Swelling in multiple sclerosis
A slightly different effect on the bodymusic. The fact that she can heal, it was known in ancient times. Thus, in ancient Egypt, with the help of singing, the choir was relieved of insomnia, in ancient Greece the sounds of the trumpet were healed from sciatica and nervous system disorders. The famous Pythagoras, who created the theory of the musical-numerical structure of the Cosmos, successfully used the melodies he composed for the treatment of "diseases of the soul." The effectiveness of music therapy is determined not only by its emotional impact on a person, but, as the latest studies prove, by the bioresonant compatibility of musical sounds with the vibrations of individual organs and body systems.
Multiple sclerosis is a chronic immune-inflammatorya disease in which, as a result of disturbances in the functioning of the immune system, the myelin sheath of nerve fibers is damaged, which leads to a gradual loss of various functions of the nervous system associated with the physical and psychoemotional state of the patient.
For the first time the morphological picture of the scatteredSclerosis was described by French scientists Cruevell and Kraswell in 1835. They discovered "islands of gray degeneration scattered over the spinal cord, brainstem, cerebellum and sometimes in the large hemispheres." The first detailed description of multiple sclerosis belongs to the well-known French neuropathologist Jean Martine Charcot (1856), who considered the most characteristic symptoms of the nystagmus (jerking of the eyeballs), intentional (amplified when approaching the target) trembling and chant (intermittent) speech ("Charcot's triad" ). A detailed microscopic description of brain lesions in multiple sclerosis belongs to James Dawson (1916). Thomas Rivers in 1935 for the first time experimentally reproduced demyelinating disease in animals and suggested the autoimmune character of the pathogenesis of multiple sclerosis. The famous American neurologist John Kurtzke, using computer technology, in 1955 found that with multiple sclerosis there are 685 symptoms, however, he did not reveal any symptom specific to this disease. A significant contribution to the study of the pathogenesis and clinical manifestations of multiple sclerosis was made by domestic neurologists - A.P. Zinchenko, R.K. Shamrey, V.I. Golovkin, D.A. Markov et al.
Prevalence of multiple sclerosis
In the world of multiple sclerosis is sick about 3 000000 people. The prevalence of the disease depends on geographical zones, being the lowest in the equator and increasing to the north and south. In Russia, multiple sclerosis affects 10 to 70 people per 100 000 population. In most patients, the first symptoms of the disease occur at a young age (20 to 40 years). Women get sick 1,5-2 times more often than men.
Symptoms of Multiple Sclerosis
A feature of multiple sclerosis isa wide variety of symptoms. The first signs of multiple sclerosis often arise after provoking effects of any factors: trauma, surgery, disease, nervous stress, childbirth, etc.
Multiple sclerosis can begin with changessensitivity in the form of transient tingling sensations and "goose bumps" in the hands and feet, visual disorders, vestibular disorders in the form of dizziness attacks, with reversible motor disorders. In the far-reaching stage of multiple sclerosis, the following symptom groups usually appear:
- Violations of motor activity - paresis, spasticity (abnormal increase in muscle tone), pathological reflexes.
- Coordination disorders - shakiness, intentional trembling, nystagmus, instability in the vertical position, etc.
- Sensitivity disorders - decreased sensitivity, numbness, tingling, pain, etc.
- Visual impairment - reduction of acuity, change of visual fields, etc.
- Violations of speech - speech slowing, chanted speech, etc.
- Disorders of the pelvic organs - imperative (sudden and strong) urge to urinate, delay or incontinence, impotence, constipation or incontinence of feces.
- Changes in the psychological sphere - emotional instability, euphoria, depression, memory impairment, decreased concentration, etc.
- Weakness (fatigue), fatigue
- Heat intolerance (often leads to an increase in other symptoms)
It should be noted that with multiple sclerosis there is nono specific, characteristic only for this disease of the symptom. Each patient has an individual combination of different symptoms.
Degree of disability of the patient with scatteredsclerosis is determined using a special international scale, which is abbreviated as EDSS (Expanded Disability Status Scale). The minimum value of this scale (0) corresponds to the absence of neurological symptoms. With an EDSS of 1.0 to 4.5, MS patients are fully self-serving, while an EDSS value of 7.0 or more corresponds to a deep degree of disability in patients.
Neurologists around the world use this scale forTo characterize the patient's condition with multiple sclerosis at the time of the examination. The EDSS index, as measured by repeated visits to the doctor, helps to understand how the disease develops, and how effective is the treatment that the patient receives.
It is very important that, regardless of location,moving from one city to another, or even to another country, when assessing the patient's condition, doctors use the same units of measurement, so that information about the patient is not distorted or lost. However, the patient does not have additional difficulties associated with presenting information about his illness and condition to medical workers.
Since multiple sclerosis occurs, beforein total, as a result of a defect in the immune system, immune cells are the main target for the treatment of this disease. Medicinal products registered for the treatment of multiple sclerosis are divided into immunomodulators (interferons and glatiramer acetate-Copaxone) and immunosuppressants (mitoxantrone, cyclophosphamide, azathioprine, glucocorticosteroids, etc.).
IFN? -1b (Betaferon) was the first drug approved for the treatment of multiple sclerosis in 1993. Two versions of IFN-1a, slightly different from Betaferon in chemical structure (Avonex and Rebif) were then registered.
Clinical efficacy of various drugs IFN? when choosing the optimal dosage and treatment regimen is the same.
Action IFN? is due to binding to receptors on the cell surface and the production of a number of proteins that have an antiviral and anti-inflammatory effect. Therapeutic effect of IFN? with multiple sclerosis is caused by inhibition of the proliferation of cells of the immune system and the creation of an anti-inflammatory background, which helps to reduce the severity of the pathological process.
Another important mechanism of action is thea decrease in the rate of migration of leukocytes from the blood into the central nervous system. In addition, it was shown that IFN? contributes to the acceleration of the natural death of pathological T-lymphocytes, and is also an antagonist of IFN? - a protein that plays an important role in the pathogenesis of multiple sclerosis. When using IFN? the course of treatment is at least 6 months, and in the presence of effect should continue for life.
Analysis of the clinical efficacy of IFN? with multiple sclerosis shows that IFN therapy? somewhat reduces the frequency of relapses during the first year of treatment. Long-term effectiveness of IFN? It is not obvious and requires further study.
Copaxone (Glatiramer acetate)
Glatiramer acetate was developed as an analog of thatpart of the myelin protein against which the attack of autoimmune T-lymphocytes is directed. Glatiramer acetate suppresses the autoimmune reaction by triggering the production of anti-inflammatory cytokine proteins and activation of T suppressors: T-lymphocytes that specialize in suppressing immune responses.
From the immunological point of view, this mechanism of action is rather doubtful, and has repeatedly been criticized.
Reduction in the number and area of lesions in Copaxon is observed not earlier than, 6-7 months after the initiation of therapy.
Review of the results of clinical trialsCopaxone, published in 2003, did not confirm the presence of any positive effect from the appointment of Copaxone in multiple sclerosis. However, more recent studies have shown some effectiveness of the drug in a number of situations. In terms of cost / effectiveness, Copaxone is the most disadvantageous of all drugs used to treat multiple sclerosis.
Immunoglobulin G (hamimun, pentaglobin, octagam, humaglobin).
Immunoglobulin G carries out transientblockade of certain receptors on macrophages, suppressing the mediated destruction of myelin; reduces the formation of new immune complexes, neutralizes proinflammatory cytokines. Intravenous administration of immunoglobulin G reliably reduces the number of exacerbations of the disease. This treatment is considered most appropriate in the initial stage of the disease, with a frequency of exacerbations no more than 2 times a year.
The drug can be administered if ineffectiveCopaxone and beta interferons. The possibility of using immunoglobulin G in patients with multiple sclerosis in the postpartum period is shown to reduce the risk of developing an exacerbation after childbirth.
Cytostatic immunosuppressants are used foractive progressive course of the disease and inefficiency of glucocorticosteroids. The use of cytostatics is due, above all, to their systemic immunosuppressive action.
Glucocorticosteroids (prednisolone, methylprednisolone, salt-medrol, dexamethasone) - have a pronounced anti-inflammatory, anti-edema and mebranostabilizing action.
Glucocorticosteroids decrease the severityinflammatory reactions and restore the impulses to the stored fibers, which causes a rapid positive clinical effect. However, corticosteroid therapy is not specific, does not cure the disease and does not change the course of multiple sclerosis.
The use of glucocorticosteroids is most effective in the period of exacerbation of multiple sclerosis. With the stabilization or slow progression of the disease, the appointment of these drugs is not effective.
Glucocorticosteroids have many side effectseffects: delayed healing of wounds, weight gain, erosive and ulcerative lesions of the gastrointestinal tract, edema, arterial hypertension, increased coagulability, osteoporosis, mental disorders.
New treatments for multiple sclerosis
The method of stem cell transplantation in multiple sclerosis began to be studied in the US and Europe simultaneously since 1995.
In Russia, the first transplantation of stem cells with multiple sclerosis was performed in 1999 under the guidance of prof. A.A. Novik.
By 2007, around 400 stem cell transplant operations have been performed in the world with multiple sclerosis.
This method allows you to eliminate the causediseases - to eliminate autoimmune T-lymphocytes, which damage the nerve tissue of the brain and spinal cord. Transplantation performed in the early stages of the disease, can stop the progression of the disease for many years and prevent the formation of disability patients.
Transplantation is not performed in patients with advanced stages of multiple sclerosis, in which the functions of movement, urination, and bowel evacuation are irreversibly lost (for many years).
The question of the expediency of carrying out stem cell transplantation in multiple sclerosis is considered for each patient after a detailed examination.
The effectiveness of stem cell transplantationMultiple sclerosis (excluding far-advanced stages of the disease) in patients who previously received various types of standard therapy, according to the European Registry, is 75-80%.
The choice of a method of treatment is a stage of veryan important decision that must be based on accurate data on the diagnosis of the disease, taking into account the individual characteristics of the patient. Discussion of treatment issues with the patient and, at his request, with his relatives is an integral part of the approval of the general treatment program.