February 16, 2016 at MONIKI them. M.F. Vladimirsky held a scientific and practical conference ” Demyelinating diseases”. Chairman of the Scientific Committee – Sergei Viktorovich Kotov – Chief Neurologist of the Ministry of Health of the Moscow Region, Chairman of the Moscow Regional Society of Neurologists, Head of the Neurological Department, Head of the Department of Neurology of the Faculty of Advanced Training of Doctors at the Moscow Regional Research Clinical Institute named after M. Vladimirsky. In his report, he spoke about the mechanism of occurrence of demyelinating diseases, as well as how they are treated.
Demyelinating diseases, combined into a group of neurological disorders, represent an important problem. This is due, on the one hand, to their prevalence, and on the other hand, to the disability that accompanies them. Demyelinating diseases – it CNS disease in which the myelin sheath is affected, leading to expose nerve fibers. With demyelination, the conduction of nerve impulses through the affected area is disrupted, which leads to various manifestations: visual impairment, muscle weakness, increased muscle tone, impaired coordination, and dysfunction of the pelvic organs.
At the beginning of the conference were presented short reports of doctors neurological department of such demyelinating diseases like multiple sclerosis Balsa (EV Mukhina) optica Devic (SB Magomedov), Marburg disease (KV Firsov). Further, the issues of diagnosis and treatment of multiple sclerosis in adults and children were discussed.
Multiple sclerosis is the most common pathology among demyelinating diseases of the central nervous system; around 2.1 million people worldwide have multiple sclerosis. Multiple sclerosis is an autoimmune disease in which the body’s immune system begins to destroy its own nerve tissue by damaging myelin. Due to damage to myelin, as we said above, the conduction of impulses along the nerve fibers is disrupted: a person has weakness in the legs, arms, impaired speech and vision. Multiple sclerosis begins in almost 60% of cases between the ages of 20 and 40, the average age of clinical onset ranges from 29 to 33 years. Currently, the early onset of multiple sclerosis in childhood (10-12 years) is increasingly reported, which accounts for 2-8% of the total number of patients with multiple sclerosis.
Olga Vladimirovna Bykova , Dr. med. Sci., Chief Researcher, GBUZ Scientific and Practical Center for Pediatric Psychoneurology, DZM. Tatyana Igorevna Yakushina – senior researcher of the neurological department of the M.F. Vladimirsky. Treatment of multiple sclerosis is carried out with the help of MITRS – drugs that change the course of multiple sclerosis. They affect the body’s immune system and slow down the destruction of myelin. It is possible to suppress the inflammation that occurs during the acute process of demyelination with the help of special synthetic hormonal agents. Also, drugs have been created that allow you to restore the nervous tissue, but so far they have not been registered in Russia. Also at the conference, the issue of how to properly prescribe PITRS for children was discussed, the report was presented by Margarita Vladimirovna Panteleeva – senior researcher of the neurological department of the N.N. Vladimirsky.
Very often, patients diagnosed with multiple sclerosis also suffer from various kinds of mental disorders. Sergey Viktorovich Kotov gave a brief overview of these diseases. In the course of the disease, pronounced asthenic disorders come to the fore. Asthenic syndrome is characterized by symptoms of general weakness, rapid fatigue during mental and physical exertion. Asthenic syndrome affects up to 80% of patients, 70% experience it almost daily. Asthenia can be accompanied by a lowered background of mood or, conversely, euphoria with an inexplicable feeling of well-being, despite a decrease in professional capabilities.
Multiple sclerosis is also characterized by the development of depression that occurs at various stages of the course of the disease. Depression is the most common behavioral disorder in multiple sclerosis. It is detected in almost half of patients, and in 20-25% of patients it is so pronounced that it requires treatment by a specialist. Depression can be the result of a difficult situation or stress at the diagnosis. It can also be caused by the disease itself: the myelin covering of the nerves that transmit signals that affect mood is destroyed. Depression can also be a side effect of some drugs used to treat multiple sclerosis.
With multiple sclerosis, a disorder of the patient’s cognitive functions occurs, but it almost never reaches the degree of dementia. The spectrum and severity of impairments in the cognitive sphere is diverse: some patients have pronounced cognitive deficits already at the initial stages of the development of the disease, while others may never experience cognitive difficulties or have small changes. Most often, in multiple sclerosis, the following cognitive impairments are encountered: impaired short-term and delayed memory, impaired maintenance of active attention and the timing of its switching, impaired speed of sensorimotor reactions, impaired abstract and conceptual thinking, impaired visual perception.
The most severe, but rare clinical mental disorders in multiple sclerosis include polymorphic psychotic states. These conditions can include a very wide range of psychopathological manifestations – from fragmentary deceptions of perception to vivid, sometimes prolonged, psychotic episodes with polymorphic productive symptoms.
It is very important in the early stages of the disease with multiple sclerosis to identify abnormalities in the patient’s psyche and refer him to the appropriate specialist. Since this will help a person not to lose the quality of life and remain a full-fledged member of society for as long as possible.