Lupus – Symptoms & causes

Overview

Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.

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Symptoms

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
• Skin lesions that appear or worsen with sun exposure
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss

Lupus facial rash

A typical sign of lupus is a red, butterfly-shaped rash over your cheeks and nose, often following exposure to sunlight.

When to see a doctor

See your doctor if you develop an unexplained rash, ongoing fever, persistent aching or fatigue.

Causes

As an autoimmune disease, lupus occurs when your immune system attacks healthy tissue in your body. It’s likely that lupus results from a combination of your genetics and your environment.

It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus. The cause of lupus in most cases, however, is unknown. Some potential triggers include:

• Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.
• Infections. Having an infection can initiate lupus or cause a relapse in some people.
• Medications. Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications and antibiotics. People who have drug-induced lupus usually get better when they stop taking the medication. Rarely, symptoms may persist even after the drug is stopped.

Risk factors

Factors that may increase your risk of lupus include:

• Your sex. Lupus is more common in women.
• Age. Although lupus affects people of all ages, it’s most often diagnosed between the ages of 15 and 45.
• Race. Lupus is more common in African Americans, Hispanics and Asian Americans.

Complications

Inflammation caused by lupus can affect many areas of your body, including your:

• Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.
• Brain and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.
• Blood and blood vessels. Lupus may lead to blood problems, including a reduced number of healthy red blood cells (anemia) and an increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels.
• Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Bleeding into lungs and pneumonia also are possible.
• Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane. The risk of cardiovascular disease and heart attacks increases greatly as well.

Other types of complications

Having lupus also increases your risk of:

• Infection. People with lupus are more vulnerable to infection because both the disease and its treatments can weaken the immune system.
• Cancer. Having lupus appears to increase your risk of cancer; however, the risk is small.
• Bone tissue death. This occurs when the blood supply to a bone declines, often leading to tiny breaks in the bone and eventually to the bone’s collapse.
• Pregnancy complications. Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressure during pregnancy and preterm birth. To reduce the risk of these complications, doctors often recommend delaying pregnancy until your disease has been under control for at least six months.

Lupus – Symptoms & causes

Overview

Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.

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Symptoms

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
• Skin lesions that appear or worsen with sun exposure
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss

Lupus facial rash

A typical sign of lupus is a red, butterfly-shaped rash over your cheeks and nose, often following exposure to sunlight.

When to see a doctor

See your doctor if you develop an unexplained rash, ongoing fever, persistent aching or fatigue.

Causes

As an autoimmune disease, lupus occurs when your immune system attacks healthy tissue in your body. It’s likely that lupus results from a combination of your genetics and your environment.

It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus. The cause of lupus in most cases, however, is unknown. Some potential triggers include:

• Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.
• Infections. Having an infection can initiate lupus or cause a relapse in some people.
• Medications. Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications and antibiotics. People who have drug-induced lupus usually get better when they stop taking the medication. Rarely, symptoms may persist even after the drug is stopped.

Risk factors

Factors that may increase your risk of lupus include:

• Your sex. Lupus is more common in women.
• Age. Although lupus affects people of all ages, it’s most often diagnosed between the ages of 15 and 45.
• Race. Lupus is more common in African Americans, Hispanics and Asian Americans.

Complications

Inflammation caused by lupus can affect many areas of your body, including your:

• Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.
• Brain and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.
• Blood and blood vessels. Lupus may lead to blood problems, including a reduced number of healthy red blood cells (anemia) and an increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels.
• Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Bleeding into lungs and pneumonia also are possible.
• Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane. The risk of cardiovascular disease and heart attacks increases greatly as well.

Other types of complications

Having lupus also increases your risk of:

• Infection. People with lupus are more vulnerable to infection because both the disease and its treatments can weaken the immune system.
• Cancer. Having lupus appears to increase your risk of cancer; however, the risk is small.
• Bone tissue death. This occurs when the blood supply to a bone declines, often leading to tiny breaks in the bone and eventually to the bone’s collapse.
• Pregnancy complications. Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressure during pregnancy and preterm birth. To reduce the risk of these complications, doctors often recommend delaying pregnancy until your disease has been under control for at least six months.

Multiple sclerosis – symptoms, treatment

Multiple sclerosis or disseminated sclerosis is a pathology of the nervous system of a wave-like progressive nature. An autoimmune-inflammatory process develops. There is a destruction of the white matter (myelin) of the spinal cord and brain. A large number of plaques are formed – zones of damage to nerve fibers. Nervous tissue is sometimes replaced by connective tissue.

Symptoms and signs of multiple sclerosis

The most common signs of multiple sclerosis are incoordination, muscle weakness, problems with urination, sensory disturbances, fatigue, dizziness, vision problems, decreased intellectual abilities, tingling and numbness of the extremities, impaired speech function , sexual dysfunctions, problems with swallowing.

• Let us dwell on the manifestation of these symptoms in more detail.

Impaired coordination of movements

The most common coordination disorders in multiple sclerosis are: 11 gait disturbances: she becomes wobbly and clumsy, walking becomes unsteady.

Coordination disorders can be a response to sensitive genesis (in this case, the cause is impaired muscle-articular sensitivity), directly vestibular disorders, malfunctions at the level of the cerebellum.

Muscle weakness

First of all, muscle weakness manifests itself through reduced motor activity.

• Tendon reflexes in the area of ​​the knees and calves are disturbed.
• Decreased strength of one half of the body (hemiparesis).
• Decreased muscle tone. The natural tension of the muscles begins to be insufficient to ensure movement.
• Painful spasms appear on leg extension. With the progression of the disease, they are painful even when the person is in the supine position.

Often, movement disorders lead/adjacent to osteoporosis. – a disease of the skeleton, which is associated with metabolic disorders.

Sensitivity disorders

Another characteristic symptom at an early stage is paresthesia – sensory disorders.

• Most often, the toes and cheeks begin to go numb, the sensitivity of the legs decreases – from the ankles to the ribs.
• Worried about “crawling” and tingling of the body.
• Possible false sensations of electric shock in the back, arms. Especially often this happens when bending the head, with sharp turns.
• A number of patients develop expressive unilateral sensory disturbances in the face area.

It is with a violation of sensitivity in 30-50% that multiple sclerosis begins in people at a young age.

Vision problems

Vision problems in multiple sclerosis are related to damage to the optic nerve.

Retrobulbar or optic neuritis occurs in 60% of people with multiple sclerosis. Its characteristic symptoms are:

• Reduced visual acuity. In this case, the problem may appear in one or both eyes.
• Pain when moving the eyeballs.
• It becomes difficult to perceive and distinguish colors, especially many difficulties arise in the perception of green and red colors.
• Narrowing of the field of view. A person is forced to choose a convenient angle for himself.

Blindness progresses in a number of patients. Also, visual disturbances are accompanied by headaches.

Urination disorders

The nature of the disorders depends on the damage to the area of ​​the brain.

• In case of damage to the area above the pons of the brain, control over urination decreases, urinary incontinence occurs:

• incomplete emptying.
• If the sacrum is affected, problems with urge to urinate and chronic urinary retention begin. In this case, infection often develops rapidly. Problems associated with leukocyturia and microflora come to the fore.

In the early stages of multiple sclerosis, delay, increase in frequency, imperative urges (uncontrolled leakage) are more characteristic, and in the later stages – incontinence, loss of control over urination.

Sexual disorders

• Present in most patients with urinary disorders.
• The problem is exacerbated by several factors at once: both damage to a number of parts of the central nervous system, and fatigue characteristic of the disease.
• In men, sexual disorders are associated with problems with ejaculation, erection. Many men experience decreased libido.
• In women, problems are manifested both in pain during intercourse and the inability to achieve orgasm.

Rare symptoms of multiple sclerosis

There is also a group of symptoms that occurs only in a subset of patients with multiple sclerosis. But these symptoms are also very serious:

• Short-term semi-consciousness – paroxysmal state (for a few seconds). Completely consciousness is not lost, but the attacks can be repeated several times (sometimes dozens) per day. The problem is to a lesser or greater extent relevant for 5-10% of patients with multiple sclerosis.
• Epileptic seizures. They occur in approximately 2% of patients.
• Acute psychosis (more often in women).
• Sudden onset of back pain with a feeling of pressure from a tight belt (transverse myelitis).
• Respiratory disorders. Characteristic for patients with brain stem damage.
• Sweating disorders.
• Hypothermia – a decrease in basal temperature (below 35 ° C). Multiple sclerosis is a multifactorial disease. The reasons, prerequisites are a combination of unfavorable external and internal factors.
  • Frequent infections – bacterial and viral nature.
  • Increased radioactive background.
  • Past injuries. Often the disease is discovered after an accident.
  • Stressful situations.
  • Genetic predisposition (especially important genes that are responsible for controlling the immune response).

  Also, many doctors point to the autoimmune nature of the occurrence of multiple sclerosis. The immune system begins to recognize nerve cells as foreign.

  Routes of infection

  Despite the fact that a viral, bacterial infection can provoke a disease, it is impossible to directly become infected with multiple sclerosis from person to person.

  Infection can only push the immune system to aggressive production of antibodies, and the body to replace the organ parenchyma with dense connective tissue, forming pathological foci in the brain and spinal cord.

  But since viruses, bacteria are “provocateurs” for persons predisposed to the disease (for example, close relatives suffer from multiple sclerosis), it is recommended to pay special attention to the prevention of colds, to vaccinate against infectious diseases in a timely manner.

  Risk factors

  Pay attention to the statistics:

  • Women suffer from multiple sclerosis more often than men.
  • Most of the patients who are diagnosed with the disease are persons from 18 to 50 years old. But it is possible to get sick with multiple sclerosis in early childhood (up to 10% of diagnosed cases occur in childhood) and in adulthood.
  • A high risk of developing multiple sclerosis in those who have problems with the endocrine system. Especially dangerous is the presence of diabetes and thyroid pathology.
  • Significantly increases the risk of chronic inflammatory diseases.

  Overweight is also a risk factor. Especially if excess body weight in a person is not all right with lipids: in particular, when the content of low-density cholesterol in the blood is increased.

  There is also a relationship between the disease and the geographical location of a person:

  • Most patients with multiple sclerosis are in a temperate climate. Here 1 case is recorded for 300-1000 people.
  • In the tropics, one in 5,000-20,000 people with multiple sclerosis occurs
  • Among people who were born and live near the equator, the smallest number of cases

  Significantly increases the likelihood of developing multiple sclerosis and smoking. This fact has been proven by Norwegian and American scientists. The fact is that smoking saturates the body with neurotoxins.

  Diagnosis

  Many diseases, especially at the first stage, in terms of symptoms and clinical manifestations are very similar to multiple sclerosis. Therefore, in order to make an accurate diagnosis, a complex of studies is important. Classical computed tomography, CT angiography, laboratory diagnostics, puncture of the cerebrospinal fluid, Holter ECG, electroencephalography 9 are of great help in substituting the diagnosis. 0003

  Tomography

  The basic diagnostic procedure for the detection of multiple sclerosis is tomography.

  CT and CT scans are available at the 5th hospital

  CT helps to detect large foci of demyelination and a number of other signs that occur in patients with multiple sclerosis.

  Huge pluses in the use of CT-agniography:

  • The diagnostic method helps to organize the search for constrictions, expansions in the vessels or a complete cessation of blood flow through them. Allows you to create a complete picture of the state of the vessels.

  • This is a radiological radiopaque examination.

  • Good alternative if MRI is contraindicated.

  If it is necessary to determine the number and localization of areas of destruction of the myelin sheath of nerve fibers in the world of diagnostics, such a type of tomography as MRI is also used.

  Laboratory diagnostics

  Comprehensive examination. The following indicators are taken into account:

  • Leukocyte formula.
  • Glucose.
  • Protein.
  • Total number of cells.
  • Albumin.
  • Myelin protein (protein component of myelin).
  • Opening pressure,
  • IgG oligoclonal groups.

  SSEP testing

  Somatosensory evoked potentials are tested in some patients. They show how nerve impulses are transmitted to the brain from the receptors of the lower and upper extremities. The method is aimed at finding delays in electrical responses to sensory stimulation.

  SSEP is extremely important for the diagnosis of patients in whom lesions are only in the spinal cord, and the brain has not met with the disease.

  Ultrasound of the brachiocephalic arteries (BCA)

  A quick opportunity to take full control of the neck vessels involved directly in the blood supply to the brain, to assess the degree of atherosclerotic lesions, metallogeny of the vessels in this area.

  Ultrasound of the brachiocephalic arteries is very important if multiple sclerosis is accompanied by osteochondrosis of the spine, there is a risk of stroke.

  Vessels are viewed from different angles. The results of ultrasound diagnostics – a “picture” with the diameter, lumen of the vessels.

  Holter ECG

  In patients with suspected multiple sclerosis or its development, it is important to study in detail the state of the cardiovascular system as a whole. And just ECG is not limited here. The ideal option is a Holter ECG.

  Monitoring is a record of the heart rate over a sufficiently large amount of time: a day or more.

  At the same time, the heart rate is recorded in different phases: at rest, during movement, while eating and, accordingly, during chewing and swallowing.

  A solid picture of the rhythm (gastric extrasystoles, pauses), heart rate, ischemic changes is visible.

  Electroencephalography

  • Electroencephalography allows you to graphically record the electrical activity of brain cells.
  • The procedure is painless and harmless.
  • The study is based on the registration of ultrasonic waves.
  • Electroencephalography is effective for analyzing and monitoring brain structures and their displacements. Thanks to these results, the doctor can accurately determine the degree of development of disorders.

  Ophthalmological examination

  70% of patients with multiple sclerosis for more than 5 years have optic nerve disorders. Such patients require diagnostics of the structure of the eye disk, computerized

  computerized perimetry to detect the affected area.

  Changes in the retina and optic disc detected during the examination are directly related to the level of degenerative damage in the white matter brain.

  Diagnosis is based on anamnestic and clinical data. At the same time, in order to prescribe the correct treatment, it is important to determine the type of multiple sclerosis:

  Primary progressive. With the progression of the disease, but there are periods with periods of stabilization.

  Remittent. Two or more exacerbations, between which there is no increase in the severity of the disease. During periods of remission, a complete restoration of impaired functions is possible;

  Secondary progressive. The severity of the neurological deficit is constantly and steadily increasing.

  It is also important to correctly determine the clinical form of the pathology. It can be cerebrospinal, spinal, optic, stem, cerebellar.

  Timely diagnosis is the key to choosing the right treatment regimen. But since the picture is often very blurred, it often takes 5 years from the onset of the disease to the diagnosis. This is due to the fact that many diseases are similar clinically. But the more comprehensive the examination, the higher the chance that the diagnosis will initially be made correctly, the patient will be prescribed adequate treatment on time, and there will be no serious complications.

  Complications, prognosis

  If treatment is not started in time, or treatment does not take into account the type of multiple sclerosis, the risk of complications is high: 1 bedsore,

• tremor,
• epileptic seizures;

• paralysis in the upper and lower extremities,
• trigeminal neuralgia,
• depression,
• diplopia – double vision,
• Lermitte’s symptom – paresthesia (a sudden feeling of intense burning) with a feeling of electric current passing through the back.

Despite the fact that the disease is not easy, a favorable prognosis can be confidently voiced for a number of patients.

If earlier, when the diagnosis of “multiple sclerosis” was made, after 3-5 years, most patients began to become disabled, now with properly selected drugs, it is possible to delay the progression of the disease by 10, and sometimes 20 years.

But much depends on the form of sclerosis. One of the most insidious primary progressive form. At first, the symptoms are the most vague. The diagnosis is often made not immediately, to treatment, respectively, too. But there are cases when, after 10 years from the onset of the disease, the patient simply cannot take care of himself, it is difficult for him to move around.

Up to 50% of patients experience a form of natural course. with the preservation of working capacity and practically habitual way of life. The only thing is that they cannot visit baths, stay in the heat for a long time. The main difficulty is to learn to accept your diagnosis and live with it.

Treatment

Treatment of multiple sclerosis is aimed at solving several problems: “plaques”,

Medicines and physiotherapy are used to solve problems.

Complex drug therapy

In the treatment, it is important to take immunomodulators and anti-inflammatory drugs. The following drugs are especially well known:

• Interferons beta. The drugs have an immunomodulatory effect on the main links of immune reactions.
• Medicines based on glatiramer acetate. Drugs of this group are able to replace myelin antigens and start the process of inhibition of T1-lymphocytes. T2-lymphocytes, on the contrary, are activated. Due to this, the drug has a neuroprotective and anti-inflammatory effect.
• Fingolimod. Modulator of sphingosine phosphate receptors on lymphocyte membranes. Significantly reduces the number of “auto-aggressive” T-cells circulating in the blood.
• Natalizum. It slows down the penetration through the blood-brain barrier and reduces the activity of T-lymphocytes in the foci of axonal damage. The inflammatory process is significantly slowed down.

In exacerbations, when the disease is accompanied by obvious attacks, adrenocorticotropic hormone, corticosteroids (methylprednisolone) are used. Thanks to these drugs, it is possible to quickly reduce the movement of immune cells to the spinal cord, the brain. But these drugs are only good as short-term therapy. For long-term use, they are not suitable, as they can cause addiction.

If the disease is accompanied by signs of depression, the doctor may prescribe amitriptyline, melipramine. However, the appointment of these drugs is carried out very carefully – only after a detailed examination. Alas, many patients already have urinary retention, and amitriptyline, melipramine can greatly aggravate the situation. All sorts of selective inhibitors without anticholinergic properties, but with an excellent ability to reuptake serotonin, can become an alternative for such patients. These drugs include trazadone, sertraline, fluoxetine, and paroxetine.

Agomelatine has also been widely used in recent years for depression. It is a drug with a melatonergic mechanism of action. It normalizes circadian rhythms (oscillations).

Problems with urination require targeted therapy to address the problem.

If the main problem is urgency, tolterodine oxybutynin, amitriptyline, nifedipine are used.

If you have trouble emptying your bladder, the blocker terazosin helps. But it is important that when taking the drug there should be careful monitoring so that orthostatic hypotension does not develop.

Some patients may also receive additional drugs to reduce external sphincter tension. Among them are diazepam, tizanidine.

The above preparations are used in tablet and injection forms.

Hypobaric oxygenation

Oxygenation is a great help for patients with multiple sclerosis. It is possible through the procedure of hypobaric oxygenation.

Especially hypobaric oxygenation is relevant for patients in whom multiple sclerosis is accompanied by cardio diseases and diabetes.

Hypobaric oxygenation is carried out in a pressure chamber. Oxygen is supplied under high pressure. In the process of hypobaric oxygenation, adaptive and regenerative mechanisms are activated.

Massage

An excellent remedy for reducing discomfort and pain in patients with different types and stages of sclerosis is massage. Especially massage is useful for solving the following problems:

• Muscle relaxation and spasticity relief.
• Activation of blood circulation.
• Prevention of bedsores. Relevant for people who are forced to spend most of their time in bed.

Diet therapy for multiple sclerosis

• The general principle for all patients with multiple sclerosis is to limit the dietary sources of fast carbohydrates. The main ones are sugar, pastries made from refined flour.
• The remaining principles of nutrition largely depend on what specific problems the patient has in each particular case.
• In case of difficulty in chewing, pureed food is recommended.

In the presence of constipation, it is worth using more liquid food (if there are no problems with the urinary system at the same time), products with bifidobacteria.

Conclusions:

1. Multiple sclerosis is a pathology affecting the nervous system. The basis is damage to the sheaths of nerve fibers and impaired conduction of impulses.
2. The disease is not hereditary, but with certain combinations of genes, the risk is higher.
3. Increased radiation background, intoxication, stress, trauma can provoke the development of the disease.
4. When the first symptoms of multiple sclerosis appear, it is important to see a doctor promptly. It’s better to let it be confirmed that this is just overstrain, fatigue, and not be in a situation where one on one is the acute phase of the disease.
5. Multiple sclerosis significantly impairs the quality of life. First of all, because physical activity decreases. But, if earlier multiple sclerosis was immediately a sentence, now there are methods, drugs, through which it is possible not only to stop the symptoms of the disease, but also to slow down the development of the disease. Doctors have learned to keep the disease under control. With timely diagnosis and treatment, pathology has ceased to negatively affect life expectancy.
6. CT, laboratory diagnostics, plays an important role in diagnosis. When clarifying the diagnosis, it is essential where the problem foci are located: in the brain or spinal cord.

In the 5th hospital of the city, the treatment of multiple sclerosis is one of the main profiles. The base of the hospital has expert-class equipment for diagnosing this disease. Consultations of experienced neurologists are available. The approach to treatment is complex. Medical therapy, massage, physiotherapy exercises, including bicycle training on special simulators, sessions of hypobaric oxygenation are organized.

Multiple sclerosis – treatment, symptoms, causes, diagnosis

Multiple sclerosis is a disease that affects the spinal cord and brain, resulting in loss of muscle control, visual disturbances, imbalance of the body, sensory disturbances (numbness). In multiple sclerosis, the nervous system is damaged by the body’s own immune system. That is, in fact, multiple sclerosis is considered an autoimmune disease. In autoimmune diseases, the immune system attacks its own organs and tissues (examples of autoimmune diseases are systemic lupus erythematosus and rheumatoid arthritis).

The central nervous system is made up of nerves that act as the body’s information system. Each nerve is covered in a fatty substance called myelin, which insulates the nerves and helps in the transmission of electrical impulses along the nerves, carrying information from the brain to the organs. These nerve impulses control muscle movements such as walking and talking.

Multiple sclerosis gets its name from an increase in scar tissue in the brain or spinal cord. Scar tissue or plaques form when the protective and insulating myelin that covers the nerves is destroyed, a process called demyelination. Without myelin, the electrical signals transmitted through the spinal cord and brain are interrupted or not transmitted. The brain then becomes unable to send and receive information. It is this communication breakdown that causes the symptoms of MS.

Although nerves can replicate myelin, this process is quite slow and has not kept up with the damage caused by demyelination. Symptoms and their severity depend on the location of the scar tissue and the degree of demyelination.

In the US, multiple sclerosis is one of the most common causes of neurological disability in middle-aged people.

MS is two to three times more common in women than men and is extremely rare before puberty. Most often, multiple sclerosis occurs between the ages of 20 and 40; as a rule, it does not occur at an older age.

Causes

The causes of multiple sclerosis are still unclear, but there is evidence that genetics, environment and even viruses can play a role.

Epidemiological data reveal several interesting trends in the incidence of multiple sclerosis: there is a different prevalence and a certain ethnic dependence of the disease of multiple sclerosis. The disease is more common in northern countries and in people of the white race.

Studies show that MS is more common in certain parts of the world, but if you move from a higher-risk area to a lower-risk area, the risks decrease if the move was before puberty.

In addition, MS is a disease of temperate climates. In both hemispheres, its prevalence increases with increasing distance from the equator.

There have also been “epidemics” of MS in history, for example, a group of people living off the coast of Denmark fell ill with multiple sclerosis after the Second World War, possibly due to some environmental problems.

Multiple sclerosis researchers believe that there are certain genetic prerequisites for the disease of multiple sclerosis.

Researchers believe that there is more than one gene that predisposes to the risk of developing multiple sclerosis. In addition, scientists believe that a person is born with a genetic readiness to develop this disease under certain environmental triggers. With the development of gene analysis, it may be possible to obtain more information about the role of genes.

Certain studies do not exclude the role of viruses, especially Epstein-Bar, herpes zoster, even hepatitis vaccines. But clear evidence of the involvement of viruses in the development of multiple sclerosis has not yet been received. The provoking factors in the development of multiple sclerosis also include sex hormones (estrogen and testosterone), which, if released in excess, can depress the immune system, especially estrogen (women get sick 2-3 times more often than men). But their role is also not clear. Currently, scientists have come to the conclusion that the disease occurs due to a number of factors.

Symptoms

Symptoms of multiple sclerosis appear more often between the ages of 20 and 40. Typically, a person notices symptoms after two or more distinct episodes of symptoms have developed before MS is suspected.

The most common early symptoms of MS include:

• Tingling
• Numbness
• Body imbalance
• Weakness in one or more limbs
• Visual impairment or diplopia
• Much less common other symptoms:
• Slurred speech
• Sudden onset of paralysis
• Impaired coordination of movements
• Cognitive disorders

As the disease progresses, symptoms such as spasticity, sensitivity to heat, fatigue, changes in thinking or perception, and sexual dysfunction appear.

• Fatigue. This is a characteristic and common symptom of MS. It usually appears in the afternoon and can present with severe muscle weakness, mental fatigue, sleepiness. Feeling physically exhausted is not related to the amount of work done and many MS patients complain of extreme fatigue even after getting enough sleep.
• Sensitivity to high temperature. Heat sensitivity: The onset or worsening of symptoms after being exposed to heat (eg, after taking a shower) occurs in most MS patients.
• Muscle spasticity. Muscle spasticity is a common and often debilitating symptom of MS. Muscle spasticity usually affects the muscles of the legs and arms, and can affect the motor abilities of the limbs.
• Dizziness. Many patients with multiple sclerosis experience a feeling of dizziness. The occurrence of this symptom is associated with a violation in the transmission of nerve impulses in a complex system that ensures the balance of the body (vision, proprioception, etc.)
• Cognitive impairment. Problems with thought processes occur in approximately half of MS patients. There is a violation of concentration, memory impairment. In 10% of patients, severe cognitive impairment occurs and they lose the ability to serve themselves.
• Impaired vision. Vision problems are quite common in MS patients. Visual impairment is mainly associated with optic neuritis and occurs in 55% of cases. As a rule, visual impairment rarely leads to complete blindness.
• Pathological sensations. Many patients experience various pathological sensations such as tingling with pins, itching, and point pain. As a rule, these symptoms are not life-threatening and are quite well removed by treatment.
• Speech and swallowing disorders. Some patients have problems with both swallowing and speech. This is due to damage to the nerves responsible for these functions.
• Tremor. This symptom is quite common in patients with multiple sclerosis and, unfortunately, is difficult to treat.
• Walking disorder. Gait disturbance is a fairly common symptom in multiple sclerosis. This is mainly due to muscle weakness or muscle spasticity. In addition, the cause may be a violation of coordination of movements and balance of the body.

Rare symptoms of multiple sclerosis include breathing problems and seizures.

Symptoms are divided into three categories: major, secondary, and tertiary.

The main symptoms are a direct result of the demyelination process. Demyelination impairs the transmission of electrical signals to the muscles (to allow the muscles to move) and to the organs of the body (to allow them to perform their normal functions.) Symptoms include: weakness, tremors, tingling, numbness, imbalance, blurred vision, paralysis, and problems with function bladder or intestines. Modern methods of treatment allow you to control these symptoms.

Secondary symptoms are a consequence of the main symptoms. For example, paralysis (the main symptom) can lead to pressure sores, and bladder dysfunction can cause frequent, recurrent urinary tract infections. These symptoms are also treatable, but the main task is to prevent the occurrence of complications.

Tertiary symptoms – social, psychological, and vocational symptoms arising from the patient’s disability and disability in varying degrees. Depression, for example, is quite common in patients with multiple sclerosis.

Unfortunately, the symptoms of each patient manifest themselves in a peculiar way, as well as the progression of the disease. Some patients may have mild symptoms for years without progression. In other cases, the disease can progress rapidly over several months. And with a variety of symptoms, some may have some symptoms and not have others.

Diagnosis

Unfortunately, there is no specific analysis or instrumental research method that can make a 100% diagnosis of multiple sclerosis. However, there are generally accepted criteria for making a diagnosis, but even this system of criteria is not perfect.

The initial diagnosis of MS can be difficult. In almost 10% of cases, under the guise of multiple sclerosis, other diseases occur, such as vascular inflammation, multiple strokes, SLE brain infections, and even hypo- or beriberi. Sometimes even stress-related functional impairment can lead to a misdiagnosis of MS.

Multiple sclerosis develops in different ways and its course is sometimes unpredictable. In many patients, the disease begins with a single symptom that persists for months or even years without any progression of the symptoms. In other cases, symptoms worsen over weeks or months.

It is important to understand that with all the variety of symptoms, each individual patient may have only a few symptoms and never have others. Some symptoms may occur once and never appear again.

MRI is the best way to visualize changes caused by multiple sclerosis. The accurate image produced by MRI provides strong evidence of scar tissue in the deep structures of the brain and spinal cord that is characteristic of multiple sclerosis

However, MRI lesions can also be caused by other conditions (eg, similar changes are observed in elderly people with cerebral atherosclerosis). Therefore, MRI data must be compared with clinical data and neurological status.

In addition, a normal MRI does not absolutely exclude the diagnosis of MS. Approximately 5% of patients with clinical manifestations of multiple sclerosis may not have morphological changes visually confirmed by MRI. This is especially possible when conducting studies on MRI devices with low resolution (low-field MRI).

Spinal tap is sometimes used to diagnose multiple sclerosis, but to a greater extent it is necessary when it is necessary to exclude other diseases of the central nervous system (tumors of infection) and analysis of the punctate allows to verify the diagnosis. For the diagnosis of multiple sclerosis itself, the puncture is not of great diagnostic value.

Neurophysiological studies using evoked potentials help detect impaired function of the nerves that provide hearing, sensitivity and pathways.

Laboratory blood tests are prescribed for the differential diagnosis of other diseases with similar symptoms and are necessary to rule out a diagnostic error.

Prognosis

After any patient is diagnosed, a natural question arises about life expectancy. Unfortunately, it is sometimes not possible to unambiguously predict what the course of a disease will be in a particular person, even if a full-fledged treatment is carried out. Prognostic chances increase with early diagnosis and slow progression of the disease. The maximum life expectancy is very variable and ranges from 7 years or more.

Treatment

New drugs that have recently appeared have significantly improved the prognosis of this devastating disease.

Even though the long-term prognosis of these drugs is not yet fully understood, some of the risks are accepted by patients in exchange for sustained remission and less disability in the near future. This is one of the reasons why physicians have recently changed the criteria based on which they diagnose multiple sclerosis.

In the past, physicians typically waited for the second clinical manifestation of a particular set of symptoms or MS attack before actually diagnosing the disease and starting therapy. But as a result of recent research, they have made some changes. Two medical criteria are used to diagnose multiple sclerosis:

• Clinically isolated syndrome. This is a complex of physical symptoms associated with multiple sclerosis, lasting at least 24 hours. It can be as significant as Williamson’s palsy, or it could be more minor, like permanent numbness in one arm or leg, or sudden loss of vision in one eye (optic neuritis).
• Signs of damage in the brain. Lesions in MS are usually detected using magnetic resonance imaging. These lesions are caused when inflammation leads to the loss of myelin, a protective substance that insulates nerves in the brain and spinal cord.

A single clinically isolated syndrome is now sufficient to diagnose MS if clinicians see characteristic changes on MRI.

Currently, a whole group of drugs has appeared, which will appear in medical institutions in 2012. But today there are eight drugs, the effectiveness of which has been proven by numerous clinical studies.

• Avonex (interferon beta-1a) Betaseron (interferon beta-1b)
• Copaxone (glatiramer acetate)
• Extavia (interferon beta-1b)
• Gilenia(fingolimod, FTY720)
• Novantrone (mitoxantrone)
• (interferon beta-1a)
• Tysabri (natalizumab)

What drugs are preferable for treatment? Unfortunately, opinions about first-line drugs are divided and, at present, each patient is prescribed a drug from this group, taking into account side effects and the clinical picture.