during which the patient feels practically healthy, then an exacerbation again.
It already proceeds harder, leaving behind a neurological defect, and this is repeated until disability occurs.
Diagnosis of multiple sclerosis is based on data from a patient survey, a neurological examination and the results of additional examination methods.
To date, magnetic resonance imaging is considered the most informative. head and spinal cord and the presence of oligoclonal immunoglobulins in the cerebrospinal fluid.
Considering the leading role of immunological reactions in the development of multiple sclerosis, regular research in patients with blood — the so-called immunological monitoring — is particularly important for monitoring the disease.
It is necessary to compare immunity with previous indicators of the same patient, but not healthy people.
Antiviral drugs are used in the treatment. The basis for their use is the assumption of the viral nature of the disease.
Betaferon is the most effective drug for multiple sclerosis. The total duration of treatment for them is up to 2 years; has strict indications: it is appointed to patients with the remitting form of a current and not rough neurologic deficit.
The experience of using betaferon showed a significant decrease in the number of exacerbations, their lighter course, a decrease, according to magnetic resonance imaging, of the total area of foci of inflammation.
Reaferon-A has a similar effect. IFN is prescribed 1.0 w / m 4 times a day for 10 days, then 1.0 w / m once a week for 6 months.
Interferon inducers are also used:
- nonsteroidal anti-inflammatory drugs (indomethacin, voltaren).
Ribonuclease – an enzyme preparation derived from the pancreas of cattle, retards the reproduction of a number of RNA-containing viruses.
Ribonuclease is administered 25 mg i / m 4-6 times a day for 10 days.
The drug is used after the test: a working solution of RNA-ase in a dose of 0.1 is injected subcutaneously on the inner surface of the forearm. 0.1 ml of saline (control) is similarly injected into the symmetrical area. The reaction is read after 24 hours. Negative – in the absence of local manifestations.
In case of reddening, swelling of the site of RNAase injection, the drug is not used.
Dibazol has antiviral, immunomodulatory effects. He is prescribed in micro doses of 5–8 mg (0.005–0.008) in the form of pills every 2 hours for 5–10 days.
In multiple sclerosis hormones are used – glucocorticoids. There are many schemes for using glucocorticoids in multiple sclerosis.
Sinakten depot is a synthetic analogue of the hormone corticotropin, consists of its first 24 amino acids, is a very effective drug for the treatment of multiple sclerosis.
It can be used as an independent means and in combination with glucocorticoids. The action of synacthen depot continues after a single injection of 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 in 2-3 days, 3-4 times, then once a week, 3-4 times or 1 mg for 3 days, then after 2 days on the 3rd, the course of treatment is 20 injections.
Complications while taking this group of drugs – Itsenko-Cushing syndrome, increased levels blood sugar , edema, asthenia, bacterial infections, stomach bleeding, cataracts, heart 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, potassium preparations.
Ascorbic acid is involved in the synthesis of glucocorticoids. Its dosage varies widely and depends on the condition of the patient.
Etimizol activates the hormonal function of the pituitary gland, which leads to an increase in the level of glucocorticosteroids in the blood, has anti-inflammatory and antiallergic action. Assign 0.1 g 3-4 times a day.
Nootropil (piracetam) is administered orally on 1 capsule 3 times a day and the dose is adjusted to 2 capsules 3 times a day; when the therapeutic effect is reached, the dose is reduced to 1 capsule 3 times a day.
In the treatment of piracetam, complications in the form of allergic reactions are possible, which is largely due to the presence of sugar in the preparation. Therefore, during the course, it is necessary to limit the amount of sugar in food and eliminate sweets from the diet. The course of treatment with nootropil – 1-3 months.
Glutamic acid – up to 1 g 3 times a day.
Actovegin is shown to improve metabolic processes in the brain. The drug is introduced into / into the drip in the amount of 1 ampoule with glucose at a rate of 2 ml / min.
Close effect has solcoseryl, which is prescribed in / in. Improves metabolic processes, tissue regeneration.
Cerebrolysin for multiple sclerosis is recommended to enter in / in 10 ml, a total of 10 injections.
Plasma transfusion is a very effective treatment method. Native and fresh frozen plasma of 150–200 ml i / v 2–3 times with intervals of 5–6 days infusion is used.
Desensitization therapy: Calcium gluconate is widely used in / in or in tablets, suprastin, tavegil, etc.
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, repeat the procedure on the next day or the following course of treatment is carried out: for 3 days, 1 tablet, then a 4-day break and reception for another 3 days according to the same scheme.
To means that increase urination, you can add gemodez. This drug also has anti-toxic effects. Hemodez is administered intravenously by 200–500 (adults) in the form of heat (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 the injection of hemodesis with the introduction of reopolyglucine.
Reopoliglyukin in addition to the detoxification effect improves blood counts, restores blood flow in the capillaries.
Dalargin normalizes regulatory proteins, is an immunomodulator, acts on the functional state of cell membranes and nerve conduction. It is recommended that 1 mg / m 2 times a day for 20 days.
T-activin is applied at 100 mcg daily for 5 days, then after a 10-day break another 100 mcg for 2 days.
Plasma exchange in the treatment of multiple sclerosis
This method is used in severe cases with exacerbations. Recommended from 3 to 5 sessions.
Plasmapheresis uses a lot of options: from 700 ml to 3 liters of plasma during each session (at the rate of 40 ml per 1 kg of mass), an average of 1000 ml. Compensate the removed liquid with albumin, polyionic solutions, reopolyglucine. Course 5-10 sessions.
Plasmapheresis: 2 days on the 3rd 5 times or every other day.
Usually, plasmapheresis is combined with the introduction of metipred (after a plasmapheresis session, injecting 500–1000 mg i.v. into 500 ml of saline solution is administered 5 times) followed by switching to prednisone every other day at a rate of 1 mg / kg with a 5 mg dose reduction each subsequent reception to the maintenance dose (10 mg 2 times a week).
Cytochrome-C is an enzyme derived from the tissue of the heart of cattle. It is prescribed in 4–8 ml of a 0.25% solution 1–2 times a day intramuscularly. Before starting the use of cytochrome, individual sensitivity to it is determined: 0.1 ml of the preparation is injected into / out. If within 30 minutes no facial flushing, itching, urticaria , then you can proceed to treatment.
Means to improve blood circulation
Nicotinic acid has a pronounced vasodilating effect. Administration of the drug is used in increasing doses from 0.5 (1.0) to 7.0 ml / m and from 7.0 to 1.0.
Xanthinol nicotinad has a similar effect. Synonyms: theonikol, komplamin. The drug combines the properties of substances of theophylline group and nicotinic acid, acts on the peripheral circulation, increases cerebral circulation.
In multiple sclerosis, cinnarizine has proven itself well. Its use is long (up to several months) at a dose of 25–75 mg (depending on the severity of the condition) 3 times a day.
Cinnarizine has a multilateral action: it improves cerebral and coronary circulation, microcirculation, has a positive effect on the blood, relieves vasospasm, etc.
Cavinton is used in the treatment of multiple sclerosis. If there are no contraindications (pregnancy, arrhythmias ), it is prescribed inside 1-2 tablets (0.02) 3 times a day. It selectively expands the brain vessels, improves the oxygen supply to the brain, and contributes to the absorption of glucose by the brain.
There is information about the possibility of using Cavinton in the form of intravenous injection (drip). Introduce it in a dose of 10–20 mg (1–2) ampoules in 500 ml of isotonic solution.
Trental, chimes, pentamer, agapurin have an action close to cavinton. Trental is prescribed in a dose of 0.2 (2 tablets) 3 times a day after meals. After the onset of therapeutic effect, the dose is reduced to 1 tablet 3 times a day. 0.1 mg (1 ampoule) in 250–500 ml of isotonic solution is administered intravenously over a period of 90–180 minutes. In the future, the dose may be increased.
The agent that improves cerebral and coronary circulation is chimes. It is well tolerated, it cannot be prescribed only in severe forms of coronary atherosclerosis and in precollaptoid conditions. It is usually taken in a dose of 25 mg for several months, 1-2 pills an hour before meals 3 times a day.
Phytin, a complex organic preparation of phosphorus containing a mixture of calcium and magnesium salts of various inositol phosphoric acids, is a tonic agent that improves brain function. 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 the biosynthesis of proteins, cell division, tissue respiration. It has the ability to inhibit lipid peroxidation. Daily intake – 50–100 mg for 1–2 months (one drop of a 5%, 10% or 30% solution of the preparation from an eye dropper contains, respectively, 1, 2, 6.5 mg of tocopherol acetate).
Folk remedies in the treatment of multiple sclerosis
Seeds of germinated wheat: 1 tablespoon of wheat is washed with warm water, placed between layers of canvas or other fabric, put in a warm place. After 1-2 days, shoots of 1-2 mm appear.
Sprouted wheat is passed through a meat grinder, poured hot milk, cook gruel. Eat should be in the morning, on an empty stomach. To accept daily within a month, then 2 times a week. The course is 3 months. Sprouted wheat seeds contain B vitamins, hormonal substances, trace elements.
Propolis is a waste product of bees. Preparing a 10% solution: 10.0 propolis is crushed, mixed with 90.0 preheated to 90 ° butter, mix thoroughly. Take with 1/2 teaspoon, jam honey (with good endurance) 3 times a day. Gradually, the reception can be increased to 1 tsp 3 times a day. The course of treatment is 1 month.