Demyelinating disease: What can you do about it?

What types of demyelinating disease affect the central nervous system, and what can you do about them?

Answer From Jerry W. Swanson, M.D.

A demyelinating disease is any condition that results in damage to the protective covering (myelin sheath) that surrounds nerve fibers in your brain, optic nerves and spinal cord. When the myelin sheath is damaged, nerve impulses slow or even stop, causing neurological problems.

Multiple sclerosis

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. In this disorder, your immune system attacks the myelin sheath or the cells that produce and maintain it.

This causes inflammation and injury to the sheath and ultimately to the nerve fibers that it surrounds. The process can result in multiple areas of scarring (sclerosis).

Other causes

Other types of demyelinating disease and their causes include:

• Optic neuritis — inflammation of the optic nerve in one or both eyes
• Neuromyelitis optica (Devic’s disease) — inflammation and demyelination of the central nervous system, especially of the optic nerve and spinal cord
• Transverse myelitis — inflammation of the spinal cord
• Acute disseminated encephalomyelitis — inflammation of the brain and spinal cord
• Adrenoleukodystrophy and adrenomyeloneuropathy — rare, inherited metabolic disorders

MS and other demyelinating diseases most commonly result in vision loss, muscle weakness, muscle stiffness and spasms, loss of coordination, change in sensation, pain, and changes in bladder and bowel function.

Treatment

No cures exist for demyelinating diseases and their progression, and symptoms are different for everyone. Getting treatment early is important. Treatment focuses on:

• Minimizing the effects of the attacks
• Modifying the course of the disease
• Managing the symptoms

A variety of drug therapies are recommended depending on your specific disorder. Strategies to treat symptoms include physical therapy, muscle relaxing drugs, and medications to reduce pain and fatigue. Talk with your doctor about the best course of treatment for your specific disorder.

• Stress management for MS
• Exercise and multiple sclerosis

May 05, 2020

Show references

1. Overview of demyelinating disorders. Merck Manual Professional Version. http://www.merckmanuals.com/professional/neurologic_disorders/demyelinating_disorders/overview_of_demyelinating_disorders.html. Accessed June 7, 2017.
2. Hardy TA, et al. Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurology. 2016;15:967.
3. Related conditions. National Multiple Sclerosis Society. http://www.nationalmssociety.org/What-is-MS/Related-Conditions. Accessed June 7, 2017.
4. Signs and symptoms consistent with demyelinating disease. National Multiple Sclerosis Society. http://www.nationalmssociety.org/For-Professionals/Clinical-Care/Diagnosing-MS/Signs-and-Symptoms-Consistent-with-Demyelinating-D. Accessed June 7, 2017.
5. Longo DL, et al., eds. Multiple sclerosis and other demyelinating diseases. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2016. http://accessmedicine.mhmedical.com. Accessed June 8, 2017.
6. Olek MJ, et al. Pathogenesis and epidemiology of multiple sclerosis. https://www.uptodate.com/home. Accessed June 9, 2017.

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What They Are, Their Function, & Damage From MS

Myelin sheaths are sleeves of fatty tissue that protect your nerve cells. These cells are part of your central nervous system, which carries messages back and forth between your brain and the rest of your body.

If you have multiple sclerosis (MS), a disease that causes your immune system to attack your central nervous system, your myelin sheaths can be damaged. That means your nerves won’t be able to send and receive messages as they should.

Because of this, MS can weaken your muscles, damage your coordination, and, in the worst cases, paralyze you. MS affects about 1 million Americans, and it usually shows up between ages 20 and 50. It’s not clear what causes it, and there’s no known cure.

Myelin and Your Nerves

The myelin sheath wraps around the fibers that are the long threadlike part of a nerve cell. The sheath protects these fibers, known as axons, a lot like the insulation around an electrical wire.

When the myelin sheath is healthy, nerve signals are sent and received quickly. But if you have MS, your body’s immune system treats myelin as a threat. It attacks both the myelin and the cells that make it.

When that happens, the nerves inside the sheath can be damaged. That leaves scars on your nerves — known as sclerosis — and that makes it harder for them to carry the messages that tell your body to move.

Myelin Research

A lot of the research into MS is focused on boosting your body’s ability to repair damaged myelin. Scientists are looking into:

• Ways to prevent the chemical reactions that lead to myelin damage
• Drugs or experimental treatments that might prevent or fix multiple sclerosis
• Which antibodies — the disease-fighting proteins your immune system makes when you get sick — attack myelin
• If stem cells — which can grow into different types of tissues — can be used to reverse the damage caused by MS

New strategies for restoring myelin on damaged nerve cells

When axons of nerve cells lose myelin, they are not able to communicate well with each other. But new research shows that a combination therapy can restore myelin on regenerated axons after injury. (Image: AdobeStock/Illustration: Sebastian Stankiewicz, Boston Children’s)

Key takeaways

Myelin is an essential fatty substance coating surrounding nerve axons.

After injury, regenerated nerve axons usually fail to remyelinate, inhibiting nerve cell communication.

A combination treatment led to remyelination in about 60 percent of regenerated axons.

This research may have implications in other diseases associated with myelin loss, like multiple sclerosis.

Loss of myelin — the fatty substance that surrounds the axons of nerve cells — is one of the reasons nerve cells fail to recover after injury and in some diseases. Myelin acts like insulation, covering the long axon threads that enable high-speed communication between neurons.  Without myelin, the neurons may not be able to coordinate well, leading to less than optimal function. In new research from the laboratory of Zhigang He, PhD, of the F.M. Kirby Neurobiology Center, scientists discovered a two-pronged approach to restore myelin on regenerated axons in a mouse model of optic nerve injury. Their findings may have implications for disease associated with myelin loss, like multiple sclerosis (MS).

“We believe that this work represents an important step towards functional restoration of cells in the adult central nervous system,” says He.

Axons fail to remyelinate after injury

In earlier research, He’s lab discovered several treatments that could promote the regeneration of damaged axons in the optic nerve, but do not restore nerve function. The reason? These regenerated axons are not myelinated.  In this new study, published in Neuron, He explains why those axons fail to remyelinate after injury. 

Zhigang He

In the adult brain, myelination is carried out by cells called oligodendrocyte precursor cells (OPCs).

“We found that in injured optic nerves, OPCs fail to differentiate into mature myelination-competent oligodendrocytes,” says He, meaning they do not develop into cells capable of producing myelin and functioning normally.

He’s team discovered two reasons why. The first is that OPCs in injured nerves produce a protein known as GPR17, which blocks the first step of OPC differentiation into mature cells. Second, inflammatory cells in the injured nerves interfere with another step of OPC differentiation.

Combination treatment restores myelin

After testing a set of available compounds, co-first author Jing Wang, PhD, of the He lab, discovered that montelukast, an anti-inflammatory used for treatment of asthma and seasonal allergies, blocked development (or action) of GPR-17. Some axon remyelination was restored but only in about approximately 15 percent of treated nerve cells.

However, myelination rates were boosted significantly after removing immune cells, called microglia, from the damaged nerve cells with a drug called PLX3397. By itself, PLX3397 increased remyelination in 21 percent of axons. In combination with montelukast, the combination lead to remyelination in about 60 percent of damaged axons.

Combination treatment with montelukast and PLX3397 leads to robust remyelination of regenerated axons in injured optic nerve cells. The image on the left shows the demyelinated axons before treatment. On the right, remyelinated axons are shown after treatment. (Image: Zhigang He, Boston Children’s)

Typically, microglia act as scavengers in the central nervous system, looking for damaging inflammatory cells and infectious compounds and removing them from the site of the injury. However, in this case, the presence of microglia stopped the OPCs from developing into normal oligodendrocytes.  Further studies with microglia showed that when they were removed later after injury — in this case two weeks after injury to the optic nerve — OPC development followed more normally.

“In a mice model of optic nerve injury, we found that when we combined treatment of montelukast and removing microglia later after injury, the majority of axons could be remyelinated,” He says. 

Relevance to multiple sclerosis

In the advanced stage of multiple sclerosis (MS), injured nerves suffer from myelination failure. While this research was not conducted in a MS mouse model, the fact that He’s team discovered a way to remyelinate regenerated axons is encouraging since no currently available MS treatments currently work by rebuilding the myelin sheath.

“It is similar to what we see in the optic nerve after injury, “says He. “Both suffer from myelination failure so we believe our results could have some implications for new MS treatments, particularly for progressing MS.”

Other authors on this paper include co-first author Xuelian He, Huyan Meng, Yi Li, Phillip Dmitriev, Feng Tian, and Jessica C. Page of Boston Children’s, and Richard Lu of Cincinnati Children’s Hospital.

This study was supported by grant from the National Eye Institute, Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, and the National Center for Complementary and Integrative Health. 

Learn more about research from the F.M.Kirby Neurobiology Center.

Mechanisms identified to restore myelin sheaths after injury or in multiple sclerosis — ScienceDaily

A research team led by neurobiologist Professor Claire Jacob has identified an important mechanism that can be used to control the restoration of myelin sheaths following traumatic injury and in degenerative diseases. With the insights gained, the researchers were able to regenerate damaged myelin sheaths in mice by treating them with the active substance theophylline, thereby restoring their nerve cell function. The groundbreaking findings are the result of research carried out at Johannes Gutenberg University Mainz (JGU) and the University of Fribourg in Switzerland.

Neurons are composed of axons, i.e., long fiber-like extensions that transmit signals to other cells. Many of them are surrounded by a myelin sheath, a thick fatty layer that protects them and helps to transfer stimuli rapidly. Without myelin, the functional capacity of neurons — and therefore of the whole nervous system — is limited and neurons can easily degenerate. Multiple sclerosis (MS) is one of the diseases associated with myelin sheath degradation. MS patients suffer successive episodes of demyelination resulting in a progressive loss of function of their nervous system. Remyelination of the axons can prevent this.

The aim is to restore the axons’ protective myelin coating

Intact myelin sheaths are a prerequisite for the healthy functioning of the peripheral and central nervous systems. If the peripheral nervous system (PNS) is damaged, in an accident involving injury to the arms or legs for example, the axons and their myelin sheaths can recover relatively well. “Regeneration of the PNS is quite efficient, although it could be improved,” said Professor Claire Jacob, pointing out that even young people do not experience complete regeneration.

However, the central nervous system (CNS) is completely different in this regard as there is no efficient restoration of the axons and therefore of the myelin sheath after a lesion. This means that CNS injuries usually result in permanent paralysis — as in the case of MS when loss of myelin leads to axon degeneration. MS is the most common neurodegenerative disease of the CNS and is attributable to the degradation of the myelin sheath of neurons. The occurrence of successive lesions can cause permanent loss of function of the CNS if myelin sheath restoration is inefficient. The capacity of the body to remyelinate decreases dramatically with age. “In order to promote the restoration of myelin, we need to understand the process that controls the mechanism,” emphasized Jacob.

In the recent project, her research group investigated how remyelination occurs in both peripheral and central nervous systems of mice. “First, we wanted to understand the process that blocks remyelination. We subsequently studied how to counteract this blocking effect.” The neuroscientists identified a protein called eEF1A1 as a key factor in the process and found that eEF1A1 activated by acetylation prevents the remyelination process, but if eEF1A1 is deactivated by deacetylation, myelin sheaths can be rebuilt. The protein that deacetylates eEF1A1 is the enzyme called histone deacetylase 2 (HDAC2).

Theophylline promotes myelin reconstruction in both peripheral and central nervous systems

“Once we understood this process, we decided to try to control it by boosting the HDAC2 activity and its synthesis in cells,” said Jacob. This was achieved by using the active substance theophylline, which is also present in tea leaves and has long been used in the treatment of asthma. In a mouse model, the use of theophylline over a period of four days resulted in significant recovery. Restoration of myelin sheaths was particularly impressive in the PNS, where they recovered completely. Regeneration also improved in the CNS, as there was rapid and efficient rebuilding of myelin sheaths in both young and old mice. A low dose of the active substance was sufficient to trigger the improvements — a big plus with regard to the known side effects of theophylline, which occur at higher doses.

“In summary, this study […] shows that theophylline, by activating HDAC2, promotes eEF1A1 deacetylation, increases […] remyelination speed and efficiency after lesion of the PNS and CNS, thus appearing as a very promising compound to test in future translational studies to accelerate and promote remyelination after traumatic lesions or in the context of demyelinating disorders,” write the authors in their paper published in Nature Communications. Currently, funding for corresponding clinical trials in patients is being sought, while a patent application has already been filed.

Professor Claire Jacob has been researching the development of myelin, axon injuries, and their regeneration for 16 years — previously at the University of Fribourg in Switzerland and since October 2018 as head of the Cellular Neurobiology Group at Johannes Gutenberg University Mainz.

What is Multiple Sclerosis (MS)?

What is Multiple Sclerosis (MS)?

Multiple sclerosis (MS) is a chronic, incurable, and unpredictable disease of the central nervous system (CNS) including the brain, optic nerves, and spinal cord. MS is characterized by the destruction of the fatty insulating myelin sheath that surrounds nerve cells and serves the dual purpose of augmenting the conduction of nervous signals and protecting the underlying axons from the destructive chemicals of the broader CNS environment. As myelin breaks down, lesions appear over demyelinated areas forming hard plaques, or sclerosis, which give the disease its name. The classical course of the disease involves an initial phase alternating between inflammatory autoimmune attacks on myelin by infiltrating T-cells and periods of remission and partial recovery, called relapsing-remitting MS (RRMS). RRMS can be followed by a progressive phase of irreversible degeneration of demyelinated and exposed nerve cells, called secondary progressive MS (SPMS). In some patients, the disease is progressive from the onset, called primary progressive MS (PPMS). These destructive processes cause a variety of disabling and sometimes painful symptoms including blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, paralysis, blindness, and irregular function of the bowels, bladder and sexual organs.

The distinguishing symptoms and pathological features of MS were first authoritatively described and presented to the medical community as indicative of a specific disease by Jean-Martin Charcot in 1868. An immunologic cause of MS was not seriously investigated until after World War II, and disease-modifying drugs that directly fight MS only began to appear in the early 1990s. Approximately 400,000 Americans acknowledge having MS, and every week about 200 individuals are diagnosed with MS. Worldwide, MS may affect more than 2.5 million individuals. The vast majority of the individuals inflicted with MS live a normal lifespan but MS patients may struggle to live productive lives, often with increasing limitations.

MS is an autoimmune disorder, meaning that the patient’s own immune system attacks the nerve tissue. There is no full understanding of the cause and mechanism of the disease. While a variety of effective treatments have been shown to reduce some symptoms and, in some cases, arrest the progress of the disease, there is no cure for MS. For approximately 150 years after Charcot’s early descriptions of the disease, the pace of research into its cause and remedy was agonizingly slow. However, the last two decades have seen rapid improvements in MS treatment and, concomitantly with advances in the field of neuroimmunology, signs that major breakthroughs in basic MS research may be at hand. The Tisch MS Research Center of New York is at the forefront of these developments and is committed to discovering the cause of and the cure for MS.

Click Here to learn more about our investigations into the cause of MS.

Multiple sclerosis – Harvard Health

Multiple sclerosis is a disabling illness that affects the brain and spinal cord. It usually gets worse over time.

Nerve cells are surrounded by a layer of insulation called myelin. Myelin helps transmit nerve impulses. In multiple sclerosis, the myelin sheath becomes inflamed or damaged. This disrupts or slows nerve impulses and leaves areas of scarring along nerves. Multiple sclerosis can also damage nerve cells themselves, not just their myelin lining.

There are different types of multiple sclerosis, and they follow different patterns.

Relapsing-remitting multiple sclerosis. This is the most common type of multiple sclerosis. Relapsing means that symptoms come and go. Episodes during which symptoms suddenly get worse are called relapses, attacks, or flare-ups. Relapses can last for days to weeks. They are followed by remissions, or periods of recovery. During remissions, many people with MS feel close to normal.

Secondary progressive multiple sclerosis. About half of people with relapsing-remitting multiple sclerosis eventually enter a secondary phase. Brain and spinal cord damage gradually but steadily gets worse. As a result, symptoms gradually but steadily get worse.

Primary progressive multiple sclerosis. Symptoms worsen gradually and continuously from the start, without periods of relapse or remission.

Progressive relapsing multiple sclerosis. Symptoms steadily get worse, and there are also flare-ups.

Symptoms of multiple sclerosis

The first symptom of multiple sclerosis is often blurred or double vision. 

Other common symptoms include:

• Not everyone with multiple sclerosis will experience all of these symptoms. Most people only have a few of them.weak, stiff, or rigid muscles
• painful muscle spasms
• trouble walking
• tingling or numbness in the arms, legs, trunk, or face
• difficulty maintaining balance
• trouble with thinking and memory
• trouble speaking
• dizziness
• mental or physical fatigue
• tremor
• depression
• inappropriate laughing or crying, unrelated to mood
• problems controlling bladder or bowel movements
• erectile dysfunction.

Diagnosing multiple sclerosis

No one test can diagnose multiple sclerosis. If your symptoms suggest multiple sclerosis, you will probably need several tests to confirm if you have it or to rule it out as the cause of your symptoms.

Magnetic resonance imaging (MRI) is an imaging test that uses powerful magnets and radio waves to create pictures of the body. The damage caused by multiple sclerosis creates scars called lesions in the brain and spinal cord. An MRI can spot such lesions. Though MRI provides important information, it may not be enough to confirm that you have multiple sclerosis.

Other tests you may need to have include:

• evoked potentials. This test measures how quickly and accurately your nervous system responds to certain types of stimulation.
• lumbar puncture (spinal tap). Spinal fluid may contain proteins and inflammatory cells associated with multiple sclerosis.

Sometimes it’s important for you and your doctor to see how your symptoms or test results change over time before making a diagnosis of multiple sclerosis.

Treating multiple sclerosis

Self-care

You can do several things to keep yourself feeling as well as possible.

Manage stress. Stress can intensify symptoms. Learn relaxation techniques such as meditation, progressive muscle relaxation, deep breathing, tai chi, or yoga.

Stay cool. People with multiple sclerosis often become more sensitive to heat. The smallest change in body temperature can aggravate symptoms. Take extra steps to keep cool:

• Turn on an air conditioner in your home or car.
• Take a cool shower or bath.
• Mist yourself with a spray bottle of water when you feel hot.
• Drink plenty of fluids to stay hydrated.
• Dress in light layers that you can remove if you feel warm.
• Buy a cooling vest or cooling packs that you can use on your wrists, neck and head.

Exercise. Regular exercise can help fend off fatigue and depression. It can help improve your strength, balance, coordination, and overall health and well-being. Ask your doctor how often you should exercise, and at what intensity. Your doctor may recommend that you work with a physical therapist to design an individualized exercise program. Exercise in the morning or evening, when temperatures are cooler.

Rest. Multiple sclerosis makes people tired. Try to get enough sleep.

Eat a healthy diet. A healthy diet can help keep you feeling your best. It should include plenty of:

• vegetables and fruits
• whole grains
• low-fat dairy products
• poultry
• fish
• nuts.

Go easy on red and processed meats; white rice, white, bread, and other sources of highly processed grains; and sugary foods and beverages.

Achieve and maintain a healthy weight. You can do this with a combination of diet and exercise.

Build a support network. Stay connected to family and friends. Join a support group. Surround yourself with people who will help you maintain a positive attitude.

Medical treatment

Although there is no cure for multiple sclerosis, a number of different treatments can manage flare-ups, slow the worsening of the disease, and ease symptoms.

Treating flare-ups. Corticosteroid drugs are the primary treatment for relapses. They shorten the length of flare-ups, but they do not change the course of the disease. Methylprednisone (Solu-Medrol, Depo-Medrol), given through a vein, is usually the first choice for severe attacks.   Another treatment, called plasmapheresis, is also sometimes used to treat flare-ups. In this procedure, blood is removed from the body, harmful substances are filtered out of the liquid portion of blood, and the remaining blood is transfused back into the body.

Disease-modifying therapy. Disease-modifying medications help slow the speed at which multiple sclerosis gets worse. Most of the drugs work by affecting the immune system.

• interferons. These are a type of protein. They reduce the frequency of relapses and reduce the duration and severity of attacks when they do occur. Interferons also slow the worsening of symptoms. Examples include interferon beta-1b (Betaseron), interferon beta-1a (Avonex, Rebif), and peginterferon beta-1a (Plegridy).
• glatiramer (Copaxone). This drug blocks cells that damage myelin. It may also reduce the frequency of relapses.
• monoclonal antibodies. These drugs reduce the frequency of attacks. One example of monoclonal antibodies is alemtuzumab (Campath).
• Nrf2 activators. This group of drugs decreases inflammation and prevents nerve damage that may cause symptoms of multiple sclerosis. One Nrf2 activator is dimethyl fumarate (Tecfidera).
• immunomodulators. As the name implies, these drugs affect the immune system. They decrease the action of immune cells that may cause nerve damage. One immunomodulator used to treat multiple sclerosis is teriflunomide (Aubagio).

Although they can be quite effective, these drugs can also have serious side effects.

Treating symptoms. You also can take medications to treat specific symptoms of multiple sclerosis including:

• Fatigue. Feelings of overwhelming exhaustion are common in people with multiple sclerosis.
• Spasticity. Muscle tightness and spasms can be disabling for multiple sclerosis patients with spinal cord damage.
• Bladder dysfunction. Bladder problems are common in patients with spinal cord damage from multiple sclerosis.
• Depression. This is a common problem for multiple sclerosis patients.
• Neurological symptoms. Anti-seizure medications decrease the risk of repeat seizures. They may also reduce other uncomfortable neurological symptoms that occur during attacks.

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What is Multiple Sclerosis? – My Shepherd Connection

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves. Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity and specific symptoms of MS are unpredictable and vary from one person to another. Today, new treatments and advances in research are giving new hope to people affected by the disease.

MS Thought to be an Autoimmune Disease

In a person with MS, the body’s own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers in the central nervous system. The nerve fibers themselves can also be damaged. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.

Most people with MS learn to cope with the disease and continue to lead satisfying, productive lives.

The Four Courses of MS

People with MS can typically experience one of four disease courses, each of which might be mild, moderate or severe.

• Relapsing-Remitting MS:  People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks, which are called relapses, flare-ups or exacerbations, are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. About 85 percent of initial diagnoses are relapsing-remitting MS.
• Primary-Progressive MS:  This disease course is characterized by slowly worsening neurologic function from the beginning with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. About 10 percent of diagnoses are primary-progressive MS.
• Secondary-Progressive MS:  Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions) or plateaus. Before  disease-modifying medications became available, about 50 percent of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.
• Progressive-Relapsing MS:  In this relatively rare course of MS (5 percent of cases), people experience steadily worsening disease from the beginning, with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

Because no two people have exactly the same experience with MS, the disease course may look very different from one person to another. And it may not always be clear to the physician, at least at first, which course a person is experiencing.

Source: National MS Society  

90,000 Demyelinating diseases: symptoms, diagnosis, treatment of demyelinating diseases

Demyelinating diseases is a group of common, socially significant pathologies that affect the working-age population. Despite the polymorphism of symptoms, these diseases are based on the destruction or disruption of the formation of the myelin sheath of nerve fibers. According to modern concepts, the cause of these demyelinating processes has not been established, and the pathogenesis of these diseases affects the problems of viral infection, autoimmune processes.The most common disease in this group is multiple sclerosis.

Multiple sclerosis is a chronic progressive disease of the nervous system that occurs mainly at a young and middle age (15-40 years), a feature of which is the simultaneous damage to several different parts of the nervous system, which leads to the appearance of various neurological symptoms in patients.

The causes of multiple sclerosis have not yet been precisely clarified.

Clinical manifestations of multiple sclerosis are associated with focal lesions of several different parts of the brain and spinal cord. They can be expressed in a decrease in muscle strength in the limbs; in more severe cases, reaching the degree of plegia (i.e. paralysis). In patients with multiple sclerosis, central and peripheral paralysis of the cranial nerves can be detected, most often of the oculomotor, trigeminal, facial and hypoglossal nerves. These can be disorders of various types of sensitivity and coordination, tremors, unsteadiness when walking.The severity of these symptoms can vary from minimal to maximal (up to the inability to perform any movements). Along with this, a tingling and burning sensation in the limbs can be detected, which can subsequently spread to the trunk. Frequent symptoms of multiple sclerosis are dysfunctions of the pelvic organs: urge to urinate or defecate, increased frequency, retention of urine and stool, in later stages – incontinence. Incomplete emptying of the bladder is possible, which often leads to a urological infection.Some patients may experience problems related to sexual function, which may coincide with the dysfunction of the pelvic organs or be an independent symptom. Violations of visual functions are often noted: decreased visual acuity, changes in visual fields, blurred images of objects, loss of brightness of vision, distortion of colors, violation of contrast. Neuropsychological changes in multiple sclerosis include decreased intelligence, behavioral disorders. Depression is very common in people with multiple sclerosis.Euphoria in most cases is combined with a decrease in intelligence, an underestimation of the severity of one’s condition, and disinhibition of behavior. The course of the disease is chronic, the options for the course of multiple sclerosis are very diverse: both periods of prolonged remissions and a steadily progressive course can be noted.

Diagnosis of multiple sclerosis is based on history data, neurological examination and the results of additional examination methods. Today, the most informative is considered to be magnetic resonance imaging (MRI) of the brain and spinal cord, the study of evoked potentials (to determine the degree of safety of some pathways) and the presence of oligoclonal immunoglobulins in the cerebrospinal fluid of patients.

Treatment of multiple sclerosis is necessarily individual, depends on the stage of the disease, is complex. In the treatment of exacerbations and the progressive course of multiple sclerosis, drug therapy is prescribed. Physiotherapeutic procedures, physiotherapy exercises, massage, psychological work with patients are of particular importance in the treatment of patients with multiple sclerosis in our department. An individual comprehensive treatment program is selected for each patient.

Any alarming signs are a reason for making an appointment with a neurologist – delay in this case will only lead to an aggravation of the situation. In Moscow, a qualified consultation of a neurologist can be obtained at the Central Clinical Hospital of the Russian Academy of Sciences. You can make an appointment either by phone or using the form on the website of the clinical hospital.

90,000 For whom is multiple sclerosis dangerous and how to deal with it

Multiple sclerosis affects 2 million people worldwide.Who is at risk and how to recognize the disease in time, says Gazeta.Ru.

Contrary to the prevailing stereotype, multiple sclerosis is not related to memory problems in older people. It is an autoimmune disease characterized by multiple lesions of the myelin sheath of nerve fibers in the brain and spinal cord, which is necessary for the transmission of signals between nerve cells.

Usually, multiple sclerosis first appears in 20-40 years, but it can also occur in 90,035 children .

The disease is typical for countries with cold climates. It is customary to distinguish three zones, differing in the prevalence of multiple sclerosis. The highest prevalence, more than 50 cases per 100 thousand population, is recorded in northern and central Europe, northern regions of the United States, southern Canada and Australia, and New Zealand. Average (10-50 cases per 100 thousand population) – in southern Europe, southern USA and northern Australia. The lowest, up to 10 cases per 100 thousand of the population, is in South America, Asia, Africa and Oceania.

In Russia, multiple sclerosis is common in the middle lane, more often in the western and central regions, somewhat less often in Siberia and the Far East.

Women suffer from sclerosis more often than men. In addition, representatives of the Caucasian race are usually victims of the disease; in Korea, China, Japan, there are only 2-6 cases per 100 thousand population. In the United States, the prevalence of multiple sclerosis among blacks is lower than among whites, but higher than among indigenous people in Africa.In large industrial cities and regions, the incidence is higher. In total, there are about 150 thousand patients with multiple sclerosis in Russia, and about 2 million

in the world.

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In the early stages, it is difficult to make a correct diagnosis due to the abundance of possible symptoms. Multiple sclerosis can begin with weakness in the legs, numbness in different parts of the body, sensation of current flowing through the spine, dizziness, vomiting, blurred vision, increased frequency or retention of urine and stool.Symptoms can occur singly or several at the same time.

To assess the patient’s condition and make a diagnosis, neurologists use the scale of the state of functional systems and the extended scale for assessing disability. With the help of the first, they assess the severity of the lesions, with the help of the second, the general degree of the patient’s disability. Also, magnetic resonance imaging is used to clarify the diagnosis.

Multiple sclerosis is a multifactorial disease.

Its development is due to the interaction of environmental factors (exposure to bacteria and viruses, ecology, bad habits) and hereditary predisposition.Multiple sclerosis is not a genetic disorder, but certain genomic changes increase the risk of developing the disease .

Possible risk factors include stress, a decrease in the level of uric acid in the body and vaccination against hepatitis B. It should be noted that these hypotheses have not been sufficiently confirmed, only in some studies certain correlations were found.

Remitting-relapsing multiple sclerosis is most common. It is characterized by periods of exacerbation, interspersed with periods of improvement or even full recovery, and symptoms do not progress over time.With secondary progressive sclerosis, symptoms begin to worsen. In primary progressive periods of slight improvement are possible only occasionally. And, finally, with the most rare, progressive with exacerbations, the symptoms are steadily progressing from the very onset of the disease, and against their background, pronounced exacerbations develop periodically.

Treatment consists in preventing and stopping exacerbations, combating symptoms that interfere with a normal lifestyle, and strengthening the compensatory and adaptive mechanisms of the body.For this, corticosteroid drugs, immunosuppressants, anticancer drugs are used. To relieve muscle spasms, drugs are used to reduce muscle hypertension.

Research is ongoing to find new ways to fight the disease.

So, in mid-December 2017, based on the analysis of clinical trials of more than a thousand drugs, it was possible to establish that the antidepressant clopyramine can be used to relieve symptoms, it is especially effective during exacerbations.

And on December 28, was published an article concluding that the female sex hormone estrogen can be used to treat multiple sclerosis. Researchers from the University of California at Los Angeles noted that in women in the last trimester of pregnancy, the risk of exacerbation of the disease is reduced by 70 % compared to the rest of it. During this time, the levels of estrogen in the body increase almost 30 times over baseline. Mouse studies have shown that

Estrogen activates certain proteins that help protect the brain from damage.

Scientists are currently working on a more advanced synthetic estrogen-like compound that will reliably protect nerve cells.

Also, as it turned out, taurine plays an important role – a sulfonic acid used in medicine for cardiovascular insufficiency, as well as in the form of eye drops for degenerative lesions of the retina. In the central nervous system, taurine acts as an inhibitory neurotransmitter.

Scientists found that the use of taurine with drugs that accelerate the maturation of oligodendrocyte precursor cells – cells responsible for creating the myelin sheath of axons – contributes to their more efficient formation and, accordingly, faster recovery of nerve cells.

“Combining taurine with drugs that promote cell differentiation significantly improves the process,” the authors note. “We’re getting more myelin.”

Well, the easiest way to relieve symptoms turned out to be proper nutrition. A diet high in vegetables, fruits, and whole grains may be able to curb the progression of the disease.

“People with multiple sclerosis often ask whether certain foods are worth eating to avoid disability or at least delay its onset.Many people want to know if their nutrition plays a role, but there has been little research on that topic yet, ”the authors of the work explain.

Almost 7 thousand people with different types of multiple sclerosis took part in the study. Scientists have divided them into five groups depending on the diet. It was found that patients who ate the healthiest diet were 20% less likely to suffer from severe depression, and they also had a reduced risk of developing disabilities. Overall, participants with healthier lifestyles were 30% less likely to experience severe fatigue and 40% less likely to experience pain.

However, the researchers have another version about the reasons for this correlation. They suggest that, perhaps due to increased symptoms, patients simply do not have enough energy for a healthy lifestyle and proper nutrition.

90,000 Multiple sclerosis

About what everyone needs to know in order not to miss the first signs of this serious illness, Vera Vyacheslavovna Pshenichnikova, neurologist, Ph.D., head of the department of neurology for patients with acute cerebrovascular accident

Multiple sclerosis – what kind of disease?

This is a neurological disease, which is based on an inflammatory process in the central nervous system – in the brain and spinal cord.Most of the nerve fibers are covered with a sheath – a special substance called myelin. In multiple sclerosis (MS), myelin is destroyed, followed by the formation of connective tissue (hence “sclerosis”). And the term “diffuse” means the extent of the lesion.

Inflammation occurs in different parts of the brain at different times and causes many symptoms. At the onset of the disease, sensory disorders and a feeling of weakness may occur. Patients are sometimes observed for several years with diagnoses of osteochondrosis, vegetative dystonia syndrome, asthenic-depressive syndrome.In the future, most patients develop a symptom complex, which includes: impaired vision and eye movement; paresthesias, impaired coordination of movements, functions of the genitourinary organs and intestines, more on this below.

What are the causes of the development of the disease? What are the risk factors?

The reason for the development of the disease is still unknown to us, but the central link is a dysregulation in the immune system. The immune system, by tragic mistake, acting against its own body (autoimmune process) destroys the myelin sheath of nerve fibers in the brain and spinal cord.As a result, different systems of the body stop receiving signals from the brain and symptoms of the disease appear. There are many reasons for negatively affecting the immune system. Therefore, MS is called a multifactorial disease.

Geoepidemiological factors are responsible for the high prevalence of MS among people from Northern Europe; there is a latitude gradient – in areas with higher latitudes (distant from the equator), the incidence is higher. Interestingly, Asians hardly ever get MS. Quite popular, especially among American scientists, is the version associated with a violation of the intestinal microbiota.There has been a link between vitamin D levels and the prevalence of MS. It is assumed that women with a significant deficiency of this vitamin during pregnancy have a significantly higher risk of having a child who subsequently develops MS. Also, people who are infected with the Epstein-Barr virus and have had infectious mononucleosis have a doubling risk of developing MS. Ironically, smoking is a risk factor for MS. The incidence of this disease among smokers is higher than among those who have never smoked.But, perhaps, smoking is a marker of a certain psychotype, and not the cause of the disease.

MS is a disease of the young, although in the last ten years the boundaries have shifted towards both children and the elderly. The peak incidence falls on the most active period of a person’s life – 20-40 years. Typically, the later the onset of MS, the more severe it becomes. Women get sick about three times more often than men. It is extremely rare to inherit the disease because MS is not believed to be linked to any particular gene.

When should you be alert?

How MS manifests itself depends on the location and extent of the nerve damage. MS symptoms are nonspecific and can be related to neurology, ophthalmology, vertebrology, and psychiatry. The disease can be suspected by a combination of the following symptoms:

• Visual impairments (blurred vision, changes in color perception, double vision) are more likely to occur in one eye, but can also affect both eyes.
• Increased fatigue, fatigue.These are one of the most common manifestations of multiple sclerosis, which can occur during physical exertion, or they can be felt constantly, interfering with performing even the lightest work.
• Change in sensitivity: numbness, burning, tingling, itching, change in temperature sensitivity in different parts of the body. A variation of this type of disorder is Lermitte’s syndrome, a sensation of the passage of an “electric current” when the head is tilted.
• Pain in the eye when moving the eyeball.
• Muscle weakness, increased muscle tone of the limbs (increased muscle tension).
• Impaired coordination of movements, resulting in loss of balance, instability when walking, trembling limbs.
• Bladder problems: frequent urge to urinate, urinary incontinence or urinary retention.
• Bowel problems – constipation or fecal incontinence.
• Sexual problems

How not to miss a disease?

It is rather difficult to diagnose the disease in time.First, the symptoms are usually mild and go away quickly. And in our intense life there is no time to do that which does not restrict us. And even if the patient comes to the doctor, he gets a diagnosis – depression, asthenia, osteochondrosis. Although in a number of cases patients themselves ignore the first symptoms: they do not notice that they cannot walk normally, that “the legs are becoming heavy”, “they blur before their eyes”. You have to listen to yourself.

SO: if these symptoms periodically appear and spontaneously stop, if they are provoked by physical or emotional stress, occur in hot climates or after taking a hot bath, you should consult a neurologist and undergo a complete neurological examination.

Are there any difficulties in diagnosing the disease?

MS is a chameleon disease. It is easy to diagnose when there is visual impairment or movement disorders. But in most cases, the diagnosis takes many years. Patients get to a specialist after a dozen transient exacerbations, they are observed for years by psychiatrists, psychotherapists, until the disease progresses to obvious symptoms. Neurological symptoms caused by inflammation and demyelination in the central nervous system, combined with the results of MRI at different times, excluding all other probable diagnoses, allow to establish a diagnosis of “reliable multiple sclerosis”.It should be noted that in recent years, due to the availability of MRI, the diagnosis is made earlier.

Where to go for help?

In Moscow, the routing is as follows. The patient consults a neurologist and receives a referral to the Interdisciplinary Multiple Sclerosis Unit (MORS). There are five such branches, each with several districts of Moscow. To speed up the time to get to a specialist to confirm the diagnosis, it is advisable to do an MRI of the brain and cervical spinal cord in advance.

What treatment approaches exist? What are the predictions?

Treatment is divided into three main blocks: treatment of exacerbations, treatment that inhibits or alters the course of MS, and symptomatic treatment (pelvic dysfunction, spasticity, etc.). In case of exacerbation, immunoglobulin, hormonal drugs, plasmapheresis sessions are used. Multiple sclerosis modifying drugs (MSMDs) are a specific, expensive treatment that is prescribed only in MORS at the site of attachment.The prognosis of the disease depends on the duration and form of the disease, the response to the treatment, and, of course, adherence to the correct lifestyle (you should avoid prolonged exposure to the sun, go to the bathhouse, sauna). Most people with MS can live life to the fullest with timely and appropriate treatment.

Center for Neuroimmunology and Multiple Sclerosis

Multiple sclerosis is a chronic autoimmune disease in which the myelin sheath of nerve fibers in the brain and spinal cord is affected.The term “diffuse” means “multiple”, since a distinctive feature of the disease is the presence of sclerosis foci scattered throughout the central nervous system and replacement of normal nervous tissue with connective tissue.

A feature of the disease is the simultaneous damage to several different parts of the nervous system, which leads to the appearance of various neurological symptoms in patients. The morphological basis of the disease is the formation of so-called multiple sclerosis plaques, which are foci of myelin destruction (demyelination) of the white matter of the brain and spinal cord.

The disease mainly occurs in young and middle age (15 – 40 years). Multiple sclerosis is common in the Armenian population. Knowledge of the epidemiological characteristics of the disease contributes to its early detection.

The main cause of multiple sclerosis is a malfunction of the immune system in which the patient’s immune cells attack the cells of their own nervous system, destroying their myelin sheath. A site of inflammation arises, at the site of which scar tissue is formed, which disrupts the conduction of impulses from the brain to the organs.As a result, the brain cannot effectively control the processes and actions of the body.

Factors provoking the onset of the disease can be:

• Genetic predisposition
• Severe stress
• Viral and bacterial diseases
• Severe chronic vitamin D deficiency

The first signs appear when about 50% of the nerve fibers are already affected.At this stage of the disease, patients have complaints such as:

• One or two-sided visual impairment
• Pain and double vision
• Numbness and tingling sensations in the fingers
• Decreased skin sensitivity
• Muscle weakness
• Impaired coordination of movements.

Over time, as a result of the increase in the number of sclerotic plaques, other signs of the disease appear.

• Spasm and soreness in the muscles.
• Retention of urination and constipation, over time the patient may lose the ability to control the processes of emptying the bladder and bowels.
• Changes in sexual life.
• The appearance of pathological pyramidal reflexes, which do not occur in healthy people. They can only be identified by a neurologist.
• Increased fatigue when performing physical activities.
• Incomplete paralysis of the limbs, difficulty in voluntary movements.
• Paralysis of the cranial nerves: oculomotor, trigeminal, facial, hypoglossal.
• Rhythmic oscillatory movements of the eyeballs.
• Behavioral disorders and decreased intelligence.
• Neuroses, emotional instability, alternation of depression and euphoria.

The course of the disease is characterized by periods of exacerbation and remission, when the symptoms are significantly weakened.Timely and correctly selected treatment can significantly reduce the duration of the exacerbation period and prolong the period of remission.

The Center for Neuroimmunology and Multiple Sclerosis carries out diagnostics, treatment and dispensary observation of patients with multiple sclerosis. Today, about 100 patients are under outpatient dispensary observation at the center. In the diagnosis of the disease, the entire arsenal of modern equipment of the diagnostic clinic is used.

Highly qualified specialists of the center treat patients in accordance with international standards and guidelines, using modern achievements in the field of medicine.

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Multiple Sclerosis Treatment | Pension for the elderly

Excessive activity of the immune system often becomes the cause of neurological disorders. In this case, damage to the spinal cord or brain can occur.And it, in turn, may be associated with the development of multiple sclerosis. This disease can be characterized as an autoimmune lesion of the myelin sheath of nerves.

Pathology occurs in both the elderly and young people. In the process of progression, multiple sclerosis can provoke serious complications. However, with proper and modern therapy, there is a possibility that the disease will recede and its development will slow down, and this will have a positive effect on the quality of human life.A thorough examination and consultation with an experienced doctor will allow you to choose a competent course of treatment. And you can get important information about this painful condition, which can be used to combat it, from our article.

Contents:

1. What is known about the disease and what is the prognosis?
2. Anatomical features
3. Causes of the development of the disease and diagnosis
4. Method of treatment of multiple sclerosis

What is known about the disease and what is the prognosis?

Multiple sclerosis is a progressive pathology of the central nervous system, which is caused by the process of gradual loss of the myelin sheath of nerve fibers.This disease is manifested by various physical and mental disorders.

One of the first signals of the development of multiple sclerosis is the problem of the functioning of the organs of vision, often leading a person to blindness. Also, the primary signs of the disease include muscle weakness, disruption of the vestibular apparatus, leading to a loss of coordination of a person in space.

There are two stages of the course of multiple sclerosis – progressive and recurrent.The second is expressed in the form of separate attacks of demyelination, and during the breaks between them, the absolute clinical well-being of the patient can be noted

Unfortunately, at the moment, specialists do not know all the exact reasons for the loss of the myelin sheath of the nerves. However, research in this area continues, and doctors can already determine the main mechanisms of the development of pathology. This refers to the autoimmune process and the violation of histological barriers in the central nervous system.

Also, at the moment, there is no full-fledged treatment of multiple sclerosis, but, despite this, modern methods of therapy have been created, which, if applied in a timely manner, can eliminate the main symptoms of pathology and suppress the destruction of white matter.To see the best results, you should resort to treatment at the earliest stages of the development of the disease. In the network of resorts “Doverie” people suffering from multiple sclerosis can undergo a course of therapeutic and rehabilitation procedures. At the same time, they will not feel like they are in a hospital, but will feel warm home-like care, sensitivity, understanding and support.

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10 minutes from the Govorovo metro station, next to the residential complex Tatyanin Park

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It is important to understand!

Multiple sclerosis should not be confused with senile.Despite the fact that symptoms and treatment are partly interrelated, in fact, these diseases have nothing in common. In this situation, sclerosis means the destruction of the myelin sheath of the nerves and the replacement of the voids that have arisen with connective tissue. At the histological level, the pathology can be clearly traced due to the numerous foci of scarring of the tissues of the central nervous system. In many cases, a large number of small scars eventually develop into a cluster of large lesions. Since the pathological process is common in different parts of the spinal cord and brain, multiple sclerosis can have different neurological symptoms.

The prognosis of the development of the disease is often influenced by various factors. The most common are:

• pathology subtype,
• sex and age of a person,
• characteristics of the initial symptoms and the presence of complications.

One of the most favorable forecasts is formed with the following factors:

• female patient,
• relapsing disease,
• the presence of demyelinating attacks at a young age.

The average life expectancy of a patient in this situation is about 30 years from the moment when the disease was detected. About 40% of people with multiple sclerosis reach the average life expectancy in our country. With timely and competent treatment of this disease with the help of medicines, an improvement in patient survival rates is observed.

Anatomical features

The human CNS is formed by the brain and spinal cord.These bodies are interconnected. Their main function is to regulate such important vital processes as physical activity, heart rate and respiration. Thanks to the joint work of the central nervous system and hormonal factors, a balanced control of the key systems of the body occurs. If at least one part of the central nervous system is damaged, the risk of developing severe pathologies increases.

Gray and white matter make up the main morphology of the brain.The cells include neurons – structural and functional units that are responsible for primary functions, as well as neuroglia. These are auxiliary cells whose task is to maintain the health of the main tissue. Thus, neurons are responsible for the formation of key structures of the brain, which include the cortex and nuclei of the cerebral hemispheres. Neuroglia produces the myelin nerve sheath. Thanks to myelin, the nerve processes receive support and protection. Also, this substance provides fast transmission of impulses.Demyelination is the process of losing myelin. In the case of the development of this process, a significant deterioration in the functioning of the spinal cord and brain is observed, which significantly worsens the quality of life. For this reason, multiple sclerosis is a great danger.

As for the nature of demyelinating pathologies, it is necessary to know the essence of autoimmune diseases. In a normal state, the immune system protects internal organs and tissues from the influence of disease-causing factors (for example, viruses and bacteria).It does this by producing antibodies called immunoglobulins. Their task is to attach to malicious structures. Other cells then destroy the antigens.

The development of the pathology of the immune system leads to its failure. She begins to see disease-causing phenomena in normal cells and tissues of the body and fights against them. Thus, multiple sclerosis is characterized by the penetration of immune cells into the central nervous system with a damaged blood-brain barrier with subsequent damage to myelin.

This is how a rehabilitation course is underway in one of the boarding houses of the Doverie network.

Causes of the development of the disease and diagnosis

Modern researchers are actively studying the etiology of multiple sclerosis. Thanks to innovative molecular genetic techniques, scientists have been able to identify new factors that create the risk of developing pathology. These include primary diseases and hereditary predisposition. But all the same, these data are still not enough to develop an effective prophylactic agent.

Scientists have identified an autoimmune theory of the development of multiple sclerosis. This helped the specialists to take the path of effective treatment of the disease. Scientists have been able to create medicines that can suppress the process of abnormal activity of the body’s defense systems.

Possible risk factors for the development of multiple sclerosis include:

1. A certain age. Most often, pathology is diagnosed at the age of 15 to 40 years. With early detection of the main symptoms of the disease, many doctors talk about a favorable prognosis of treatment.
2. Female patient. Studies have shown that multiple sclerosis occurs in women much more often than in men.
3. Family history of demyelinating pathologies. Genetic mutations can be passed from parents to children that are responsible for the development of this disease.
4. Presence of certain infections. Mononucleosis, which is caused by the Epstein-Barr virus entering the human body, can significantly increase the risk of developing multiple sclerosis.
5. Pathology is common in northern Europeans.
6. Climate. According to epidemiological studies, demyelinating processes mainly affect residents of regions with a temperate climate.
7. Primary autoimmune diseases of the thyroid and pancreas. It can also be intestinal inflammation and diabetes mellitus. The presence of these diseases indicates a higher risk of developing multiple sclerosis.
8. Smoking. Cigarette tobacco smoke deposited in the cells of the body can increase the risk of developing a demyelinating process and increases the likelihood of relapse.

If you take into account the risk factors, you can promptly learn about the presence of a person’s predisposition to pathology. If the patient has a complicated family history, he or she should visit the doctor regularly for examination. This measure will help to start therapy for multiple sclerosis on time and increase the chances of a successful prognosis.

After collecting anamnesis and conducting an initial examination, the specialist will prescribe examinations such as:

• blood test,
• magnetic resonance imaging,
• spinal puncture.

Early diagnosis significantly increases the chances of a positive prognosis for therapy. You can find out more about the courses of treatment and rehabilitation available in the boarding houses of the Doverie network by calling our specialist.

Treatment of multiple sclerosis

At the moment, measures have not yet been invented to completely cure this disease. Despite the fact that it is not yet possible to rid a person of all symptoms and stop the demyelinating process, it can be significantly slowed down.Thanks to modern therapy methods, it is possible to achieve long-term suppression of relapses and significantly increase the patient’s life expectancy. So, when contacting a specialist at an early stage, the treatment of multiple sclerosis in women with a recurrent type of the disease gives excellent results.

The main areas of treatment for multiple sclerosis are:

1. Therapy aimed at suppressing autoimmune processes. This measure prevents possible damage to the white matter of the central nervous system in the future
2. Therapy aimed at alleviating the symptoms of pathology.
3. Physiotherapy and rehabilitation.

Based on the latest research in this area, therapies for the relief of symptoms of multiple sclerosis are constantly being improved.

This is how a rehabilitation course is underway in one of the boarding houses of the Doverie network.

As for medical prescriptions, it is mainly drug therapy. The first step is to suppress the increased autoimmune activity. Also, an important task is to alleviate the patient’s condition.

The doctor can prescribe medications of the following action:

• corticosteroids,
• beta interferons,
• human immunoglobulin (ocrelizumab),
• glatiramer acetate (copaxone),
• fingolimod,
• alemtuzumab,
• natalizumab.

Symptomatic treatment and rehabilitation measures include:

• plasmapheresis, which allows to clear blood from antibodies,
• physiotherapy to improve muscle activity,
• muscle relaxants,
• prevention of apathy and depression.

From this it follows that the main directions of therapeutic therapy are reducing the risk of complications and suppressing the immune system. Thanks to the combined medical and physiotherapy treatment, you can achieve good results. It is necessary to consult a neurologist in a timely manner when the first signs of multiple sclerosis are detected. The specialist will carry out the examination, prescribe the appropriate physiotherapy measures and medications according to the individual indications.And you can take a full-fledged course of rehabilitation in one of the “Doverie” boarding houses. For more information about this, contact the manager by phone or online.

90,000 Neuroscientists have learned to measure the content of myelin in the brain of the fetus in the womb

The nerve fibers of the peripheral and central nervous system are surrounded by a protective sheath made of myelin – a multilayer cell membrane consisting of fats and proteins. Ionic currents cannot pass through myelin, so the nerve impulse passes through the myelinated fibers in large “jumps” – only along the areas of rupture of the myelin sheath, such areas occur at regular intervals of about 1 millimeter.As a result of this spasmodic signal transmission, the nerve impulse propagates along myelinated fibers several times faster than along fibers without myelin. Damage to the myelin sheath can severely damage the nervous system.

The process of myelination begins at about the fifth month of fetal development and continues intensively after birth, when a person learns to hold his head, walk, speak, think, and so on. Violation of this process, as well as some diseases (for example, multiple sclerosis) can damage the myelin sheath of nerve fibers and thus disable the central nervous system.Scientists from Tomsk State University and the Institute “International Topographic Center” of the Siberian Branch of the Russian Academy of Sciences have developed a method for quantitative assessment of the process of myelination of the fetal brain in a clinical setting using magnetic resonance imaging (MRI).

“Myelination disorders often underlie delays in the physical and mental development of a child, and are also a possible mechanism for the formation of a number of neurological and psychiatric diseases.Our study opens up the possibility of non-invasive study of the formation of myelin in the fetal brain at the earliest stage and subsequent application of the knowledge gained in clinical diagnostics and fundamental neurosciences, ”said Vasily Yarnykh, project leader, professor at Tomsk State University and the University of Washington (USA).

Modern MRI methods make it possible to qualitatively assess pronounced myelination disorders, but do not make it possible to measure the exact amount of myelin in the nervous tissue.Earlier MRI technologies are also not sensitive enough to the small amounts of myelin that are present in the brain of the fetus or newborn baby. The authors of the study propose to use a new method for these purposes – mapping of the macromolecular proton fraction (MPF). In conventional MRI, the source of the signal is the protons contained in the water, while the MPF mapping method measures the number of protons that make up the cell membranes. Thanks to a special algorithm for mathematical processing of images and a data collection protocol, the new method allows you to isolate the signal of protons related to the myelin sheath.In previous studies, scientists have proven the effectiveness of this method for quantifying myelination, and new work has demonstrated the use of MPF mapping to visualize subtle differences in myelination of the anatomical structures of the fetal brain.

“Our study was made possible thanks to close cooperation with clinicians from the MRT Technologies department of the International Topographic Center Institute of the Siberian Branch of the Russian Academy of Sciences under the leadership of Alexandra Korostyshevskaya, MD, and their significant experience in diagnosing fetal pathologies.As a result of our work, we have proposed a new method for constructing maps of human brain myelination during prenatal development. For the first time, the possibility of non-invasive quantitative assessment of the content of myelin in the fetal brain using widely available clinical equipment for MRI has been shown, ”the scientist added.

The study involved more than forty pregnant women at a gestational age of 18 to 38 weeks. Scientists have shown the ability of their method to reliably assess the spatio-temporal trajectories of myelin development in various anatomical structures of the fetal brain.The new technology allows detecting very small amounts of myelin in the early stages of its formation with high spatial resolution and short scan time (less than 5 minutes). The authors compared the data obtained for the adult brain and the fetal brain and found that MPF mapping is the most sensitive to the content of myelin among all known methods of MRI.

Photo: Examples of MPF maps of the brain of fetuses of different gestational ages.Source: Vasily Yarnykh

Chronic inflammatory demyelinating polyneuropathy (CIDP) (information for the patient)

Chronic inflammatory demyelinating polyneuropathy (CIDP)

What do these terms mean?

“Chronic” – means that the disease has a long course of the course, and the symptoms can steadily progress and recur.To establish a diagnosis of chronic polyneuropathy, it takes more than 8 weeks from the moment the first symptoms appear.
“Inflammatory” – means “inflammation” as the main mechanism of damage to peripheral nerves due to a violation of the complex functioning of the immune system, therefore this disease can also be called “autoimmune”.
“Demyelinating” – characterizes the type of damage to the peripheral nerves, in which the myelin sheath of the nerve is predominantly affected.
“Polyradiculoneuropathy” – means that the pathological process involves more than one nerve, as well as the roots of the spinal cord and plexus trunks.

How common is this disease?

CIDP is a rather rare disease. The average prevalence of patients with CIDP in the world averages up to 0.81-1.90 cases per 100,000 people. Men get sick more often than women. CIDP can make its debut at any age, even in childhood, however, the peak incidence occurs at an average age of 40-50 years.

What are the causes of the development of the disease?

The reasons for the development of CIDP are still not fully understood.However, the results of numerous studies and the effectiveness of immunomodulatory therapy indicate a dysfunction of the immune system as a key cause of the development of the disease. The immune system is a very complex and harmonious mechanism. The key links of the immune system are antibodies, a number of serum proteins and white blood cells, leukocytes. Normally, the immune system fights against foreign agents (proteins, viruses, bacteria). However, in a number of diseases (autoimmune diseases), components of the immune system mistakenly start working against their own body.One of these diseases is CIDP. In this case, a reaction develops against the components of the peripheral nerve sheath, which manifests itself in the form of specific symptoms characteristic of CIDP.

Are there any risk factors for the disease?

Respiratory viral diseases, surgery, pregnancy, vaccination and other reasons are described as trigger factors, however, a direct connection of the above factors with the development of the disease has not yet been proven.

Is it possible to inherit the disease?

No. There are a number of studies that have identified genes that are suspected in the development of the disease. However, their involvement in the risk of developing the disease in offspring has not yet been proven.

How is CIDP manifested and what are the features of this disease?

CIDP is a disease of the peripheral nerves. The overwhelming majority of the pathological process involves the so-called “thick” nerve fibers that have a thick layer of myelin sheath, which is the target for this disease.These fibers carry information from the brain and spinal cord to our musculoskeletal system about the motor command and, in the opposite direction, about the position of the body in space to ensure balance. Therefore, the most common symptoms are:

• weakness in the arms and legs
• instability when walking
• feeling of numbness in the hands and feet
• muscle loss and decreased muscle tone

The exact mechanism of CIDP is not fully understood due to the complexity of immune reactions. and therefore the symptoms and nature of the course of the disease may vary.Hence, the so-called atypical forms of CIDP are distinguished, which differ somewhat from the classical course of the disease and may have features of prognosis and treatment. Diagnosing these forms can be difficult. Atypical forms of CIDP include:

• multifocal form of CIDP (Lewis-Sumner syndrome)
• distal form of CIDP
• purely sensory or purely motor forms of CIDP
• CIDP with acute onset
• chronic immune sensory disease
• chronic immune sensory disease may be variable – in some patients, severe symptoms may develop, leading to disability, in others, minimal neurological disorders; some patients may experience frequent exacerbations, while there are cases with a single exacerbation in life.

  How was I diagnosed with CIDP?

  A clinical examination by a neurologist is the key to making a diagnosis. There are disease criteria proposed by the European Federation of Neurological Communities in 2010. To confirm the diagnosis and exclude alternative causes of polyneuropathy, a number of laboratory tests are usually performed, as well as instrumental research methods. Unfortunately, there is still no “gold” diagnostic standard that could point to “CIDP” with high accuracy.Therefore, the diagnosis is often made on the basis of the clinical picture and the results of the study.

  The key instrumental method for diagnosing CIDP, like any polyneuropathy, is electroneuromyography. This is a study of the conduction of peripheral nerves using short electrical impulses transmitted along the nerve. Stimulation leads to a contraction of the muscle innervated by the nerve under study, which is recorded by an electrode.

  If the data to establish a diagnosis are insufficient, MRI of the plexus, analysis of cerebrospinal fluid, ultrasound of the peripheral nerves and, in rare cases, a biopsy of the nerve may be additionally performed.One of the criteria for the correctness of the established diagnosis is the improvement of the condition, or the suspension of the progression of the disease against the background of pathogenetic therapy.

  What treatment options are there for CIDP?

  Up to 80% of patients with CIDP benefit from therapy that modulates the immune system. Based on large studies in the treatment of CIDP, the following treatment options have proven efficacy:

  • glucocorticosteroid drugs
  • intravenous human immunoglobulin preparations
  • plasmapheresis

  None of the currently known drugs cure CIDP, it only helps to reduce the activity of the disease, from further deterioration or exacerbation, as well as reduce the severity of symptoms.In addition, the response to treatment may differ from person to person.

  Does each method of treatment have its own pros and cons, which are discussed by the doctor, taking into account all the individual characteristics?

  Glucocorticosteroid drugs (prednisolone, methylprednisolone) are prescribed in the form of tablets and infusions. First, a high dose is selected based on body weight, which gradually decreases over time. The duration of administration and the magnitude of the maintenance dose depend on the severity of the symptomatology, the rate of its progression, and the response to treatment.However, to assess the effectiveness of treatment, the duration of therapy should be at least 12 weeks. Despite the proven effectiveness and relatively low cost, the treatment of GCS can be associated with a number of side effects – weight gain, nausea, insomnia, irritability, exacerbation of peptic ulcer disease, increased blood pressure and blood sugar levels, and decreased bone density. Therefore, along with the main drug, complex therapy is prescribed to prevent the development of the above treatment consequences.

  Human immunoglobulin preparations are similar in effectiveness to glucocorticosteroids, however, the latter are much less likely to be associated with the development of side effects, and therefore are safer. Perhaps the main disadvantage of this treatment is its high cost. Human immunoglobulin preparations are obtained by purifying large quantities (> 10,000 L) of human plasma (> 1000 donors), which makes them expensive. Treatment consists in a monthly course of intravenous administration of the drug.The course usually takes 4-5 days. In the future, the frequency of administration of the drug may vary depending on its effectiveness. An important point is the choice of the drug. It is necessary to pay attention to its main characteristics: the drug must be suitable for high-dose intravenous immunotherapy, the IgG content must be at least 95%, the IgA and IgM amounts must be trace. In this case, the amount of IgA should be clearly indicated in the instructions, since it is with this class of immunoglobulins that the development of allergic reactions is associated.

  The third treatment option is high volume plasmapheresis. This method of therapy is a collection of plasma with pathogenic antibodies through a catheter and its replacement with sterile solutions, protein solutions and / or donor plasma. The procedure is repeated about 5 times, usually every other day. The effect of this treatment lasts for 3-4 weeks. Given its complexity, this method of therapy is not used for long-term treatment and is often useful in case of rapid and / or severe exacerbation.

  In some patients, despite proper treatment, the disease may still progress or not be controlled. In these cases, immunosuppressants (mycophenolate mofetil, azathioprine, cyclosporine, cyclophosphamide) or monoclonal antibodies (rituximab) are prescribed. The appointment of these drugs should come from a doctor who has experience in their use, taking into account all the indications and contraindications, followed by careful monitoring of the effectiveness and safety of therapy.

  Do you need to make any changes to your daily routine?

  Yes.There are a number of recommendations for patients with a diagnosis of CIDP:

  • to avoid any viral and bacterial infections (respiratory viral, enteroviral diseases, etc.) walking – orthoses, etc.
  • to limit smoking, alcohol consumption, which has a negative effect on blood circulation, aggravating the course of polyneuropathy
  • exclude the use of neurotoxic drugs that aggravate the course of polyneuropathy
  • Careful foot care is very important, especially in the presence of concomitant diabetes mellitus.It is necessary to inspect the feet daily for cuts, calluses, ulcers.
  • Eat a low-fat diet rich in grains, fruits and vegetables.
  • avoid prolonged compression of the limbs

  What are the prognosis for this disease?

  In general, life expectancy does not differ from that of people without the disease. The course of the disease can be different – it can occur with frequent exacerbations, have a slowly progressive course, or achieve a stable remission with minimal clinical manifestations.Timely prescription of treatment, careful monitoring of the patient and the effects of the therapy are extremely important for the prognosis.

  If you have symptoms of polyneuropathy or you have been diagnosed with Polyneuropathy or CIDP, you can undergo a comprehensive examination at the Center for Peripheral Nervous System Diseases of the FGBNU NTSN, where you will be helped to clarify the diagnosis, identify the causes of peripheral nerve damage and prescribe therapy from the standpoint evidence-based medicine.