Multiple sclerosis surgery price. Treatment of otosclerosis

• stem cell transplant;
• radon baths;
• antler baths;
• acupuncture and acupuncture;
• gymnastics and exercise therapy ( physical therapy);

Plasmapheresis

The fact is that with an exacerbation of the disease in the patient’s blood, the concentration of immunoglobulins G and other immune complexes increases, which then penetrate the central nervous system, causing the development and progression of the autoimmune process. The more of these substances in the patient’s body, the more severe the exacerbation will be. During the plasmapheresis procedure, the blood is cleansed of these substances, which reduces the severity of autoimmune processes, thereby easing the course of the disease and preventing the development of complications.

The plasmapheresis procedure itself is relatively simple, but is associated with certain risks, and therefore should only be performed in a hospital setting. Its essence is as follows. First, the patient is given a vein ( usually in the elbow area) a special catheter is installed. Next, a plasmapheresis device is connected through it. After turning on the device, blood from the patient’s vein will flow into its special compartment, where it will be purified. Next, the purified blood will be returned to the body, and a new portion of blood will be pumped into the device.

The process of purifying plasma from immune complexes and antibodies occurs relatively slowly, and therefore the duration of the procedure can reach an hour and a half or even more. After the procedure is completed, the device is disconnected from the patient, but the catheter installed in the vein is left in place, since plasmapheresis may need to be repeated in the future.

The course of treatment usually includes 5 – 10 procedures performed every other day. At the same time, in case of severe exacerbation of multiple sclerosis and in case of ineffectiveness of other treatment methods, plasmapheresis can be performed daily.

Plasmapheresis is contraindicated:

• For severe anemia ( anemia). During the procedure, a small number of red blood cells may be destroyed. Under normal conditions, this will not affect the patient's condition in any way, but in severe anemia ( when the hemoglobin concentration in the blood is less than 70 grams/liter) this can lead to the development of severe complications.
• With myocardial infarction. Plasmapheresis can be performed no earlier than 4 to 6 months after myocardial infarction.
• In case of a violation of the blood coagulation system. If the patient has a tendency to bleed, plasmapheresis can be performed only after correction of existing coagulation disorders.
• For severe liver diseases. With pathologies such as cirrhosis or liver cancer, a pronounced decrease in the concentration of proteins in the blood may be observed. After performing plasmapheresis, this can lead to the development of edema and other complications, and therefore the procedure should be prescribed with extreme caution.

Transplantation ( transfer) stem cells from bone marrow ( TSK) with multiple sclerosis

The fact is that in the body of every person there are so-called stem cells. They are poorly differentiated, that is, they perform practically no functions ( unlike all other cells). Their peculiarity is that under certain conditions they can differentiate ( transform) into almost any cell of the human body.

As a result of many studies, it was found that stem cell transplantation into patients with multiple sclerosis leads to partial restoration of impaired motor functions. It is assumed that these cells enter the central nervous system and find damaged neurons ( nerve cells), after which they turn into them, beginning to perform their functions. At the same time, it is worth noting that the exact mechanism of action of stem cells in multiple sclerosis has not been fully established.

The process of stem cell transplantation itself is quite labor-intensive and requires large financial and time costs. First, a certain amount of material is taken from the patient's bone marrow ( Most of the stem cells are located there). Then necessary cells separated and grown in special conditions, after which it is administered intravenously to the patient once a month. The duration of treatment can reach 2 or more years, but the first results ( improvement of motor activity in paralyzed limbs) can be noticeable after 6 – 12 months.

Radon baths

Radon is a radioactive substance that can be enriched in air or water. When the body is exposed to radon, the process of cell division of the immune system is disrupted, which can help to subside the exacerbation of multiple sclerosis.

Despite the danger of the method, many sanatoriums still continue to use radon baths as complex therapy for multiple sclerosis and many other diseases.

Acupuncture ( acupuncture)

With acupuncture you can:

• reduce the severity of muscle pain;
• eliminate headaches;
• eliminate dizziness;
• normalize sleep;
• reduce the likelihood of developing seizures and so on.

Exercises ( gymnastics, exercise therapy, physical therapy) for patients with multiple sclerosis

A set of exercises is selected by the attending physician individually for each patient. It depends on the stage of development of the disease, general condition the patient, as well as the predominance of certain symptoms. So, for example, exercises for a patient with paralyzed legs will be different from exercises prescribed for a patient with paralyzed arms, visual impairment, and so on.

The principles of gymnastics and exercise therapy for multiple sclerosis are:

• Individual approach. Each patient should select exactly those exercises that will allow maximum use of the affected muscle groups and nerves.
• Gradual increase in loads. Regardless of the stage and severity of the disease, you should begin to exercise gradually. From the first days you should do simple exercises for no more than 10 - 15 minutes. Further ( on average every 5 – 7 days) you can increase both the duration of classes and their intensity ( adding new exercises or increasing the number of repetitions of each of them).
• Avoiding overwork. The patient should not experience any discomfort during the exercises. If shortness of breath occurs ( feeling of lack of air), dizziness, blurred vision, or acute pain in any part of the body, you should immediately stop doing the exercises and resume them the next day.
• Take regular rest. It is important to remember that restoration of the body is one of the most important points in physical therapy. Adequate sleep and a balanced diet will make the exercises as effective as possible and, at the same time, safe for the patient.

• Improve microcirculation in all tissues, including the central nervous system. This will increase the delivery of oxygen to neurons, thereby reducing the likelihood of their death.
• To increase the patient’s resistance to physical stress, thereby preserving his ability to work and the ability to self-care for a longer period, while increasing his quality of life.
• Maintain muscle tone, thereby preventing their atrophy ( decrease in muscle mass accompanied by loss of muscle strength).
• Keep the nervous system in good shape. The fact is that with regularly performed exercises, the corresponding nerve impulses pass through the nerve fibers. It stimulates metabolic processes in neurons, thereby reducing the likelihood of their death during the development of inflammatory processes.

For multiple sclerosis, you can do:

• Exercise 1. Starting position sitting or standing. First, you should take a maximum breath through your nose, while raising your arms up above your head, and then slowly and completely exhale the air, lowering your arms down.
• Exercise 2. Starting position sitting on a chair ( barefoot). Without lifting your heels from the floor, you should bend your legs at the feet, trying to raise your toes as high as possible. After this, you should return your legs to their original position, and then, without lifting your toes from the floor, raise your heels as high as possible.
• Exercise 3. Starting position sitting or standing. With your arms stretched out in front of you, palms down, you should alternately bend and straighten them at the hands ( simultaneously). Then, remaining in the same position, you should begin to bend one arm, while at the same time extending the other, which will improve coordination of movements.
• Exercise 4. Starting position: sitting, legs slightly apart, hands on knees, palms down. Turning your hands over with your palms up, you should synchronously move your feet apart, and then also simultaneously return them to their starting position. This exercise, like the previous one, improves fine motor skills and coordination of movements in the limbs.
• Exercise 5. Any starting position. First, you should put your hands together, palms facing each other, with your fingers spread out. Then, without lifting your fingertips from each other, you should bring them all together and then return them to their original position. This exercise improves fine motor skills of the hands and also reduces the severity of tremor ( shaking).
• Exercise 6. Starting position: sitting on a chair, legs bent at the knees and brought together. When lifting one leg, you should move it as far as possible to the side and lower it to the floor, and then return it to the starting position in the same way and repeat the exercise with the other leg. If your legs “don’t obey” or the exercise is too difficult, you can hold them with your hands in the initial stages.
• Exercise 7. Starting position: standing, legs brought together, hands on the belt. Perform circular movements with the pelvis, first in one direction, then in the other direction.
• Exercise 8. Starting position: standing, feet shoulder-width apart, arms at your sides. When taking a step forward, you should smoothly raise your arms up while doing deep breath. After this, you should return to the starting position, exhaling as much as possible.
• Exercise 9. Starting position lying on your back. When performing the exercise, you should alternately bend and straighten your legs knee joints, while the heel of the leg being bent should not be lifted off the floor.
• Exercise 10. Starting position: lying on your back, legs bent at the knees, fingertips touching your shoulders. Flexing right leg V hip joint, you should try to reach your left elbow to your right knee ( so that they touch), then return to the starting position and repeat the exercise with your left leg and right arm.

Massage for multiple sclerosis

For multiple sclerosis, massage is indicated:

• backs;
• heads ( improves blood supply to brain tissue) and so on.

• At infectious lesion skin in the affected area.
• For tumor diseases of the skin.
• At high body temperature ( more than 38 degrees).
• If there is a violation of the blood coagulation system ( During the massage, hemorrhage may occur in the muscles or other tissues).
• For mental disorders in the acute stage.

Physiotherapy

It is immediately worth noting that all of the listed procedures should be used only in the stage of clinical remission ( beyond the exacerbation of the disease). Also, in case of multiple sclerosis, any warming procedures are absolutely contraindicated, since an increase in body temperature can provoke an exacerbation of the disease.

Physiotherapy for multiple sclerosis

Phytotherapy

It is worth noting that phytotherapeutic drugs should be selected individually in each specific case, depending on the form and stage of the disease, as well as the predominance of certain symptoms, the general condition of the patient and other factors.

Herbal medicine for multiple sclerosis

ILBI ( intravenous laser blood irradiation) with multiple sclerosis

The positive effects of laser irradiation include:

• Improving blood flow. Laser irradiation of red blood cells ( red blood cells) increases their strength and stability, thereby extending their life. At the same time, when exposed to laser irradiation, the so-called “deformability” of red blood cells increases, that is, their ability to change their shape. As a result, red blood cells can pass through small blood vessels, delivering oxygen to all parts of the central nervous system. This improves the nutrition of neurons, increasing their stability in conditions of the inflammatory process.
• Improving blood transport function. With laser irradiation, the ability of red blood cells to bind and transport oxygen also increases.
• Anti-inflammatory effect. It is assumed that laser irradiation reduces the activity of antibodies and immune complexes circulating in the patient’s blood during an exacerbation of multiple sclerosis. This reduces the severity clinical manifestations diseases and prevents the development of complications.

• In case of a violation of the blood coagulation system– Bleeding may develop during the procedure.
• In the presence of tumor diseases– the risk of their progression remains.
• For severe infectious diseases.
• In case of renal and/or liver failure.
• In severe heart failure, it can lead to sudden death of the patient.
• When the patient is mentally unstable.
• With the development of seizures.

Hirudotherapy ( treatment of multiple sclerosis with leeches)

It is also worth noting that the positive effect of hirudotherapy may be associated with blood thinning that develops after the procedure. This is due to the fact that during a leech bite, a special substance, hirudin, enters the patient’s tissue. Hirudin thins the blood, improving its fluidity, as a result of which microcirculation in tissues affected by the inflammatory process improves ( including in the central nervous system). This can also help speed up the recovery of damaged nerve fibers.

At the same time, it is important to remember that hirudotherapy should be used only in combination with other ( medicinal) treatment methods, since otherwise further progression of the disease and the development of a number of complications are possible.

Is surgery necessary for multiple sclerosis?

Is apitherapy effective in treating multiple sclerosis? bees, bee venom)?

Bee venom has:

• Anti-inflammatory effect. One of the causes of damage to nerve fibers in multiple sclerosis is the development of an autoimmune inflammatory process in the central nervous system. Cells of the immune system are directly involved in this. Included in bee venom MSD peptide blocks the activation of some of these cells, thereby reducing the severity of inflammatory phenomena. This slows down the progression of the disease and the development of complications.
• Antioxidant effect. Prevents damage to nerve fibers and other tissues of the central nervous system at the site of inflammation.
• Antihypoxic effect. Improves oxygen delivery to nerve cells and their fibers, thereby increasing their resistance when exposed to various pathological factors.
• Rheological effect. Improves rheological properties ( fluidity) blood, thereby facilitating the delivery of oxygen to the affected areas of the central nervous system. This, in turn, helps restore damaged nerve fibers.

Nutrition ( Embry diet) with multiple sclerosis ( what you can and cannot eat)

The principles of diet therapy for multiple sclerosis are:

• Balanced diet. The diet should contain proteins, fats and carbohydrates in required quantities. At the same time, it is recommended to limit the consumption of animal proteins, as they can contribute to the progression of the disease.

• Regular meals. Patients are recommended to eat 4-5 times a day in small portions, which will avoid complications from gastrointestinal tract and digestive systems ( constipation, diarrhea and so on).
• Proper drinking regime. For multiple sclerosis, it is recommended to limit fluid intake to 1.5 - 2 liters per day. Firstly, this will prevent the development of cerebral edema during an exacerbation of the inflammatory process. Secondly, in case of dysfunction of the bladder ( that is, with urinary incontinence) this will reduce the frequency of involuntary urination.
• Eating foods rich in linoleic acid ( walnuts, vegetable oil, whole grain cereals). This acid is part of the cell membranes of most cells of the human body, including nerve fibers. With its deficiency, there is a more rapid destruction of the myelin sheaths and damage to the processes of nerve cells, accompanied by an irreversible disruption of their functions.
• Exclusion of foods to which the patient is allergic. Consuming even a small amount of such a product can further stimulate the immune system, thereby provoking more pronounced damage to the nervous system.

According to the Embry diet, the following should be excluded from the diet:

• Milk and dairy products.
• Gluten containing products– cereals, soy products, candies and so on.
• High Protein Products – butter, margarine, cheeses, yoghurts.
• Carbonated drinks.
• Foods that can cause allergies– chocolate, citrus fruits and so on.

Green tea for multiple sclerosis

At the same time, it is worth remembering that excessive fluid intake can negatively affect the functions of the central nervous system in multiple sclerosis, as a result of which it is not recommended to drink green tea more than 2 times a day ( 1 cup each).

Can you drink coffee if you have multiple sclerosis?

Coffee should be completely excluded from the diet:

• If there are seizures and/or tremors ( trembling limbs). Due to its stimulating effect on the central nervous system, coffee may exacerbate these symptoms.
• For urinary disorders. Coffee stimulates the release of fluid from the body. With urinary retention, this can lead to bladder overflow and damage to its muscle layer, while with urinary incontinence, the patient will experience frequent involuntary urination.
• For headaches. Drinking coffee can lead to increased blood pressure, which will be accompanied by increased headaches.
• At mental disorders. Stimulation of the central nervous system in a mentally unstable patient can lead to severe exacerbations, psychosis, and so on.

Is a raw food diet effective against multiple sclerosis?

At the same time, it is worth noting that a raw food diet may come with certain risks. For example, if eating raw foods plant origin will not cause any particular harm to the patient; consumption of raw meat or fish products can lead to the development of food toxic infection, inflammation of the mucous membrane of the gastrointestinal tract, and the development of severe allergic reactions and other complications that will adversely affect the course of multiple sclerosis.

Is fasting beneficial for multiple sclerosis?

Can you drink alcohol if you have multiple sclerosis?

At the same time, in high concentrations, alcohol inhibits the activity of brain neurons, as a result of which depression may develop, paralysis of the limbs may increase, and urinary disorders and other disorders may occur.

Consequences, complications and prognosis ( Why is multiple sclerosis dangerous?)

Multiple sclerosis can be complicated by:

• Skin infections. In advanced cases, a person loses the ability to move independently, as a result of which he may develop bedsores ( destruction of the skin in the area of ​​compression). At improper care Bedsores can become infected, which without proper treatment can lead to the patient's death from a systemic infection.

• Pneumonia. When a patient becomes unable to move independently, the risk of developing respiratory infections increases, which can lead to pneumonia ( pneumonia).
• Muscular atrophy. Complete atrophy of skeletal muscles ( decrease in muscle mass) develops in advanced cases of the disease and is one of the reasons for the patient’s loss of ability to self-care.
• Complete loss of vision. Associated with bilateral optic nerve damage.
• Mental disorders. At the final stages of the disease, the patient may experience severe disturbances in thinking, memory and psyche.
• Heart failure. This is associated with muscle atrophy and a sedentary lifestyle, resulting in impaired nutrition and heart function.

Can cancer develop with multiple sclerosis?

EDSS Disability Scale for Multiple Sclerosis

When examining a patient, the following are assessed:

• visual impairment;
• speech and swallowing disorders;
• muscle strength disorders;
• impaired coordination of movements;
• sensitivity disorders;
• mental disorders;
• disturbances of urination and/or defecation, as well as sexual functions.

Is a disability group given when diagnosed with multiple sclerosis?

The rate of development of disability is affected by:

• Period of onset of the disease. When onset in early childhood, disability develops more quickly.
• Patient's gender. Severe, disabling forms of multiple sclerosis are more common in men than in women.
• Treatment being carried out. Patients who are treated for a disease lose their ability to care for themselves much later than those who do not receive any treatment.
• Patient's lifestyle. Proper nutrition, good sleep and an active lifestyle delay the period of development of disability, while smoking, alcohol abuse and a sedentary lifestyle contribute to the rapid development of complications.

A patient with multiple sclerosis is given:

• 3 disability group ( 3 – 4.5 points on the EDSS scale) – if the patient’s ability to work is limited, but he can care for himself and perform work that does not require heavy physical effort.
• 2nd disability group ( 5 – 7 points on the EDSS scale) – if the patient cannot perform any work, and for self-care he requires the help of strangers or special devices ( For example, wheelchair for movement).
• 1st disability group ( 7.5 – 9.5 points on the EDSS scale) – if the patient cannot care for himself without assistance.

How long do people with multiple sclerosis live? life expectancy)?

With multiple sclerosis, a patient may die:

• From infectious complications– with improper care.
• From dysfunction of the heart muscle.
• From lack of nutrition– with improper care and inability to self-care.
• For seizures- during seizure Respiratory function may be impaired, which will be the immediate cause of death.
• For cerebral edema– damage to brain tissue that occurs against the background of an exacerbation of the disease or seizures and is accompanied by loss of consciousness, cessation of breathing and/or heartbeat.
• From injury- for example, if you fall and hit your head during dizziness or loss of consciousness, as well as against the background of mental disorders.

What can and cannot be done with multiple sclerosis ( restrictions and contraindications)?

Does multiple sclerosis affect pregnancy ( Is it possible to get pregnant with multiple sclerosis?)?

Exception from of this rule may constitute severe, advanced cases of the disease, when there is a pronounced impairment of motor, sensory, mental and mental functions. Since in most cases these disorders are irreversible, such women are not recommended to become pregnant at all.

It is also worth noting that the process of conception may be affected by the decrease in sexual desire observed in multiple sclerosis ( especially in combination with depression). However, the physiological functions of the woman are not impaired, as a result of which, when eliminating psychological problem she might get pregnant.

Is it possible to give birth with multiple sclerosis?

Breastfeeding with multiple sclerosis

It is widely known that during pregnancy, multiple sclerosis goes into clinical remission. At the same time, after childbirth, the frequency of exacerbations in women increases sharply. As a result of the studies, it was possible to establish that if a woman regularly breastfeeds her newborn baby for at least 6 months, her risk of exacerbation of multiple sclerosis is reduced by almost 2 times ( compared to women who do not breastfeed at all). It is assumed that the mechanism of action of this phenomenon is the inhibition of ovarian function against the background of breast milk production, which is also associated with hormonal changes in the female body.

Is it possible to get vaccinated if you have multiple sclerosis?

The essence of vaccination is that a certain amount of viral or bacterial particles is introduced into the human body. These particles themselves cannot cause infection, but they stimulate the human immune system. If after this a real virus or bacteria enters the vaccinated body, the immune system will cope with them much faster.

The danger of vaccination during an exacerbation of multiple sclerosis is that it can lead to excessive stimulation of the immune system, as a result of which it will increase the severity of damage to nerve cells in the central nervous system. That is why vaccinations can be performed no earlier than a month after the stage of clinical remission has been established.

Prevention, rehabilitation and recovery for multiple sclerosis

Secondary prevention of multiple sclerosis includes:

• Preventing the development of viral infections and their timely treatment– infectious diseases can become a provoking factor in the development of exacerbation.

• To give up smoking– Smoking increases the risk of developing multiple sclerosis and the frequency of its exacerbations.
• Maintenance normal temperature body– an increase in temperature due to overheating, as well as during bacterial and viral infections, can trigger an autoimmune process and lead to an exacerbation of the disease.
• Proper nutrition– You should avoid foods that can cause allergic reactions.

Is there a vaccine for multiple sclerosis?

Rehabilitation of patients with multiple sclerosis

• Lead an active lifestyle, paying attention to sports events, gymnastics and physical therapy. It is recommended to do light jogging, swimming, cycling, athletics, and yoga.
• Eat properly and nutritiously, avoiding periods of prolonged fasting.
• Get enough sleep regularly.
• Avoid heavy, exhausting physical work or exercise.
• Regularly visit your doctor to assess your general condition, as well as adjust the treatment.
• Strictly follow your doctor’s recommendations regarding medications and non-drug treatments.
• Avoid overheating the body ( do not visit baths, steam rooms, saunas), as this can provoke an exacerbation of the disease.

Is it possible to drive a car with multiple sclerosis?

Patients should also not drive:

• in the presence of mental disorders;
• for depression;
• with memory impairment;
• in case of violation of mental functions;
• with decreased visual acuity;
• in the presence of convulsions and tremors ( shaking) in the arms or legs and so on.

Is it possible to sunbathe at sea if you have multiple sclerosis?

Modern doctors classify otosclerosis as genetic diseases ear, affecting the ear labyrinth, and often also the auditory ossicle. The disease can progress quite quickly, gradually reducing auditory activity. Moreover, hearing loss is the cause of fixation of the ear stapes in the oval cavity of the vestibular apparatus.
To date, the causes of symptoms of otosclerosis in humans have not been fully established. At the same time, statistics indicate more cases of the disease being detected in women than in men. The appearance of otosclerosis is mainly provoked by the following factors:
Paget's disease;
chronic or long-term inflammation of the ear, which causes necrosis of the auditory bones;
congenital fixation of the internal stapes;
genetic abnormalities of the hearing organs.
The first signs of otosclerosis usually manifest themselves at a fairly young age, and sometimes even in childhood. It is important to identify the disease as early as possible, since in the future it can lead to complete deafness. It is known that 1-2% of the total population has a predisposition to otosclerosis, but only 10-15% of all patients have clinical manifestations.
The main “bell” for diagnosing otosclerosis is hearing loss, which regularly progresses. The patient may experience discomfort from tinnitus and excruciating pain that envelops the entire head. Also, the symptoms of the disease are characterized by dizziness and increased hearing in noisy places (by the way, this is precisely the hallmark of the disease).
Otosclerosis has 3 forms of disorder: conductive (impaired sound conduction), mixed (disorder and impaired sound conduction) and cochlear (sound perception functions of the ear are practically absent) disease. Also, according to the speed of manifestation of symptoms, disorders of the auditory organs are divided into fulminant, slow and spasmodic otosclerosis. But at the same time, each of these otosclerosis goes through 3 stages of development - initial, clinically clear manifestations and terminal.
To diagnose otosclerosis, doctors prescribe audiometry, and subsequently tympanometry.
Modern medicine has only 2 ways to cure this disease - using a hearing aid on a regular basis and surgical intervention - surgery.
The first operation on the structures of the middle ear, which subsequently improves hearing, was performed by ear surgeon John Shea in 1956. Since then it has been called stapedectomy. To date, this operation is the only one effective measure fight against otosclerosis.
Today, otosclerosis is treated by surgical intervention on the stapes. Moreover, it is carried out exclusively when the stapes with the oval window or auditory ossicles is in a fixed state. During the operation, the congenital element is removed and replaced with a prosthesis. Sometimes, in the stapes itself, it is possible to create a small cavity into which an artificial prosthesis is inserted - a kind of valve. The results of such a surgical intervention are amazing: in 9 cases out of 10 operations performed, hearing not only returns, but also becomes almost 100%.
When suffering from otosclerosis, surgery is impossible in a number of cases, including threatening dizziness and tinnitus, only one functionally hearing ear, active foci of otosclerosis, low level reserves of the cochlea and the severe clinical condition of the patient. If at least one of the above factors is detected, doctors prescribe additional research and stationary observations.
For otosclerosis, surgery is performed using general anesthesia. A miniature instrument and a special microscope are inserted into the ear ear canal. A circular incision is made on the eardrum, making it possible to get close to the flap of the eardrum and lift it up. Next, the stirrup is removed, and a bone prosthesis made of a special type of safe plastic is installed in its place. The bones are connected, the membrane is set in place, and doctors treat the passage with an antiseptic swab. For better healing surgical site, it is sometimes recommended to cut the earlobe and extract some fatty tissue from it, which is subsequently installed directly into the middle ear. The postoperative period during which the patient is cared for in the hospital does not exceed 7 days.
Rehabilitation in the first days after otosclerosis surgery is characterized by some uncomfortable feeling in the ear cavity and the possibility of mild pain. Mild painkillers generally relieve unpleasant pain. In addition, it is forbidden to blow your nose and sharply inhale air through the sinuses. Otherwise, the pressure in the eardrums may be exceeded, which may lead to impaired healing of the flap due to its displacement or mobility.

Multiple sclerosis can occur in people between 18 and 60 years of age, but most often it appears in youth. Females are more at risk of getting sick than males. Multiple sclerosis is not a hereditary disease.

Reasons for appearance

Today there is a hypothesis that this disease may arise due to the action of autoimmune processes that are associated with the nervous system or with viral diseases that arose in a person in childhood. In case of exacerbation, inflammatory foci are formed, as a result of which the electrically insulating membrane, which covers the axons of many neurons, swells. After some time, swelling and inflammation slowly disappear, but scar marks or affected areas remain. All processes of nerve cells remain intact and unharmed. This provides an opportunity to comment on why people experience full or partial recovery. However, it is worth noting that if a new lesion appears next to the old one, then full recovery There can't even be any talk.

Signs of multiple sclerosis

In almost half of the cases, this disease manifests itself as disturbances in motor system: spasms, weakness when moving, loss of coordination. Colic in the hands and feet, or numbness, may occur. Some people begin to have vision problems: double vision or blurred vision. Also, it may break sexual function, control over urination is lost. In a small number of patients, mainly those who have suffered from sclerosis for a long time, their intelligence decreases.

Diagnosis of sclerosis

This disease is diagnosed through a neurological examination, a conversation with a doctor, and other methods. Today in modern medicine Multiple sclerosis can be most accurately diagnosed using magnetic resonance imaging, and in an unhealthy person, the level of gamma and immunoglobulins in the cerebrospinal fluid increases. Considering that immunological reactions are the main ones in the progression of sclerosis, it is important to constantly check them in patients: take blood for an immunological analysis. This is necessary in order to compare the indicators of the immune system of a sick person at different times.

Treatment and preventive measures

For mild exacerbations, this disease is treated big amount medications: drugs that improve tissue blood flow, restoratives, vitamins, sedatives, antioxidants and, if necessary, antidepressants. In severe forms of exacerbation, prescribed hormonal agents. During the five-day period, you need to take large doses of hormones. This method is called pulse therapy in medicine. The use of drugs that suppress the immune system and anti-inflammatory drugs makes it possible rapid recovery and reducing the duration of exacerbation. Hormones, as a rule, are not taken in long courses, which does not allow side effects to develop, and therefore they are the smallest. Also, fairly common medical procedures are massage, cleansing the blood of harmful toxins, etc.

Multiple sclerosis Quite often it is expressed by exacerbations, which contribute to the occurrence of other serious ailments. To prevent them, it is necessary to carry out preventive measures, which include the use of immune modulators. These drugs help proper operation immunity, which accordingly makes it possible for exacerbations to manifest themselves to a lesser extent, and also slows down the progression of the disease.

Traditional medicine treatment

First of all, people suffering from this disease should correct image life. A complete cessation of smoking and drinking alcohol is necessary; in the summer you need to protect yourself from the sun and never swim in hot water. An effective remedy for the treatment of multiple sclerosis is mumiyo. It strengthens and fills the body with vitamins and essential microelements. Also, it is effective royal jelly: normalizes metabolism and increases the level of protection of the entire body. People suffering from this disease should not be wiped apple cider vinegar, which is pre-diluted with water. Freshly squeezed juices and oatmeal will be very useful.

Activities such as swimming and sports training are postponed multiple sclerosis into the background, and are excellent ways to treat it.

With this disease, certain features are observed in the administration of various types of anesthesia.

General characteristics of the disease

In multiple sclerosis (MS), the myelin sheath of nerve fibers is destroyed. This disease is considered autoimmune, since it is the body itself that produces antibodies that destroy myelin.

Multiple sclerosis is an autoimmune disease

Peripheral nerves, brain and spinal cord are usually affected. There are many lesions. This disease can manifest itself with the following symptoms:

• disruption of the pelvic organs, urinary incontinence and sexual dysfunction may occur;
• damage to the cranial nerves;
• isolated paralysis or paresis;
• speech disorders, aphasia;
• nystagmus;
• impaired sensitivity of the skin.

Treatment is ongoing. Typically, basic therapy is used, which cannot be interrupted. It may consist of corticosteroids and cytostatics.

Features of general anesthesia

Multiple sclerosis is not a contraindication to general anesthesia. Patients tolerate it well. With multiple sclerosis, there are some features that must be taken into account when performing anesthesia in such patients. These include:

1. Systemic administration of corticosteroids. Corticosteroids are included in the basic treatment of multiple sclerosis. Taking them can slow down the progression of this destructive disease. Before performing surgery using general anesthesia, it is prohibited to stop taking corticosteroids! Their administration continues during the operation itself. There is no need to increase their dose.
2. Refusal to administer Ditilin. Ditilin is a muscle relaxant, a drug that is widely used in anesthesia. It relaxes muscle tissue. In multiple sclerosis, it causes a sharp increase in potassium levels in the blood. Potassium causes acute disorder heart rate and leads to ventricular fibrillation.
3. Doses of other muscle relaxants should be at least half lower than standard. It is more difficult for such patients to recover from anesthesia.

Before general anesthesia, it is necessary to consider some features of the use of anesthesia

Patients with this autoimmune disease prone to a strong increase in body temperature during surgery under general anesthesia. It is necessary to monitor body temperature and have antipyretic medications in stock.

Patients with multiple sclerosis can undergo general anesthesia, either masked or intravenous. The postoperative period may be slightly different for them. Differences postoperative period are presented below:

1. Patients with MS are prone to emotional experiences and stress, which can trigger the progression of the disease. That is why after general anesthesia it is necessary to prescribe them tranquilizers.
2. In such patients, the function of spontaneous breathing and the functioning of the pelvic organs may take longer to recover.

Use of other types of pain relief for MS

Local anesthesia is often used in patients with MS. Multiple sclerosis is not a contraindication to use local anesthetics in dentistry, surgery or other branches of medicine.

Spinal anesthesia may also be used. But when it is performed, there is a risk of toxic effects of the anesthetic on the spinal cord and peripheral nerves. During spinal anesthesia, the anesthetic is injected directly into the spinal canal, which is extremely undesirable in MS.

An alternative to spinal anesthesia in such patients is an epidural. When it is carried out, the anesthetic is injected exclusively into the epidural space and has an isolated effect on nerve roots, which exit at this level of the spinal cord.

Local anesthetic used in patients with MS should not contain epinephrine. Adrenaline promotes vasospasm and disrupts blood supply, including to nervous tissue. Typically, adrenaline is added to the anesthetic to prolong its effect. In case of MS, it is undesirable to add this drug, since the functioning of the nervous system is disrupted, and circulatory disorders can contribute to the progression of the disease.

Multiple sclerosis is not a contraindication to surgical interventions using general, local or regional anesthesia. The only method, which is not advisable to use - spinal anesthesia. When performing general anesthesia, you must remember the need to administer corticosteroids and the restrictions on the use of Ditilin. When performing local and epidural anesthesia, it is necessary to use anesthetics that do not contain adrenaline, as this substance can provoke the progression of the disease.

Can multiple sclerosis be cured forever?

Multiple sclerosis is a chronic autoimmune disease that affects 5 people in the population. The disease is called disseminated due to multiple demyelinating foci that occur unevenly in the brain and spinal cord. Treatment of multiple sclerosis - Long procces, helping to slow down the course of the disease.

Mechanism of appearance and development of the disease

Multiple sclerosis is a disease of a polyetiological nature, but in the development of pathology the main link is occupied by a person’s own immunity. If there is a genetic predisposition, the damaging component penetrates the blood-brain barrier, where it disrupts the proper synthesis of glial tissue. These tissues serve as a supporting link for neurons; oligodendroglia takes part in myelination.

With the synthesis of antigenic nucleic acids, the immune system is activated and begins to form antibodies, which, in addition to defective proteins, begin to destroy normal myelin fibers, and the process of demyelination occurs, due to which multiple sclerosis develops. On early stages Autoallergy is observed in the disease, and in later stages - distortion of immune processes and immunodeficiency.

Symptoms of the disease

The age group for the manifestation of the disease is people from 15 to 40 years old; MS rarely occurs in childhood and old age. The development of the disease occurs gradually, the symptoms of multiple sclerosis appear in isolation, less often the course of the disease is acute, with multiple lesions of the nervous system.

The optic nerve is one of the first to be affected in multiple sclerosis. The patient experiences blurred images, decreased visual acuity, transient blindness and scotoma (a dark spot in the visual field). When oculomotor neurons are damaged, diplopia (double image) and strabismus occur.

Among movement disorders, unstable central paresis predominates, with muscle hypertonicity, pathological reflexes and convulsions. Abdominal reflexes disappear, autonomic functions are disrupted, tremors and unsteadiness in walking occur due to damage to the cerebellum.

Loss of higher brain functions occurs in the terminal phase of the disease, provided there is no treatment for MS, emotional lability, depression and a decrease in intelligence to dementia are observed.

The most common clinical variants of the disease

The most dangerous form of the disease is the stem form. When the brain stem is damaged, the general hemodynamics in the body are disrupted, sudden cessation of breathing may occur, severe headache, the temperature rises to high numbers, almost every autonomic function suffers, which can quickly lead to the death of the patient

The most common form is cerebrospinal, which presents symptoms from different parts of the brain and spinal cord. It manifests itself as disturbances in movement, sensitivity, coordination and optical disturbances.

The remaining clinical forms of multiple sclerosis are rarely found individually and are found against the background of a dominant syndrome. The cerebral and optical form refers to similar variants of the manifestation of the disease.

Modern approaches to diagnosing MS

For patients with multiple sclerosis, MRI of the spinal cord and brain is used as a diagnostic method. T2 imaging reveals a large number of scattered demyelination plaques, especially near the ventricles of the brain. To detect a newly formed plaque, a contrast agent should be used. The diagnosis of MS is based on the identification of more than 4 demyelinating areas larger than 3 mm, or 3 lesions located near the bodies of the lateral ventricles, in the brain stem, cerebellum or spinal cord. Unlike other modern examination methods, MRI for multiple sclerosis allows you to see the smallest soft structures, and for diseases of the nervous system it is an important diagnostic test

Treatment methods for multiple sclerosis

There are certain difficulties in the treatment of multiple sclerosis due to the influence of etiological signs of the disease. Accordingly, the question of how to defeat multiple sclerosis forever remains open to science. It is not known when scientists from all over the world will be able to completely rid humanity of it.

Treatment of MS is based on pathogenetic mechanisms of intervention in the structure of the disease. Considering that autoimmune processes are the basis of the disease, it is necessary to use drugs for multiple sclerosis that suppress the aggressive immune response to myelin fibers and change the course of the disease.

Thus, treatment includes the following components:

• relieving exacerbations;
• changing the course of the disease with the help of DMTs (drugs that change the course of multiple sclerosis);
• lifestyle changes (gymnastics, proper nutrition, diet);
• psychological help.

"Pulse therapy" for patients with multiple sclerosis

Hormones are the drugs of choice for diseases with an immune mechanism of development. Curing in this way is problematic, but you can significantly slow down or even stop the course of multiple sclerosis and restore lost functions. The administration of high doses of hormones from the group of glucocorticosteroids in a short course is called “Pulse therapy”.

Treatment regimen: Methylprednisolone in an amount of 1-2 grams is prescribed for 5-6 days or prednisolone 1.5 mg per kilogram of body weight per day, in morning time in 1-2 doses with a 4-hour interval, every other day or daily (1000 mg per course of treatment). After ten days of therapy maximum dose reduce by 5 mg every 2 days. The general course of treatment lasts 6 weeks.

If the optic nerve is damaged, drugs are injected into the retrobulbar fatty tissue behind the eye. At the end of the therapy, injections with adenocorticotropic hormone are prescribed.

Hemosorption and plasmapheresis for multiple sclerosis are carried out in the case of an acute course of the disease that threatens human life.

Side effects of hormonal drugs

Therapy with hormonal drugs and the autoimmune nature of multiple sclerosis prompts patients to ask which doctor treats multiple sclerosis. A neurologist treats patients with multiple sclerosis and prescribes the required doses medicines. Self-prescription of hormones is not safe for health due to a large number of dose-dependent side effects.

Glucocorticoids retain sodium and water in the body, which leads to the appearance of edema, the loss of potassium leads to arterial hypertension, and the loss of a large amount of calcium provokes the development of osteoporosis, the blood glucose level increases, with long-term use the face becomes moon-shaped, and upper-type obesity occurs.

A decrease in immunity caused by the use of glucocorticosteroids leads to the activation of pathogenic microorganisms. To combat bacterial infections that appear due to side effects of drugs, courses of antibiotics are prescribed. To combat urinary tract infections, antimicrobial agents from the nitrofuran group are used. To correct the immunological activity of the body during the treatment period, antiallergic drugs are used - diphenhydramine, suprastin, lymphocyte globulin.

Immunomodulatory therapy

To combat exacerbations in relapsing-remitting MS, scientific advances in immunomodulation are used. Remedies used to gently and naturally activate the immune system reduce the likelihood of multiple sclerosis relapse by 1/3.

Among the drugs used for this purpose are betaferon and rebif. The drugs are prescribed to young patients with less than 2 exacerbations over the past 2 years.

Use of cytostatics

An alternative to treatment with immunomodulators is the use of cytostatics. Immunosuppressive drug methotrexate at a dose of 7.5 mg once a week, azathioprine at 2 mg/kg per day, both drugs are taken orally.

Cytostatics are not first-line therapy because they side effect more pronounced than any immunomodulatory agent. The use of drugs inhibits the hematopoietic function of the bone marrow and causes metabolic disorders.

Treatment with tissue metabolites

Treatment of multiple sclerosis in Russia includes the use of agents that improve tissue metabolism: amino acids ( glutamic acid, Actovegin, Cortexin), B vitamins, nootropics, drugs that stimulate energy metabolism (ATP) and co-carboxylase. The use of drugs is based on their ability to protect cells from the harmful effects of the external environment and one’s own immunity; the effect of the drugs is nonspecific and is a complementary therapy.

Symptomatic and physiotherapeutic treatment

Symptomatic treatment for patients with multiple sclerosis is selected in accordance with the clinical manifestations:

• For central paresis, muscle relaxants are prescribed to reduce increased tone muscles.
• Physiotherapy for the disease includes exchange plasmapheresis, acupuncture, stimulation of muscle biopotentials with the Myoton apparatus.
• Acupressure for multiple sclerosis is indicated for muscle twitching and cramps. The combination of physiotherapy and massage significantly facilitates the transmission of impulses along neuromuscular fibers, has a beneficial effect on metabolism, and reduces the manifestation of symptoms associated with multiple sclerosis.

Prevention of exacerbations of the disease

Secondary prevention of multiple sclerosis is used to relieve exacerbations and prevent the appearance of new foci of demyelination. Patients need to avoid cold and hot irritants, contact with infectious pathogens, and limit physical activity.

Pregnancy and childbirth in MS provoke an exacerbation of the pathology, new foci of demyelination of fibers appear, and restrictions on the use of drugs appear. Rehabilitation for multiple sclerosis occurs under conditions of complete neurological unloading. Sanatoriums for patients provide long-term remission. Spa treatment- this is a good way to support patients even after severe manifestations of the disease.

Whether multiple sclerosis can be cured remains an open topic for medicine, and spontaneous cases of recovery are rare today. But correct treatment using all modern methods will help a person live long life. Leave your opinions in the comments and take part in the discussions.

Pavlenkov Sergey Pavlovich,

Sviridov Alexey Gennadievich,

Medical portal “About sclerosis.RU”

The information presented on the site is not intended for self-treatment and is provided for your information. To draw up a treatment plan and establish a diagnosis, you must consult your doctor.

Partial or complete copying of materials is permitted only with an active link to the site page.

We invite specialists to consult patients and prepare materials for the site.

Experimental treatment for multiple sclerosis: stem cell transplantation

Multiple sclerosis is a disease of the nervous system that leads to loss of ability to work, disability and the need for help from other people. The pathology causes irreversible phenomena in the form of muscle paralysis, blindness, and deafness. Medicines will not eliminate these effects. Therefore, new technologies come to the rescue - rebooting the immune system using stem cells. The cost of such a transplant operation is naturally high, but it justifies its price if events develop successfully.

How does stem therapy help with MS?

Multiple sclerosis is a disease characterized by damage to nerve fibers, their inflammation and scarring. In this regard, the function of the pathways is disrupted, pain, muscle paralysis, and autonomic disorders occur.

The main symptoms of multiple sclerosis include:

1. Immobilization of individual muscles or entire groups of them. Paralysis can be either spastic or flaccid.
2. Loss of hearing and vision.
3. Dizziness, imbalance.
4. Pain in joints and muscles.
5. The appearance of a feeling of numbness of the skin, goosebumps.
6. Double vision.
7. Urinary and fecal incontinence.
8. Memory disorder.

Many violations are irreversible and cannot be restored. Therefore, there is a need for new treatment methods because:

1. Medicines used for multiple sclerosis (immunosuppressants, glucocorticoids) have serious side effects, sometimes life-threatening. For example, septic complications.
2. Drug treatment only slows down the development of the disease, stops it, but does not lead to the restoration of the affected, healed nerve fibers.

However medical science does not stand still, so stem cell transplantation is now being carried out for multiple sclerosis. This procedure gives hope for restoring the ability to work of seriously ill people.

Results of stem cell transplantation for multiple sclerosis

Stem cells are biological material that can transform into any tissue under the influence of certain substances and conditions. Thanks to this ability, they are used to grow new tissues. Brain neurons with new processes are no exception. However, their recovery occurs rarely and takes a very long time. Therefore, the main target of stem therapy is immunity.

The technology for restoring normal functioning of the immune system is not easy. Stem cell treatment for multiple sclerosis requires large material costs and patience. But this method gives great hope to paralyzed patients.

How stem technologies work:

1. The affected ones are restored nerve fibers together with cells (in rare cases).
2. The immune system is reprogrammed to attack its own tissues - this is the main goal of therapy.

Thus, stem therapy allows you to protect the body from its own overly aggressive immune system.

How is the stem cell transplant procedure performed?

Materials from the patient himself are used, taken from his venous blood, which is filtered by the separator to catch exactly the stem cells. The stem cell collection process can take up to three days to obtain enough of them. They are then frozen using liquid nitrogen.

Treatment is carried out in two stages:

1. Destroying all immunity.
2. Intravenous administration of stem material.

The immune system of patients with multiple sclerosis is impaired. Perhaps viruses provoked auto-aggression. Therefore, first they “kill” the immune system with immunosuppressants: Azathioprine, Cyclophosphamide, glucocorticoids.

At the same time, anti-inflammatory therapy with interferons is used to suppress viruses that may have provoked the attack. In this way, various infections are prevented.

Since the immune system is suppressed, it is necessary for the patient to be in a completely sterile environment. This is provided in special protected rooms.

Then the patient is intravenously injected with his own stem cells, which are intended to build a new immunity designed to protect his body, and not attack it. New material converted and differentiated into healthy white blood cells.

Next the patient goes through general rehabilitation. At an early stage of the disease, it occurs faster, since drug therapy almost not needed. In more serious cases, the immune system is rebooted, but residual manifestations (paralysis, paresthesia) require drug correction. The tissue of the brain, spinal cord and pathways regenerate for a long time and poorly, and are almost never restored due to their complex structure.

Cost of stem cell treatment

When they first started using autotransplantation, its cost reached about a million rubles and was not so affordable; the poet had to go to Israel and other countries.

The price of a stem cell transplantation operation for multiple sclerosis is about 250–300 thousand rubles in Russian clinics. However, the cost depends on the medical institution itself and can vary greatly and reach 2 million rubles.

How effective is stem therapy?

The effectiveness of the procedure depends on the severity and neglect of the disease. Doctors who practice this method of therapy warn that it is better to start treatment as early as possible. In this case, the immune system does not have time to attack a large amount of nervous tissue in the brain and pathways.

Judging by reviews of the use of stem cells for multiple sclerosis, some patients lost hand tremors, the progression of the disease stopped, but disability remained. Rebooting the immune system is a simpler task than restoring nerve tissue affected by sclerotic plaques.

It is important to find out how Neuromidin injections help with multiple sclerosis: who is indicated, how to use it, analogues.

Conclusion

With the steady progression of multiple sclerosis, drugs that slow down the course of the pathology do not always help. One way or another, the patient will experience disability. New method with stem cell transplantation gives hope to sick people. The clinic where treatment is carried out must have a license for this type activities. The chance of recovery is higher for people in the early stages of the disease. This method allows you to stop damage to nerve tissue forever.

Treatment of Multiple Sclerosis: Deep Brain Stimulation Method

Deep brain stimulation (DBS) is a variation of a long-standing surgical technique used to correct tremors in people with multiple sclerosis, Parkinson's disease and essential tremor. In the 1960s, such an operation was performed to destroy a small area deep in the brain - the thalamus (thalamotomy) or another part of the brain known as the globus pallidus (pallidotomy).

These operations are still performed today, although less frequently due to the advent of deep brain stimulation. Such an operation is associated with significant risks: both thalamotomy and pallidotomy are associated with the targeted destruction of certain brain tissues.

If the surgeon “misses” by a fraction of a centimeter, the operation, instead of the expected effect, can lead to serious consequences - for example, paralysis, loss of vision or speech.

Deep brain stimulation is a method that allows you to deactivate certain areas of the brain without deliberately destroying its tissue. Thus, the risk of such an operation is significantly reduced. With deep brain stimulation, an electrode is implanted into it in such a way that its working (contact) end is located in the area of ​​the thalamus (for multiple sclerosis and essential tremor) or the “globus pallidus” or subthalamic nucleus (for the treatment of Parkinson’s disease). The implanted electrode remains in the brain and is connected via wires to a device similar to a pacemaker, sewn under the skin above the brain. chest. This device generates electrical discharges.

What are the benefits of deep brain stimulation?

Deep brain stimulation has many benefits. The process of electrical stimulation can be regulated, whereas with surgical destruction of brain tissue this is not possible. The implantable electrode has 4 metal contacts that can be used in many different combinations. Even if any of the electrode contacts are not exactly where they need to be, there is a reasonable chance that one of the other three, or some combination of them, will be closer to the target. Because the patient's response to electrical impulses changes over time, electrical stimulation can be adjusted without requiring repeat surgery.

Another significant benefit of deep brain stimulation is the potential for other treatments in the future. Destructive surgery (thalamic or pallidotomy) may reduce the patient's chances of benefiting from new treatments that may be developed in the near future. With deep brain stimulation, you can simply turn off the pacemaker when attempting another treatment.

What benefits does deep brain stimulation provide to people with multiple sclerosis?

The main purpose of using the deep brain stimulation method in patients with multiple sclerosis is to correct the tremor caused by this disease. In the case of multiple sclerosis, other disorders (visual and sensory problems or muscle weakness) cannot be treated with this method.

Can multiple sclerosis be cured with deep brain stimulation?

No. Deep brain stimulation does not cure multiple sclerosis or prevent the disease from getting worse. It is only effective in correcting tremor associated with multiple sclerosis.

Is deep brain stimulation considered experimental?

The deep brain stimulation method is not experimental. FDA (Federal Control Agency medicines) has approved it as a treatment for Parkinson's disease, essential tremor and dystonia (a type motor disorder, in which the patient takes unnatural postures or makes involuntary rotational movements).

The FDA has not made a separate ruling regarding the use of deep thalamic stimulation in multiple sclerosis. However, this does not mean that this method is experimental or that its use is not covered by insurance. There are many treatments that are used in everyday practice as standard and accepted, but do not have official FDA approval.

Who needs deep brain stimulation?

There are a number of important factors to consider when prescribing deep brain stimulation. These issues need to be discussed with qualified specialist for movement disorders or with a neurologist with experience special training in this area.

Before deciding to have surgery, it is necessary to try medical treatment methods. Surgery is not indicated if your symptoms can be controlled by medication. However, surgery should be considered if medical treatment does not produce satisfactory results. If you are unsure whether this method is right for you, consult with a movement disorder specialist or neurologist who has experience working with patients with movement disorders.

Where should such an operation be performed?

The operation must be performed in a center whose team is sufficiently qualified to care for patients with multiple sclerosis. It should include neurologists and neurosurgeons with experience and special training to perform such operations.

When choosing a location for surgery, you should also clarify the location of the target area of ​​the brain (that is, the thalamus). Different centers may use different techniques for performing this operation. Obviously, the chances of success and minimizing the risk of surgery will directly depend on how close the electrode is to the target area.

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Multiple sclerosis

Neurological deficits that persist for >6 months usually do not regress.

2. information about a history of MS: the patient’s report of symptoms (preferably confirmed by a researcher) sufficient to localize the focus of MS and which have no other explanation (i.e. they cannot be associated with any other process)

3. clinical symptoms(complaints): neurological disorders recorded by a competent investigator

4. paraclinical confirmation: tests or studies that detect lesions of the central nervous system that do not cause symptoms; e.g. hot bath test, ASVP, neuroimaging (CT, MRI), qualified urological examination

5. complaints and symptoms characteristic of MS: this allows us to exclude lesions in the gray matter, peripheral nervous system, nonspecific complaints such as headache, depression, seizures, etc.

6. remission: significant improvement for a period of >1 month of complaints and symptoms that lasted >24 hours

7. separate lesions: complaints and symptoms cannot be explained on the basis of one lesion (neuritis of both optic nerves observed simultaneously or within 15 days are considered one focal lesion)

8. Laboratory confirmation: In this study, only oligoclonal bands on CSF electrophoresis (see below) were considered as confirmation (they may not be present in plasma) or increased IgG production in CSF (IgG levels in plasma may be normal). These data allow us to exclude syphilis, subacute sclerosing panencephalitis, sarcoidosis, etc.

Criteria for making a diagnosis of MS

A. 2 attacks, separated by remission, with defeat various departments CNS

B. And one of the following:

1) Clinical signs the presence of two separate lesions

2) clinical signs of one lesion and anamnestic information about another

3) clinical signs of one lesion and paraclinical signs of the presence of another

A. 2 attacks, separated by remission, affecting different parts of the central nervous system AND clinical or paraclinical confirmation of a separate lesion AND the presence of oligoclonal IgG in the CSF

B. one attack AND clinical signs of two different lesions AND the presence of oligoclonal IgG in the CSF

C. one attack AND clinical signs of one lesion and paraclinical signs of the presence of another separate lesion AND the presence of oligoclonal IgG in the CSF

A. 2 attacks, separated by remission, affecting different parts of the central nervous system AND clinical confirmation of one lesion

B. one attack AND clinical signs of two different lesions

C. one attack AND clinical signs of one lesion and paraclinical signs of the presence of another separate lesion

A. 2 attacks, separated by remission, with damage to different parts of the central nervous system and the presence of oligoclonal IgG in the CSF

MRI: MRI has become the neuroimaging method of choice for diagnosing MS. In 80% of patients with a clinically clear diagnosis of MS, multiple lesions are detected in the white matter (and on CT scan only in 29%). The lesions have a high signal in T2 mode; fresh lesions accumulate more gadolinium than old lesions. On T2-weighted examination, periventricular lesions may be invisible due to the signal from the CSF located in the ventricles. These lesions are better visible on proton density images as having greater intensity than the CSF. The specificity of MRI is ≈94%; however, lesions of encephalitis and vague bright lesions may simulate the presence of MS lesions.

2. interferon β-1a (Avonex®)75,76: injections of 33 μg weekly (9 million m.U.)

3. glatiramer (formerly copolymer-1, a mixture of tetrametric oligopeptides) (Copaxone®): 20 mg SC reduces the annual risk of relapse by 30%

4. immunoglobulins: have some effect, but are very expensive

5. Immunosuppression: Methotrexate has been shown to have moderate short-term beneficial effects

6. Corticosteroids: Commonly used, but research results are controversial

A. corticotropin (ACTH): its use is decreasing

B. Major relapses: Treat with large doses of IV methylprednisolone or 1000 mg/d (administered over 30 min) for 3 days, or 500 mg/d for 5 days

C. mild-moderate relapse: often treated with low-dose oral prednisone tapered over ≈3 weeks

Fibromuscular dysplasia

Vasculitis and vasculopathies

Arteriovenous malformations (AVMs)

Rheumatoid arthritis

Otosclerosis is a disease that leads to progressive hearing loss, ending with bone structures V soft tissues various parts of the middle and inner ear.

Loss of elasticity of the soft tissues located in the capsule of the cochlea (the main organ of the inner ear), as well as connecting the small auditory ossicles with each other and with the eardrum, reduces the transmission of the full volume of oscillatory movements to the sensory receptors, the nerve impulse from which forms sound sensations in the brain . The perception of sound at the previous level is lost, gradually leading the patient to deafness.

To varying degrees of severity, otosclerosis is observed in 1-2% of people. The rapid rate of hearing loss, which sometimes becomes one-sided, allows only 10-15% of the total number of patients to seek medical help on their own. The rest are diagnosed for the first time during a comprehensive medical examination.

Causes and predisposing factors

Today, several theories of the etiology of otosclerosis are known:

Symptoms of otosclerosis

What signs can be used to suspect otosclerosis?

Treatment of otosclerosis

Treatment depends entirely on the type of disease diagnosed.

Highlight:

• Cochlear otosclerosis(changes occur in the capsule of the cochlea and semicircular canals, in the membranes of the internal auditory canal);
• Tympanic otosclerosis(immobilization of the joint between the stapes and the eardrum occurs).
• Mixed otosclerosis(combination of cochlear and tympanic forms).

Treatment of otosclerosis without surgery is possible only for cochlear and mixed types of the disease.

Operations

Operations for otosclerosis are carried out in cases of no effect from conservative treatment for 4-5 months and in the tympanic form of the disease. Surgical treatment of the cochlear form is currently at the stage of theoretical development. Treatment of such patients is limited to the use of hearing aids.

Surgeries on the inner ear aim to restore the transmission of sound vibrations from the auditory ossicles to the tympanic membrane.

Previously, two types of surgery were quite common:

• Mobilization of the stapes. Its essence was the mechanical loosening of the stirrup.
• Fenestration of the base of the stapes. To improve the mobility of the auditory bones, a through hole was created at the base of the stapes. As a variant of this operation, fenestration of the labyrinth was also performed by creating an opening in its vestibule to improve sound transmission.

But due to the short duration of the positive effect from these operations (just over 3-5 years), at the present stage Stapedoplasty has become widely used. With it, a prosthesis is installed in place of the removed stirrup. The percentage of stable effect from this type of surgical treatment is quite high - over 80%.

In addition, this technique allows, after 5-6 months after the first operation, to perform intervention on the second ear.

The continuing development of microsurgery methods for hearing organ pathology, improvement of stapes prostheses, and increase in their biocompatibility make it possible to achieve consistently high results in the treatment of osteosclerosis.

The average price of surgery (stapedoplasty) in Moscow is from 26,000 to 100,000 rubles.

The operation is included in the list of surgical treatments provided under the compulsory medical insurance policy.