PC Types
PC affects mainly young people up to 30 years. Women are more often ill. There are four main types of disease:
• Recurrent-remitting PC-state takes the form of alternation of acute disturbance of the nervous function with remission; about a third of patients;
• Secondarily progressing PC - patients develop chronic nervous disorders that are prone to deterioration; in the majority of patients, the relapsing-remitting PC goes into this form;
• a primary-progressive PC with a gradual development of neurological symptoms without exacerbations; about 15% of patients;
• benign PC - primary attack of mild degree with almost complete recovery without disease progression; is extremely rare.
Symptoms of PC may vary depending on the type of affected nerve fibers.
• The optic nerve
In the formation of plaques of the PC on the optic nerve, which transmits impulses from the retina to the brain, the patient develops pains in the eye in combination with vague vision. Recovery, if at all possible, takes up to eight months.
• The brain stem The involvement of the brain stem, which is responsible for eye movements, the sensitivity of facial tissues, speech, swallowing and a sense of balance, can lead to double vision or disruption of their friendly movements.
• Spinal cord Interruption of the flow of nerve impulses at the level of the spinal cord is accompanied by weakness and decreased sensitivity in the limbs, as well as dysfunction of the bladder and intestines.
Progression
With the development of the secondary-progressive phase of the disease, more persistent disturbances are observed:
• loss of dexterity of hands;
• weakness and rigidity of the lower limbs;
• increased frequency of urination and urinary incontinence;
• impaired memory and concentration: these frequent disturbances are sometimes the main symptoms;
• mood swings; although it is often associated with PC euphoria, depression is still more typical.
In the early stages of the PC, foci of acute inflammation appear in the brain, which then heal with the formation of scars (plaques). Most often these plaques are deposited in periventricular spaces (areas surrounding the fluid-filled ventricles of the brain), in the spinal cord and optic nerves. In these areas, the blood-brain barrier (semipermeable boundary between the blood and the brain tissue) is damaged, which allows certain cells to contact the walls of blood vessels and then penetrate them.
Destruction of the myelin sheath
A special role in the development of the disease belongs to a group of lymphocytes that react to one or more myelin envelope antigens. When these lymphocytes (macrophages) interact with antigens, certain chemicals are released that stimulate the formation of mononuclear cells. Macrophages and activated glial cells (found in the central nervous system) attack the myelin sheath at various sites, which leads to its destruction and denudation of the axon. Some oligodendrocytes (cells producing myelin) die, others can only partially restore the lost myelin sheath. Later, against the background of the subsidence of inflammation, proliferation of astrocytes (another type of CNS cells) is observed with the development of gliosis (fibrosis). Two main factors lead to the development of the PC - the genetic factor of the environment.
Morbidity
The incidence of PC (the number of cases in a population at a certain point in time) in the world varies widely. With some exceptions, the disease occurs more often as it moves away from the equator with the highest concentration in regions above the 30th parallel on all continents. It is common to distinguish three zones throughout the world, differing in the prevalence of multiple sclerosis: high, medium and low risk areas. Changing the place of residence with a change in the risk zone leads to an increase or decrease in the individual's risk of developing PC, respectively, the zone in which he settled. In an attempt to explain these geographic features, many environmental factors have been investigated. The role of viral agents, and in particular of measles and canine plague viruses (the latter causes a serious disease in dogs) was assumed, but so far the infectious nature of PC has not been confirmed.
Genetic factors
Individuals with a family history of PC are more likely to develop the disease. For example, a woman whose sister has a PC, the risk of getting sick is increased 40 times compared to a woman without a similar anamnesis. In case of illness of one of the twins, the second is at risk of developing PC with a probability of 25%.
The immune response
Some scientists suggest that the immunological response to infectious agents (viruses, bacteria) or the inferiority of the body's immune defense is responsible for the development of the disease. Other experts are convinced of the autoimmune nature of the PC, in which immune cells destroy the body's own tissues. Diagnosis of PC is based on magnetic resonance imaging or investigation of cerebrospinal fluid. For long-term treatment of the disease, drugs such as beta-interferon are used. For PC diagnostics, two main types of research are used:
• Magnetic resonance imaging (MRI);
• analysis of cerebrospinal fluid (COC).
Mt-study
The use of MRI technology significantly increased the accuracy of PC diagnostics, and also led to a better understanding of the nature of the disease. Plaques in the central nervous system have a specific kind in the pictures, which, in combination with localization in the brain, causes suspicion on the PC. MPT plays an invaluable role in the diagnosis of PC, but the application of the method is very limited in terms of monitoring the course of the disease. Unfortunately, there is no clear correspondence between the MP-picture and the clinical manifestations of the disease.
CSF study
CSF circulates inside the ventricles of the brain, as well as washing the surface of the brain and spinal cord. At PC certain changes of protein and cellular composition are noted, which, however, are not specific. In 90% of patients in the CSF, a special type of immunoglobulin (oligoclonalD) is found.
Other tests
To measure the conductivity of pulses, for example, through optic nerve fibers, specific tests are carried out. Currently, this study is considered obsolete. Blood tests and other examinations are not important in diagnosing PC, but can be used to exclude other similar conditions. Treatment of PC covers various directions.
Acute attacks
Many PC attacks take place in an easy form and do not require specific treatment. In a more severe course, corticosteroids are given in the form of tablets or intravenous insuffins. These drugs shorten the duration of the attack, but do not affect the final outcome.
Symptomatic measures
Some medicines can relieve the symptoms of the disease.
• Dysfunction of the bladder
Typically, patients have increased urge to urinate and urinary retention - to relieve these symptoms use drugs such as oxybutynin and tolterodine. Sometimes, to reduce urine output during the night, prescribe desmopressin. Periodic self-catabolization of the bladder allows patients to control the symptoms of urinary incontinence and reduces the risk of infection. Disorders of the intestine are less common.
• Impotence
Impotence in men with PC is well treatable sildenafilom.
• Spasticity of muscles Abnormal muscle stiffness, typical for PC, usually reacts poorly to drugs, which also have a number of side effects.
• Pain
To alleviate the pain syndrome appoint funds such as amitriptyline. Long-term treatment of PC includes the use of immunomodulating agents that regulate the body's immune response. Currently, the main drug used for this purpose is beta-interferon.
Interferons
Interferons are synthesized in our body and come in three types: alpha-interferons have little effect on PC; beta-interferons play the main role of attraction; gamma-interferons cause an exacerbation of the disease. The exact mechanism of action of beta-interferon is unknown. Interferon beta is slightly different from natural interferon beta, while interferon beta completely corresponds to it. All beta interferons reduce the number of PC attacks by about 30%; some researchers suggest that they reduce the severity of the exacerbation. Different types of interferons have different effects depending on the form of the disease. Beta-interferon is ineffective against a relapsing-remitting PC, however it slows the development of a second-progressive variant of the disease. Interferon beta-1a preparations, in turn, have the opposite effect. During treatment, neutralizing antibodies are formed in the patient's body, the influence of which on the success of therapy is unclear. All forms of beta-interferon lead to a significant improvement in MP-pattern with a decrease in the number of lesions.
Other drugs
The synthetic preparation glatiramer acetate has a similar chemical structure with the main protein forming myelin. Like beta interferons, it reduces the frequency of exacerbations, but does not affect the progression of the disease. Regular monthly intravenous immunoglobulin helps to reduce the number of attacks and ease the course of the disease. Many questions regarding the comparative effectiveness of all these drugs remain unanswered. Other, more specific immunomodulators undergo clinical studies. PC is a chronic neurological disease with a progressive course. Nevertheless, there are a number of ways that help patients cope with everyday concerns.
• Diet
It is believed that a diet with limited animal fats and the presence of unsaturated fatty acids (such as sunflower oil) has a beneficial effect on the well-being of patients.
• General activities
The quality of life of a patient with a PC is due to factors such as the ability to self-service, the level of mobility and the need for long-term use of drugs. It is extremely important that the patient is provided with qualified medical care and professional care.
• Forecast
Approximately 20 years from the onset of the disease, 50% of patients are able to withstand outside distance of no more than 20 meters. The average life expectancy of such patients is lower than in the population.