What happens in the nervous system
Nerve fibers are covered with myelin, a sheath that acts like wire insulation and allows for rapid signal transmission. In multiple sclerosis, immune cells damage myelin, causing inflammation and then scars (plaques). The signal along such a fiber travels more slowly or does not travel at all - hence the symptoms.
The key word in the name is “scattered”: lesions occur in different parts of the brain and spinal cord and at different times. It is on this principle - dispersion in space and time - that diagnostics are built.
First symptoms
The onset is almost always unexpected for a person and rarely looks “neurological”. The symptom appears, lasts for days or weeks, and then goes away completely or partially - and this creates the illusion that everything turned out okay.
- Retrobulbar neuritis: decreased vision in one eye, “veil”, pain when moving the eyeball
- Numbness, tingling, or "cotton-like" feeling in an arm, leg, or half of the body
- Weakness in the limbs, fatigue of the leg when walking
- Double vision, dizziness, unsteadiness
- Lhermitte's sign - a sensation of current passing through the back when tilting the head forward
- Urinary dysfunction: urgency or retention
- Severe fatigue disproportionate to the load
Diagnostics
- Осмотр невролога с детальной оценкой рефлексов, чувствительности, координации и зрения.
- МРТ головного и спинного мозга с контрастированием — main метод; контраст показывает активные, «свежие» очаги.
- Исследование спинномозговой жидкости на олигоклональные антитела — подтверждает воспалительный процесс в ЦНС.
- Вызванные потенциалы — оценивают скорость проведения по зрительным и другим путям.
- Анализы для исключения diseases с похожей картиной: инфекций, системных заболеваний, дефицита витамина B12.
The diagnosis is not made by MRI alone: individual “nonspecific lesions” occur in many people and by themselves do not mean anything. A combination of clinic, MRI data and exclusion of other causes is needed.
How it proceeds
- The remitting form is the most common: exacerbations are followed by periods of recovery. She is the one who responds best to therapy.
- Secondary progressive - over time, an increase in symptoms without clear exacerbations
- Primary progressive - slow increase from the very beginning, without exacerbations
An exacerbation is considered to be the appearance of a new symptom or a noticeable worsening of a previous one lasting more than a day, not associated with infection or overheating. A short-term deterioration due to fever is not an exacerbation and does not require hormonal therapy.
Treatment
Treatment is divided into three areas, and they should not be confused.
- Relief of exacerbation - a short course of glucocorticosteroids in high doses; accelerates recovery, but does not affect the further course
- Course-modifying drugs for multiple sclerosis (MCD) are the basis of therapy: they reduce the frequency of exacerbations and the appearance of new lesions; accepted constantly, for years
- Symptomatic therapy - work with spasticity, fatigue, pain, urination disorders
- Rehabilitation: physical therapy, balance training, if necessary, classes with a speech therapist
Lifestyle
- Avoid overheating: hot baths, saunas, prolonged exposure to the sun
- Maintain normal vitamin D levels as directed by your doctor
- Stop smoking - it has been proven to accelerate progression
- Regular, feasible physical activity improves both strength and fatigue
- Treat infections in a timely manner - they can provoke exacerbations
- Plan pregnancy together with a neurologist: therapy is adjusted in advance