A life-changing illness. Myths about multiple sclerosis | Healthy Life

Over the 150 years that medicine has known this disease, the disease itself has changed, and its treatment has become completely different. Today, doctors advise patients to perceive this diagnosis not as a death sentence with a short delay, but as a challenge. Because with multiple sclerosis you can live life to the fullest. You just need to gain strength and patience.

Our experts:

President of the All-Russian Public Organization of Disabled People with Multiple Sclerosis, Chairman of the Council of Public Organizations for the Protection of Patients' Rights under Roszdravnadzor Yan Vlasov.

Professor of the Department of Neurology of the First St. Petersburg State Medical University. acad. I. P. Pavlova Natalya Totolyan .

Myth No. 1. Only old people get multiple sclerosis. This is a condition associated with memory loss

In fact . This disease is not associated with atherosclerosis (and serious memory impairment is a very rare symptom). Multiple sclerosis is a progressive pathology of the central nervous system. It develops as a result of autoimmune inflammation with damage to the myelin sheaths of nerve fibers, which gradually leads to the death of nerve cells. During exacerbations, multiple scattered foci of inflammation and sclerosis (scarring) form in the brain and spinal cord, which manifests itself in new symptoms or intensification of old ones.

Most often, multiple sclerosis begins at a young age (25-40 years), up to 10% - in children. Around the world, 2.5 million people suffer from this disease. In Russia, according to official data, there are 90 thousand (according to unofficial data, 150 thousand). On average, the annual increase in patients is 7%.

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How to stop multiple sclerosis: treatment of different forms of the disease

Unfortunately, despite progress in MS therapy, it is not yet possible to completely defeat the disease. However, if a person has multiple sclerosis, treatment can help reduce symptoms and reduce the number of relapses. Therapy is prescribed depending on the severity of the disease.

For progressive forms of MS, treatment can help reduce the severity of the disease. Specialists can prescribe:

plasmapheresis - purification of the patient's blood;
immunosuppressants - drugs that artificially suppress the immune system;
immunomodulators are medications that regulate the body's immune response.

To prevent relapses, B-interferons can be used, and to reduce the intensity of symptoms, the following are used:

vitamins E and B complexes;
nootropics that improve brain activity;
anticholinesterase drugs that inhibit the activity of the nervous system;
muscle relaxants that help reduce muscle tone;
enterosorbents that help remove toxins.

Myth No. 2. The main symptom of multiple sclerosis is problems walking.

In fact . Multiple sclerosis is called the disease with a thousand faces. Often the first sign may be blurred vision in one eye, numbness in an arm or leg, headaches and dizziness, and problems with coordination. Sometimes it's just increased fatigue or problems holding urine. Therefore, internists, ophthalmologists and urologists are often the first to encounter the disease. It is sometimes difficult to recognize a disease early, so special schools of neurologists are regularly held, where doctors are taught to be alert to a variety of symptoms that this disease may signal.

Until recently, diagnosis was delayed for 5-8 years. Today in Russia the situation has improved dramatically due to the fact that the community of neurologists and public organizations studying multiple sclerosis are conducting educational activities on this problem. However, the disease can be completely asymptomatic for several years. In this case, it can only be detected with magnetic resonance imaging (MRI), which shows altered areas on tomograms of the brain or spinal cord. The neurology community even proposed to the Ministry of Health to introduce screening for multiple sclerosis from childhood. But MRI is an expensive method, so such screening is not yet available.

4.Treatment of multiple sclerosis

types of medications can be used to treat sclerosis

that help solve various
problems
:

During a relapse, medications will help make attacks shorter and easier;
Over a long period of time, treatment is given to reduce the number and severity of attacks, which can delay or reduce the damage caused to the body by multiple sclerosis.
Some drugs are aimed at combating specific symptoms of multiple sclerosis - fatigue, depression, urinary problems, pain or excessive muscle tone.

It must be borne in mind that it is impossible to cure sclerosis completely. And the decision to take specific medications should be made together with your doctor after a full examination, since many drugs do not work for everyone and have very serious side effects. Sometimes, if the symptoms of multiple sclerosis are quite mild, drug therapy is not required at all. However, if your doctor deems it necessary, you will need to start taking medications as soon as you are diagnosed with multiple sclerosis, even if there are currently no obvious symptoms of the disease.

Additional treatments for multiple sclerosis include physical therapy, speech therapy and a specially selected set of exercises that can help solve some of the physical problems caused by multiple sclerosis.

Myth No. 3. Only an MRI of the head can confirm the diagnosis.

In fact . The main methods for diagnosing multiple sclerosis are clinical manifestations in combination with MRI data and cerebrospinal fluid (CSF) analysis. To analyze the CSF, a lumbar puncture is made, 1-2 ml of fluid is obtained and tested for oligoclonal immunoglobulins - their presence confirms the inflammatory process. These tests are safe and recommended in most cases for early diagnosis. There are also additional instrumental studies: evoked potential techniques, coherent optical tomography and others.

What can be done to prolong life

The quality of years lived with multiple sclerosis, how many people live without outside help - all this directly depends on the patient himself. Pathology does not at all mean a verdict that it is time to die. Achievements in the pharmaceutical industry have made it possible to maintain a high quality of life for many decades.

The following rules help preserve your ability to work and longevity:

give up bad habits - do not abuse alcohol and tobacco products;
adjust your diet - the diet contains more vegetables and fresh fruits, proteins and plant fiber;
get a good night's sleep - during the hours of night rest, the nervous tissue has time to regenerate itself and the cells are more actively renewed;
spend more time in the fresh air - daily walks fill the body with oxygen and a charge of energy;
engage in active, but not strenuous sports - swimming, running, fitness, tennis;
communicate with friends, attend exhibitions, film premieres - don’t be sour and don’t complain.

A correct lifestyle at the initial stage of sclerosis of nervous tissue allows you to achieve a long period of stabilization of the pathological process - demyelization of the nerve sheath is suspended.

Myth No. 4. The cause of the disease is viruses

In fact . Multiple sclerosis, like most chronic diseases, is a multifactorial pathology. A number of factors that provoke the disease cannot be influenced, but we can eliminate some (the so-called modifiable factors), thereby reducing the risk of MS and its more severe course.

Science knows of numerous hereditary factors of predisposition to MS (however, there are also genes that protect against the disease). The risk is also increased by an unfavorable environment, smoking, excess salt in the diet, deficiency of sunlight and vitamin D. Numerous studies in recent years also indicate the role of changes in the composition of the intestinal microflora in the development of autoimmune inflammation and even damage to nerve cells in MS.

“Untimely encounters” with some viruses also play a role. For example, the risk of developing multiple sclerosis increases later infection (in adolescence and older age) with the Epstein-Barr virus, which is accompanied by infectious mononucleosis. Some retroviruses, which at the dawn of the evolution of the animal world were “inscribed” in our genome, subsequently left their “messages” in our genes, which also contribute to the development of MS. In addition, patients with this disease are known to have an initially impaired immune response to some viruses.

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Answers to questions from patients suffering from multiple sclerosis

Patients with multiple sclerosis have many questions about how to live with such a terrible diagnosis, how not to become a hostage to the disease? In fact, these questions appear at the beginning of the disease, when a person first learns about his problem. Subsequently, there is a reassessment of values, collection of information, analysis of it and the understanding that life goes on. Moreover, this life is not much different from the life of an average healthy person, you just need to learn to concentrate on what the patient is able to control.

In this article we will try to answer the most common questions asked by patients with multiple sclerosis.

Does cognitive function suffer in MS?

Severe dementia is extremely rare in patients with multiple sclerosis. But almost every second patient encounters cognitive dysfunction, and in patients with a primary progressive type of course, such disorders are less common. Serious cases of dementia, as a manifestation of multiple sclerosis, are not observed in patients, but concentration may suffer.

How to help yourself with memory and concentration disorders?

be aware every minute, focus on what you are doing right now;
avoid noisy companies, loud sounds, listen to TV and music at a muted volume;
do not walk along streets with fast traffic, in transport do not look out the window in which objects and people are flashing;
Keep a diary, plan your day hourly, try to stick to a stable routine;
say your actions out loud, for example, before leaving the house - “I checked that I turned off the iron”, “I turned off the stove”, “I locked the door and hid the key in my bag”, etc.
use smartphone reminders, program an alarm for the time of taking a medicine, an appointment, etc.
use a voice recorder and tell yourself the algorithm of your actions for the near future;
put things strictly in places so as not to look for them;
train your memory - learn poetry, solve crosswords, puzzles, remember phone numbers of friends, read;
talk into the recorder about how your day went, what meetings you had, what you remember most;
don’t take on many things at once, choose one, focus on it and complete it, then move on to the next one;
learn to juggle

Does multiple sclerosis affect your sex life?

Yes, sexual function is impaired during illness. The patient may complain of decreased sexual desire, problems with ejaculation, weak or absent erection, patients note vaginal dryness, numbness in the perineum and labia, and lack of orgasm. How to get rid of these manifestations or at least reduce them?

do not isolate yourself, be sincere and frank with your partner;
do not hesitate to tell your doctor or psychologist about problems;
for vaginal dryness, use a lubricant;
learn to feel yourself again, with multiple sclerosis, some feelings are lost, but new sensations appear, look for them, share the discovery with your partner, try new positions, experiment;

A fulfilling sex life is quite possible, but only if both partners try to please each other and are open.

Can women with MS have children?

This is a very important question because multiple sclerosis often occurs in young women of childbearing age. Experts answer that definitely, yes. Pregnancy and childbirth do not pose any special risks and are usually as uncomplicated as for other expectant mothers. And, as studies show, the frequency of relapses of the disease during pregnancy is often even significantly reduced, likely due to changes in the balance of hormones. However, women who have MS should talk to their doctor about what they need to know about pregnancy.

plan your pregnancy in advance;
stop taking some pills when you are expecting a baby (talk to your doctor about the timing of taking medications);
when breastfeeding, it is also advisable to give up certain medications;
involve your household in household chores during pregnancy and while breastfeeding, take care of yourself, rest more often;

Is it possible to play sports with MS?

Playing sports is not only possible, but also necessary. Physical exercise affects mood, overall health, and improves the overall quality of life. You just need to be careful and remember some rules:

you can’t be overzealous, moderation is the main thing when playing sports;
in the summer you need to do exercises and exercise in the morning, when it is not yet hot;
in order not to overheat, you need to take breaks by wiping yourself with a wet, cool towel;
during training, drink cool water more often and cool down with a spray bottle;
exercises should be chosen by the attending physician;
if the condition worsens, the choice of exercises must be adjusted; do not rush to quickly return to your previous form; training should decrease in time and effectiveness in the first two weeks of returning to it;
Balance and stretching exercises are helpful;
don’t train every day, give yourself days off between workouts (this doesn’t apply to walking, moderate walking should be done daily)

You can read more about choosing sports and exercise for multiple sclerosis here.

How to deal with urinary and/or fecal incontinence in MS?

Because of this delicate problem, many patients refuse to visit public places and deprive themselves of many pleasures in life. It is not always possible to completely get rid of dysuric disorders, but every patient can reduce their severity:

study your biorhythms - how long after eating do you feel the need to visit the toilet; Having discovered a certain pattern, take this into account;
in a cinema, restaurant, etc. try to take seats closer to the toilet;
wear clothes that can be easily unbuttoned if necessary;
use diaper pants, have special pads in your bag; even if you don’t use them, you will feel more confident;
regulate bowel movements with diet;
train your pelvic floor muscles;

How to walk in the summer when there is a lot of sun?

Indeed, walking in the hot season becomes problematic. But it is in the summer that you want to be outside more, play active sports and enjoy the sea. If you remember the recommendations of doctors and protect yourself from overheating, you can enjoy summer walks:

in hot weather, take a cool shower before going outside;
carry a spray bottle (in the form of a thermos) with cool water;
Place a wet, cold towel with ice cubes in the container;
clothing should be light, multi-layered and breathable;
plan your route in advance; the street you are walking along should be in the shade;
come to the sea before 10 a.m. and after 5 p.m.;
Don't forget sunglasses and a wide-brimmed hat;
do not drink hot drinks or eat first courses; if they are hot, buy popsicles;
buy a humidifier for your room and monitor the temperature and humidity in the room

But sun rays are necessary for a patient with multiple sclerosis, since the sun produces vitamin D, which has a beneficial effect on the activity of the disease. This is why high dosages of the vitamin D precursor are advisable during the winter months.

Is there a special diet for people with MS?

There is no special diet for patients with multiple sclerosis, but some recommendations are worth paying attention to:

it is advisable to limit meat, especially pork, which the body perceives especially hard;
It’s better to forget about alcohol (even weak alcohol);
It is preferable to eat vegetables and fruits baked;
Gooseberries are especially useful among berries;
vegetables – broccoli and cauliflower;
culinary processing involves steaming, baking, boiling; fried and smoked foods should be avoided;
tomatoes should be limited;
the diet should include nuts (especially pine and almonds), sesame seeds and flaxseed;
periodically take unsaturated fatty acids

For patients with multiple sclerosis, diet is important. You can’t skip meals, you can’t overeat or undereat, you can’t go on diets, you can’t abuse your body. However, all these rules are also relevant for healthy people.

Will I eventually have to use a wheelchair?

70% of patients with multiple sclerosis can walk independently until the end of their lives, that is, the disease itself does not force them to use a wheelchair. But one third of patients are forced to use mobility aids. It could be a stroller, walker, crutches, cane, but it could also be a scooter or electric scooter. In each specific case, only the attending physician will be able to recommend a means of transportation, taking into account the type of pathology.

Is it possible to fly on an airplane?

Flying on an airplane itself does not cause an exacerbation of the disease, but flying from a hot climate to a cool one and vice versa can worsen the situation. A change in temperature can trigger a relapse. So be careful! Changing climatic conditions, you should not travel alone. There should be a person nearby who knows about your illness.

Is it possible to drive a car?

With multiple sclerosis, vision, reaction, and sensitivity in the hands and feet suffer. Changes in organ function can occur suddenly against the background of excellent health. Of course, this condition is unsafe for both the driver with multiple sclerosis and his passengers. If you feel that you can drive a car and you do not have the above symptoms, then try to protect yourself and your fellow travelers:

avoid driving in the dark;
try to drive on non-busy roads;
do not talk to fellow travelers while driving;
turn off your phone or don’t be distracted by calls;
Drive only in good weather;
do not drive if you are tired and feel unwell (a simple sneeze due to allergies or a cold makes you close your eyes for 1-2 seconds, at high speed this is several meters of the highway when the car is driving blindly);
if necessary, purchase additional equipment for the car (wider mirrors, special seats, etc.);
plan your trips;
do not speed;

How to deal with increased fatigue?

Multiple sclerosis causes fatigue even after low activity. The patient may rest a lot, but feel weak and lethargic. After sleep, it becomes somewhat better, but after a burst of activity, irresistible fatigue sets in again. How to stay active?

try to ensure that the maximum load corresponds to your biopotentials - if you are a “morning person”, it is better to be active in the morning;
periodically give yourself 10-15 minute breaks while working, and if you have the desire and opportunity, you can sleep during the day;
take walks more often, even if they are short walks, but they should be in the fresh air;
if it is difficult to walk, do not overwork, use a cane or other adaptive materials;
exercise;
visit the pool, sign up for yoga, Pilates;
do not work to the point of exhaustion;
Monitor the room temperature, it should not be high, ventilate the room regularly;
Cool down more often in the hot season and drink water;
walk with a sprayer and cool yourself, if possible, take a cool shower during the day;
do not starve, do not exhaust yourself with diets, eat small portions every 4 hours;
talk about increased fatigue with your doctor, perhaps its cause is not multiple sclerosis, but another pathology

What to do if you suffer from insomnia?

Many patients (according to some data, more than 50%) face sleep problems. Insomnia affects the patient’s well-being, he becomes drowsy, distracted, chronic fatigue and depression appear. What do doctors advise?

stick to a fixed sleep time (go to bed and wake up at the same time);
create optimal temperature and humidity (usually 18 degrees 45-50% humidity), ventilate the bedroom and turn on the air purifier;
do not watch TV debates and films that evoke strong emotions before going to bed, do not read fascinating literature, do not have active conversations on the phone;
do not exercise before bedtime;
nightwear should be soft and loose; breathable fabric;
drink water no later than 4 hours before bedtime;
limit the consumption of coffee and strong tea (find out until what time you can drink coffee without having problems falling asleep);
do not overeat before bed, but at the same time do not go to bed on an empty stomach - drink warm milk or kefir;
Take a relaxing evening walk before bed;
Just before bed, listen to your favorite calming music;
if you can’t sleep for a long time, don’t move around for more than an hour, get up and do something when you feel like you want to sleep, then go back to bed;
learn to control stress and find the best ways for you to get rid of it (yoga, meditation, sports, music, prayer), do not go to bed if your head is occupied with any problems;
pay attention to your sleeping place - a comfortable mattress, pillow, comfortable bed linen,
the bedroom should be quiet and dark enough

How long do people with multiple sclerosis live?

It is known that modern medicine cannot cure this disease, so patients with absent-mindedness are most concerned about this very question - how many more years can he live, what awaits him next? The disease is not a fatal disease, that is, the life expectancy of patients, on average, does not differ from that of a healthy person. According to statistics, patients with multiple sclerosis live 6-7 years less than people without this diagnosis. And they die from the same diseases as the general population - from oncology and cardiovascular pathology. In severe forms of MS, the prognosis is worse, but the percentage of such people is extremely small. The disease affects quality of life more than length of life, and most symptoms can now be managed with medication and even self-monitored.

Multiple sclerosis is a serious and difficult test for a person; it changes some priorities and makes you look at ordinary things differently. Patients admit that they begin to appreciate life, and it reveals new amazing sides to them, new colors appear. The support of family and loved ones, communication with the same patients and a positive emotional attitude are very important. With their help, you can create the right balance in life, maintaining a healthy part of yourself and being harmonious even in this state. The patient begins not only to feel differently, but also to behave in a new way, in order to be able to overcome fears, not to plunge into despondency and depression, and to face any problem with dignity.

Myth No. 6: Multiple sclerosis is incurable. All you have to do is come to terms with it

In fact . At the moment, this disease cannot be cured, but most often it can be controlled. Over the past decade, the lives of patients with multiple sclerosis have changed dramatically. With the advent of several generations of drugs, the so-called DMTs (drugs that modify the course of multiple sclerosis), doctors have the opportunity not only to alleviate symptoms, but to prevent exacerbations and subsequent disability. The number of such drugs is growing every year.

3.Diagnosis of the disease

Diagnosing sclerosis is not always easy. The first symptoms can be very vague and often coincide with signs of other diseases. Diagnosis of multiple sclerosis

is not given if there is no certainty that the patient has had at least two manifestations of the disease (attack). The doctor examines the patient, asks questions about symptoms, and may also perform several special tests. MRI is often used to confirm the diagnosis, as it allows you to see the areas affected by the disease.

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Myth #7: Multiple sclerosis medications suppress the immune system. Therefore they are very harmful and dangerous

In fact . All PEDs suppress not immunity, but immune inflammation. There are 1st line drugs, which include milder drugs (immunomodulators), as well as 2nd line drugs - selective immunosuppressants that selectively affect the immune system, reducing its autoaggression. Not all DEDs need to be taken constantly. There are drugs whose treatment course lasts only a few days a year, but the effect can last for a very long time if the treatment was timely.

In addition to medications, there is something that can be done to help such patients. Relatives and family members can do something.

We need very serious support from family or loved ones, a non-conflict home situation. Secondly, if necessary, if there is a disability group, the patient must be provided with all social conditions and technical means of rehabilitation

It is very important that he undergoes rehabilitation techniques and takes medications in a timely manner. It is necessary for the family to become a big “reminder” of what he should watch out for, to provide emotional support

A certain diet, rich in vitamins, with a compensated amount of proteins and long-chain fatty acids, a certain daily routine, water procedures, physiotherapy - all this must be done.

It is necessary for these people to work with non-profit organizations, which exist in almost every region, so that they work with multiple sclerosis centers, which exist in every two of the three regions of Russia. So that they go to the websites of the All-Russian Organization of Patients with Multiple Sclerosis (https://ms2002.ru) and other projects that exist for these patients, where advice is given and rules of life that help patients are described. We need people to receive information and follow it.

Just a year ago my life was completely different. The first year of my master's degree was finishing, I was working a little and did not strive to settle down in this life. It seemed to me that there was plenty of time, prospects, opportunities ahead and there was no reason to get out of my usual comfort zone. During a medical examination at the military registration and enlistment office, at an appointment with a neurologist, I mentioned that sometimes I am bothered by numbness in my hands, migraines and episodes of blurred vision. On the advice of a doctor, I went to a local clinic, where I received a referral for an MRI. After the examination, I first came across the term demyelinating disease of the central nervous system - multiple sclerosis. At that time, I had little idea what this could even mean.

A disease with a thousand faces

I only recently began to understand what multiple sclerosis is. Until that moment, I tried not to think about the possible consequences: the disease seemed something distant and impossible. I clearly remember the moment when I realized that this disease would now be with me for the rest of my life. It was hard. It's hard to accept that there's a very real prospect of ending up in a wheelchair when you're young and have a lot of plans for your life. But these are new difficulties that had to be accepted and lived with.

Not without wandering to doctors, endless tests and research. During this time, I underwent an MRI three times and heard a lot of assumptions from doctors - up to the suspicion of borreliosis, which allegedly arose from an old tick bite. Now I understand that since the state provides patients with drugs for the treatment of multiple sclerosis, doctors are playing it safe and are in no hurry to make a diagnosis. Such delays in the process and bureaucracy greatly tire the patient himself, and most importantly, alienate him from treatment. So much time had passed from the first suspicion of multiple sclerosis to the diagnosis that I had already come to terms with the idea that I was sick. I must say that I did not hear clear recommendations from doctors even after it became obvious that I had multiple sclerosis. I was advised to be less nervous and move to the south so as not to burden my immune system with colds and ARVI.

Myth No. 8. Innovative medicines are not available to Russian patients

In fact . All innovative drugs for multiple sclerosis registered in the world are available to Russian patients. Patients can receive most DMTs free of charge: multiple sclerosis is included in the list of nosologies for which centralized preferential provision of drugs is provided. The latest drugs become available in Russia with a delay of 2-3 years, but doctors even find advantages in this fact. This delay allows the development of measures to prevent possible complications of therapy, which are identified precisely in the first years of widespread use of the new drug.

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Main symptoms

Signs of multiple sclerosis depend on the location of the main part of the pathological foci. As new areas are affected, the symptoms increase and become more varied.

Damage to cranial nerves

Most often, multiple sclerosis affects the optic nerve, which is responsible for image perception. Often these symptoms are the first signs of the disease:

a sharp decrease in visual acuity in one of the eyes;
feeling of a veil, haze, black dots or spots in the field of vision that do not go away after blinking;
narrowing of the view: blind spots appear in the field of vision (damage to the outer or inner half, as well as narrowing like a pipe - circular);
a sudden change in the perception of one, several or all colors;
constant feeling of a speck in the eye;
blurred outlines of objects;
pain in the eyeball, worsening with eye movement.

The changes persist for 1-2 weeks, after which they disappear completely or partially. Exacerbations occur periodically.

If the oculomotor and abducens nerves are involved in the process, a person may notice the following symptoms:

strabismus;
double vision;
slight drooping of one of the eyelids;
disorders of coordinated eye movement.

Less commonly, the disease affects other nerves, in particular the trigeminal or facial. In this case, the patient notes symptoms characteristic of their inflammation.

Cerebellar lesion

The cerebellum is the part of the brain responsible for the sense of balance and coordination of movements. If multiple sclerosis affects this area, a person experiences the following symptoms:

sudden dizziness or imbalance (including loss of ability to skate, scooter, or bicycle);
unsteadiness when walking: manifested by a short-term sensation of falling or falling to one side;
change in handwriting for the worse;
sensation of objects trembling or appearing double;
Nystagmus: small vibrations of the eyeballs that are noticeable when looking up or to the sides.

Damage to the cerebellum is often the first sign of a developing disease.

Sensory disorders

Damage to the parts of the brain responsible for sensitivity causes the appearance of paresthesia - sensations that occur without any reason. It could be:

tingling;
burning;
itching;
feeling of skin tightness;
crawling of goosebumps;
decreased sensitivity, etc.

Often only one small area is affected: finger, nose, foot, etc. Typically, such problems pass quickly, and the patient does not take them seriously for a long time until the severity of the symptoms becomes much stronger.

The disease can also manifest itself as a violation of temperature, pain or vibration sensitivity, and both a decrease and an increase in sensations are noted.

Pelvic function disorders

Damage to certain areas of the spinal cord leads to specific disorders that force a person to consult a urologist:

increased or decreased urination;
sudden and strong urge to urinate;
feeling of incomplete emptying of the bladder;
potency disorders in men, anorgasmia in women.

Movement disorders

Movement disorders occur at any stage of the disease. They are represented by a wide range of symptoms, including:

problems with fine motor skills (buttoning, sewing, etc.);
muscle weakness of varying severity;
decreased reflexes (detected during neurological examination);
muscle cramps, often occurring at night.

Emotional, mental disorders

This area is not often affected by multiple sclerosis, but as the disease progresses, a person may complain of emotional lability, irritability, memory impairment, apathy, etc.

Multiple sclerosis is characterized by a wide range of pathological foci, which is why signs of the disease are rarely limited to any one area. Often, a person notices several different symptoms at once, which occur simultaneously or replace each other. The doctor’s main task in this case is to tie everything together and prescribe tests that will help confirm or refute the diagnosis.

The disease will not go away, it will stop

Today there are about 2 million people with multiple sclerosis in the world. Every year this number continues to grow, and in large industrial areas and cities the incidence is higher. There are about 150 thousand patients with this diagnosis in Russia. Many people still associate the word “sclerosis” with memory impairment in older people, but “multiple sclerosis” has nothing to do with this. Except, perhaps, for one sad fact: this disease can actually lead to memory loss and other cognitive impairment.

“Multiple sclerosis is a chronic autoimmune disease that occurs when the body's immune system attacks its own neurons and damages the myelin sheath around nerve fibers in various parts of a person's brain and spinal cord. And this disrupts the conduction of electrical impulses in the brain and disorganizes the commutation of all information between different parts of the cerebral cortex. In fact, this is why the disease is called “multiple”, since it affects many parts of the brain. And it is called sclerosis because it leads to sclerosis, that is, scarring of tissue in the brain and the formation of plaques,” says professor, doctor of medical sciences Andrei Bryukhovetsky.

Andrey Bryukhovetsky runs the clinic and has been treating various neurological diseases, including multiple sclerosis, for many years. Bryukhovetsky is convinced: if 20 years ago the diagnosis of “multiple sclerosis” sounded like a death sentence, today medicine has stepped far forward. Yes, it is impossible to completely cure this disease, but there are many ways to stabilize the patient’s condition and stop the course of the disease for a long time.

“We now have a better idea of how the disease develops,” says Denis Korobko, candidate of medical sciences, neurologist at the Regional Center for Multiple Sclerosis and Other Autoimmune Diseases of the Nervous System.
– Due to the fact that there has been a significant breakthrough in understanding the mechanisms of disease development, in the last decade many targeted drugs have appeared that act on certain key points in the disease. The history of treatment for multiple sclerosis began in 1993, when the first drugs for therapy were registered, but they had a bad effect on the immune system. Not so long ago, we began to use drugs that only need to be administered a few times a year for a short course. If the first drugs for the treatment of multiple sclerosis required daily injections and could be accompanied by side effects, then the new group of drugs makes it possible to administer a short course once a year and keep the disease under control for a long time.”

One of the most popular treatments for multiple sclerosis is bone marrow transplantation. This is the process of transplanting a patient’s own hematopoietic stem cells. They are also called hemocytoblasts - these are the earliest precursors of blood cells. Hematopoietic stem cells are present in the red bone marrow, which in turn is found in the cavity of most bones.

“A bone marrow transplant stops the process completely in 50% of cases. I did this 12 years ago. I have patients whom I have been observing for 15-20 years, and their disease does not progress - we managed to stop it,” states Andrei Bryukhovetsky.

On the other hand, there is a group of patients for whom bone marrow transplantation does not help and is even contraindicated, the professor adds.

“We didn’t understand why before. Today, for the first time, we can say that the problem is post-genomic damage to the hematopoietic stem cell. If changes have occurred in the protein structure of this hematopoietic cell, then its descendants can become either immunotolerant, that is, not pay attention to pathologies (as a rule, patients develop tumors), or, conversely, auto-aggressive - they begin to damage their own tissue in different parts of the body . But in both cases these are postgenomic changes. If the cell is not damaged, then transplanting your own healthy ones allows you to restart the entire immune system, and the person is completely restored. I want to say again: the symptoms of the disease will not go away - the progression will end. This is a very important point, because many people think that they will do a bone marrow transplant and that’s it – the disease will go away. The disease will stop: for 15, 20, sometimes even 25 years it stops. We don't know what will happen next. Therefore, it is probably wrong to say “we cured you,” the doctor states.

Fortunately, modern medicine has a fairly wide arsenal of treatment methods, ranging from hormonal therapy to cellular approaches.

“Today we have a fairly large number of modern methods of treating this disease,” says Andrey Bryukhovetsky. – If earlier we managed with hormone therapy, plasmapheresis and plasma exchange, today immunotherapy plays a huge role, people are treated with new generations of drugs. For example, there is a fairly developed pharmacological direction - the use of all kinds of monoclonal antibodies that “knock out” auto-aggressive cells.”

Monoclonal antibodies are a new word in the treatment of multiple sclerosis. These are antibodies produced by immune cells derived from a single progenitor plasma cell. The use of drugs based on them, although it does not solve the problem as much as transplantation, does allow one to achieve long-term remission. However, there are also disadvantages here, the main one being the high cost of treatment, which turns vital procedures into a luxury.

“It’s great, but it’s very expensive,” admits Bryukhovetsky. – The cost of treating patients with multiple sclerosis is somewhere on average for any state at least 7 million rubles. This is the cost of one course! The cost of a course of one of the modern drugs made from monoclonal antibodies is 5,842,000 rubles. In addition, one course is not enough; as a rule, two courses are done once a year.”

However, in Russia today it is possible to get these medications for free. The fact is that multiple sclerosis is included in the list of diseases whose treatment is financed from the federal budget under the “14 high-cost nosologies” program. The list of drugs on the list is constantly updated, making advanced methods of therapy based on monoclonal antibodies available to Russian patients.

However, monoclonal bodies are far from the only method of treating multiple sclerosis. Thus, Andrei Bryukhovetsky admits that he is much more attracted to other, more modern approaches.

“I work mainly with cellular approaches; it seems to me that this is more correct and more promising. In 2005, Academician Yarygin and I visited Professor Oliver Brüstle in Bonn, where he showed us the amazing effectiveness of cell therapy using a model of multiple sclerosis in rats. He used oligodendrocytes (a type of nerve cell - editor's note) from the same animals. The academician and I were just sick of this idea and tried to repeat it. We were able to do this, but since the cells Brustley used were fetal (that is, from a fetus), they were banned in Russia,” said the professor.

Recently, he and colleagues have specialized in the treatment of multiple sclerosis using cell reinfusion. This process involves collecting and reinfusing the patient's own blood.

“Any bone marrow transplant can lead to death in 6-9% of cases. People with multiple sclerosis can live quite a long time, and in some cases the risk is quite unjustified. Therefore, we do a shortened version of this manipulation, calling it “reinfusion of cells against a suppressive background.” We also knock out aggressive cells with monoclonal antibodies, and after that we transplant the body’s own cells and reinfuse them after suppressing their background. This is a very effective method, we have very good results, and most importantly, there is virtually no risk of death,” assures the doctor.

Coronavirus and immune memory: how MS occurs

Multiple sclerosis, like many other diseases, begins and progresses differently for everyone. Let's say that some patients have cognitive impairment, while others do not have such problems. As Professor Bryukhovetsky explains, it all depends on in which part of the body the process of sclerosis began.

“It all depends on where the plaque is located. If this is the cortical department and the cortical neurons suffer, then first of all, of course, the brain suffers. If the plaque disrupts the commutation relationships of different parts of the brain, then cognitive function also suffers. Imagine: there are wires, these wires have a braid. This braid is the myelin sheath that covers the axons. If the insulating component disappears, the wires begin to contact each other, that is, the impulse begins to move from one wire to another, and you understand what this can lead to. It all depends on the amount of damage. Therefore, it is not at all necessary that patients with multiple sclerosis will have any intellectual defects,” explains the doctor.

Another fact that is important to know about multiple sclerosis is that it is a neuroinfection. As a rule, they are triggered by neuroinfectious processes: influenza, which we often do not pay attention to and carry on our feet, herpes and, by the way, coronavirus, which today is the most “popular” disease in the world.

“Believe me: now some period of time will pass, and a huge number of patients with demyelinating diseases (a category of diseases of the central nervous system, which includes multiple sclerosis - editor’s note) will be after the coronavirus, because it also has a pronounced neurotropic effect,” explains Bryukhovetsky . – You were sick, suffered from some kind of infectious disease - flu, sore throat, etc. It would seem like something harmless. And suddenly after that you have visual impairment. This is the first and most common symptom of multiple sclerosis. Therefore, we are very afraid of these eye symptoms, they are very bad harbingers. As a rule, they are not noticed. A person goes to an ophthalmologist, who examines him and says: “Yes, everything is fine with you, there’s nothing to worry about!” And the person forgets about this situation. It is then that the phenomena of paresis and paralysis develop.”

The reason for referral to a multiple sclerosis specialist is most often “findings” on MRI, notes Denis Korobko:

“If we talk about the most typical symptoms, these could be: decreased vision, accompanied by pain in the eyes, various disorders of the musculoskeletal system, weakness in the limbs, unsteadiness, “drunk gait,” impaired sensitivity, numbness, dysfunction of the pelvic organs. The patient, as a rule, may first contact a general practitioner or neurologist, who will then refer him for an MRI. Only then does the person see a specialist who treats multiple sclerosis. It is very important to obtain a confirmed diagnosis, because there are many diseases that are similar in MRI indicators, but have a completely different mechanism of development, and therefore different treatment. These can be metabolic, genetic diseases, cardiovascular pathologies.”

Many people believe that multiple sclerosis is inherited. In fact, this disease is based on much more complex, deep-seated processes than we can imagine.

“In this regard, very interesting work was published in March of this year by specialists from the University of Dresden. They proved that the main immune memory of our body is not in peripheral auto-aggressive cells, but in a hematopoietic stem cell. They created a model of infection on a polysaccharide and showed that a polysaccharide bacterial molecule, entering the body for the first time, leaves a trace. So-called enhancer proteins—memory proteins—are formed near DNA. And when our hematopoietic cell encounters this antigen for the second time, it instantly reacts to it, because opposite the DNA there is a mark, a “bookmark”. That is, every infection that we suffer makes many such “bookmarks”. And we carry these “bookmarks” that were passed on to us by previous generations. This is epigenetic structural inheritance. Not the heredity that is in our genome, as is the case with a hereditary disease. This is a hereditary immune memory,” explains Andrey Bryukhovetsky.

Nevertheless, there are from 5 to 7% of familial cases of the disease, notes Denis Korobko. In this regard, he advises never hiding your diagnosis from your relatives, since this knowledge can speed up the process of diagnosing the disease in one of your loved ones.

Another interesting fact (albeit of little comfort for Russia): it turns out that residents of northern latitudes suffer from multiple sclerosis much more often than southerners.

“Northerners are more likely to suffer from multiple sclerosis, this is well known. According to Israeli scientists for 2021, about 3 million people worldwide suffer from multiple sclerosis; in Israel itself there are only about 5 thousand. And mostly this is the North: Great Britain, Sweden, Switzerland. According to the European [Health] Association, almost 2.3 million people there suffer from multiple sclerosis, that is, more than 100 thousand in the UK alone. I say again: multiple sclerosis is primarily a neuroinfection, therefore, like any infections, it is more common among northerners, since they have more colds,” says the professor.

It is worth clarifying that multiple sclerosis itself is no longer the cause of human death. As a rule, the cause of death is complications.

“Previously, death in multiple sclerosis occurred with the addition of some secondary infections, pneumonia, or urinary tract infections. And since today we do not allow side diseases to develop by starting therapy on time, there is no death from multiple sclerosis. In fact, the cause of death may simply be any concomitant diseases, but not multiple sclerosis itself,” assures Denis Korobko.