Contents
Multiple sclerosis is a neurological pathology characterized by a progressive course with multiple lesions in the CNS and fewer lesions in the peripheral nervous system. In neurology, you can find the terms “multiple sclerosis”, “spotted sclerosis”, “plaque sclerosis”, “multiple sclerosing encephalomyelitis”, they are all designations for the same disease. The course of the pathology is undulating, the character is chronic.
If earlier the majority of people with multiple sclerosis lived in countries far from the equator, then at the moment there is no clear geographical distribution. In the past few decades, there has been an increase in pathology in most regions of the globe, although countries with a temperate climate still remain in the lead. There, rates reach from 50 to 100 people per 100 population.
Most often, women are ill, although about a third of cases of multiple sclerosis occur in the male population of the planet. Pathology manifests itself more often at a young age, affecting active people from 20 to 45 years old – this is almost 60% of all cases. Most often, multiple sclerosis is diagnosed in people engaged in intellectual work.
In addition, scientists are currently revising the age limits of the onset of the disease in the direction of their expansion. So, in medicine, cases of the development of multiple sclerosis at the age of two, as well as at the age of 10-15 years, are described. The number of patients in childhood varies according to different data from 2 to 8% of the total number of cases. The risk group now includes people over 50 years of age.
Causes of multiple sclerosis
As a result of the influence of a number of factors, there is an increase in the transmission capacity of the blood-brain barrier (its main function is to protect brain antigens from the destructive effects of the immune system’s own cells). As a result, a greater number of T-lymphocytes enter the brain tissue and the process of inflammation starts. The result of this inflammation is the destruction of the myelin sheath of the nerve, since the immune system perceives myelin antigens as foreign. The transmission of nerve impulses in the same volume becomes impossible and the person begins to suffer from the symptoms of the disease.
The causes of multiple sclerosis are multiple external and internal factors, so it is considered as a multifactorial pathology.
The following etiological circumstances attract special attention of scientists:
Influence of viruses on the occurrence of the disease. These are retroviruses, herpes viruses, measles and rubella virus, infectious mononucleosis, especially in combination with endogenous retroviruses. The transferred bacterial infections – streptococcal, staphylococcal, etc. have a negative effect. However, scientists have come to the conclusion that there is not a single virus that would directly lead to the development of the disease. However, they are trigger factors that support and induce the development of the inflammatory and autoimmune process, thereby stimulating neurodegenerative changes.
The influence of chronic intoxication on the human body. Of particular danger are poisonings with chemicals, organic solvents, metals, gasoline, etc. Living in an ecologically unfavorable area, especially in childhood, is considered a negative factor.
Features of the diet. In this regard, the danger is animal fats and proteins, their excessive consumption under the age of 15 years. If a person suffers from obesity from the age of 20, then the risk of developing the disease increases by 2 times. It has also been proven that excessive consumption of table salt leads to pathological activity of the immune system.
Frequent psycho-emotional overstrain, chronic stress.
Physical stress.
Head and back injuries, surgical operations.
Genetic predisposition to develop the disease. This is particularly evident in a family history of multiple sclerosis. The risk of disease in blood relatives ranges from 3 to 10%.
Taking oral contraceptives increases the risk of developing the disease by 35%.
Elevated blood sugar leads to rapid progression of the disease.
Scientists have also identified epidemiological risk factors for the development of the disease:
Belonging to the European race. So, for example, among the Eskimos, Native Indians, Majori and some other races, the disease is extremely rare.
Having familial multiple sclerosis
Belonging to the female sex, it is women who prevail in all populations of patients, however, an unfavorable course of the disease is typical for men.
A change in the area of residence affects the change in the frequency of occurrence of the disease among the migrated population.
There are cases of a sharp increase in the incidence in a limited area in a certain time period.
The first signs of multiple sclerosis
Symptoms of multiple sclerosis in 40% of cases of the disease are disturbances in motor functions – such as weakness in the muscles, impaired coordination of movement. Also, in 40% of cases, there are violations in the sensitivity of the limbs – for example, numbness, a feeling of colic in the hands and feet.
In 20% of cases of multiple sclerosis, there are visual impairments, movement disorders when walking, voluntary urination, fatigue, and sexual dysfunction. With a long course of the disease, a decrease in intelligence is observed.
Signs of the development of multiple sclerosis depend on where the focus of demyelination is localized. Therefore, symptoms vary from patient to patient and are often unpredictable. It is never possible to simultaneously detect the whole complex of symptoms in one patient at the same time.
The first signs of the disease are the result of demyelination, which causes a violation of the patency of electrical impulses along the nerve fibers. They are most often manifested rapidly, inconspicuous, latent course of the disease, doctors rarely observe.
So, the most common early signs of multiple sclerosis are:
A feeling of tingling and numbness in the extremities.
Periodically occurring feeling of weakness in the limbs, which is most often observed, on the one hand.
Blurred vision, reduced clarity, double vision. In addition, there may be a veil before the eyes, passing blindness in one or both eyes. Oculomotor disorders such as strabismus, diplopia, vertical nystagmus, internuclear ophthalmoplegia are frequent first signs of the onset of the disease.
Pelvic disorders. It is violations of the process of urination observed in almost half of all patients. This symptom in 15% of people with multiple sclerosis is the only sign. Perhaps incomplete emptying of the bladder, nocturia (when more urine is released at night than during the day), difficulty urinating, urinary incontinence, the occurrence of a sudden urge to empty it, intermittent urination.
Already in the initial stages of the disease, there is an increase in fatigue or the so-called “chronic fatigue syndrome”.
The first signs of an impending disease can be: neuritis of the facial nerve, dizziness, staggering while walking, ataxia (static and dynamic), horizontal nystagmus, hypotension, etc.
The main symptoms of multiple sclerosis
As the disease progresses, the following symptoms of multiple sclerosis are noted:
Violation of sensitivity. Sensations uncharacteristic for a healthy person: numbness, itching, burning of the skin, tingling, transient pains – all these signs begin to disturb the patient more often. The violation of sensitivity begins with the distal sections, namely with the fingers of the limb with its gradual complete capture. Violations are more often unilateral, but sometimes there is a transition to the second limb. Weakness in the initial stages of the development of the disease can be confused with fatigue, but as sclerosis progresses, it will become increasingly difficult for a person to perform even simple movements. The limbs become alien, there is no way to maintain muscle strength.
Visual disturbances. On the part of the organ of vision, there is a violation of color perception, the development of optic neuritis, an acute decrease in vision is possible. Most often, the lesion is also unilateral. Fuzziness and double vision, lack of familiarity of eye movement when trying to take them to the side – all these are symptoms of the disease.
Limb tremor. This symptom significantly affects the quality of life of the patient. It is possible that not only the limbs, but also the torso of a person will be affected by tremor. This occurs as a result of uncontrolled muscle contractions, which leads to the inability to carry out labor and social activities.
Headache. Headache is a very common symptom of the disease. Scientists suggest that its occurrence is associated with muscle disorders and depression. It is with multiple sclerosis that headache occurs three times more often than with other neurological diseases. Sometimes it can be a harbinger of an impending exacerbation of the disease or a sign of the debut of pathology. (read also: causes, signs and symptoms of headache, consequences)
Swallowing and speech disorders. These symptoms usually appear in parallel. If in 50% of cases patients do not pay attention to swallowing disorders, then it is impossible not to notice speech failures. This is manifested in its stiffness, blurring, indistinctness.
Gait disorders. Difficulties while walking are caused by numbness of the feet, imbalance, muscle spasms, muscle weakness, tremors.
Muscle spasm. It is this symptom that often becomes the cause of the patient’s disability. As a result of the resulting spasms, a person is not able to adequately control the movements of the arms and legs.
Increased sensitivity to heat. It is possible to exacerbate the symptoms of the disease when the body overheats. Similar situations often occur on the beach, in the sauna, in the bath.
Mental disorders, cognitive decline. This symptom is typical for 50% of all patients with multiple sclerosis. They have inhibition of thinking, memory impairment, decreased concentration of attention, difficulties in perceiving information, it is difficult to switch from one type of activity to another. As a result, the patient becomes unable to perform even elementary daily tasks.
Dizziness. This symptom occurs early in the course of the disease and worsens as it progresses. A person can feel both his own instability and suffer from the “movement” of his environment. (read also: dizziness – types and causes)
Chronic Fatigue Syndrome. Excessive fatigue is most clearly manifested in the afternoon. The patient experiences not only muscle, but also emotional weakness, mental exhaustion, drowsiness and lethargy.
Violations of sexual desire. Up to 90% of men and up to 70% of women suffer from disorders in the sexual sphere. This violation can be the result of both psychological problems and the result of damage to the central nervous system. Libido falls, the process of erection and ejaculation is disturbed. However, up to 50% of men do not lose their morning erection. Women are unable to achieve orgasm, sexual intercourse can be painful, and there is often a decrease in sensitivity in the genital area.
Problems with night rest. It becomes more difficult for patients to fall asleep, which is most often due to spasms of the limbs and other tactile sensations. Sleep becomes restless, as a result, during the day a person experiences dullness of consciousness, lack of clarity of thought.
Violations of the vegetative regulation. The longer the disease exists, the higher the risk of developing autonomic disorders. A person suffers from morning hypothermia, from hyperhidrosis of the feet in combination with muscle weakness, from arterial hypotension, dizziness and cardiac arrhythmias.
Depressive moods, increased level of anxiety. Depression can be the result of an underlying illness or a person’s response to a diagnosed problem. In this regard, there are frequent cases of suicide attempts, alcoholism. As a result, a person becomes completely socially maladapted, his personality is destroyed.
Violations of the process of urination. All the symptoms associated with the process of urination at the initial stages of the development of the disease worsen as it progresses.
Intestinal dysfunction. This problem can manifest either as fecal incontinence or intermittent constipation.
Rare symptoms of the disease. About 6% of all patients with multiple sclerosis suffer from hearing impairment, most often it is not deafness that develops, but hearing loss, which occurs as a result of damage to the auditory nerve.
Loss of smell is another rare but common symptom of the disease. The reasons may be damage to the mucous membranes of the nose, bone deformities.
Epileptic seizures occur in 2-3% of patients. Which may be due to the periodically occurring excessive excitation of neurons as a result of exposure to a nearby focus of demyelination.
Emotional lability, which manifests itself in unexpected mood swings.
In addition, against the background of existing symptoms, secondary symptoms of the disease may occur. Thus, the risk of urinary tract infection increases due to dysfunction of the genitourinary system, pneumonia and bedsores may develop, which is the result of a sedentary lifestyle, etc.
Consequences of multiple sclerosis
If multiple sclerosis is initially characterized by a severe course, then the risk of developing a fatal outcome with impaired respiratory function and cardiac activity is not excluded.
Often, the causes of death of patients are pneumonia, which are characterized by a severe course, and replace one another.
The occurrence of pressure sores is another consequence of multiple sclerosis. They, in turn, can lead to severe sepsis, which causes the death of the patient. Seriously ill people who are immobilized for a long time are prone to bedsores and diaper rash.
Disability awaits all patients with multiple sclerosis, however, with well-conducted therapy, it can be avoided for a long time.
Diagnostics
Doctors use special diagnostic criteria to determine the disease:
The presence of signs of multiple focal lesions of the central nervous system – the white matter of the brain and spinal cord;
Progressive development of the disease with the gradual addition of various symptoms;
Instability of symptoms;
progressive nature of the disease.
Performing MRI of the brain and some parts of the spinal column makes it possible to identify the presence of foci of demyelination and to detect their distribution. Most often they are localized near the ventricles of the brain, where its white matter is located. Priority is given to performing MRI with the introduction of a contrast agent, which allows more accurate detection of lesions in which the blood-brain barrier is broken. This allows you to determine the activity of the inflammatory process at the time of the study.
Sometimes, to confirm the diagnosis, a spinal puncture is required and its biochemical, as well as microscopic examination. The composition of the fluid during the disease changes; a moderate increase in the number of lymphocytes is observed in it, while the number of erythrocytes remains normal – this can be seen from a microscopic examination.
The key point in the biochemical analysis of the fluid is the determination of myelin and the degree of its activity. Its amount during an exacerbation of multiple sclerosis in the cerebrospinal fluid will be increased, especially in the first 2 weeks from the onset of the acute phase of the disease.
It may be necessary to study the bioelectrical activity of the brain, study VEP, SSEP, auditory evoked potentials, audiometry and stabilography.
An ophthalmological examination is mandatory in the early stages of the disease.
Answers to popular questions
How long do people live with multiple sclerosis? The life expectancy of the patient depends on the timeliness of the start of therapy, on the nature of the course of the disease, on the presence of concomitant pathologies. If therapy is absent, then the patient will not live more than 20 years from the moment of diagnosis. When negative impact factors are minimized, the average life expectancy of a person is reduced by an average of 7 years compared to the life expectancy of a healthy person. In addition, life expectancy is influenced by the age at which the disease manifested. The older the person, the higher the risk of rapid development of sclerosis and the onset of death during the first five years.
Is multiple sclerosis hereditary? Multiple sclerosis is not considered a hereditary disease, although there is a tendency for family predisposition to it. Doctors explain this by the monotony of provocative factors that influence the development of the disease in the conditions of one family.
Can you drink alcohol with multiple sclerosis? Bulgarian scientists conducted a study that found that a small amount of alcohol has an anti-inflammatory effect in multiple sclerosis. However, doses are important in this regard. When intoxication occurs in patients, coordination and speech disorders are more pronounced, with the abuse of alcohol, the number of exacerbations of the disease increases. In addition, some doctors insist that the prognosis worsens even with small doses. Therefore, the question of the compatibility of alcohol and multiple sclerosis is still open and each person makes his own decision.
Is it possible to bathe in the bath with multiple sclerosis? No. Any increase in body temperature (when in a bath, during summer heat, with fever, etc.) leads to a deterioration in the patient’s condition, to a violation of nerve conduction. During a visit to the bath, a feeling of numbness of the limbs, fatigue, tremor will increase. In addition, visual disturbances are aggravated and cognitive abilities are reduced. However, it is worth considering that the symptoms of the disease will decrease as the body temperature decreases. That is, being in the bath will not lead to persistent organic lesions in sclerosis.
Treatment
Multiple sclerosis is currently considered incurable. However, people are shown symptomatic therapy, which can improve the quality of life of the patient. He is prescribed hormonal drugs, means to increase immunity. Sanatorium-and-spa treatment has a positive effect on the condition of such people. All these measures allow you to increase the time of remission.