Treatment of multiple sclerosis with folk remedies

Diagnostics

To determine multiple sclerosis, doctors use interviews and neurological examinations, and then confirm the diagnosis with MRI studies and tests.
MRI scans the brain and spinal cord for old and new lesions. For better visualization of fresh plaques, contrast is used. The diagnosis is made if the patient has 4 or more foci of demyelination measuring at least 3 mm, or 3 foci near the lateral ventricles, in the brain stem, cerebellum or spinal cord. In addition to MRI, the following may be prescribed for multiple sclerosis:

• regular blood tests to determine the level of immunoglobulins in the cerebrospinal fluid;
• lumbar punctures to study the composition of the spinal cord fluid.

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.

ON THE. Malkova, PhD, head of the regional Center for the treatment of patients with multiple sclerosis, Novosibirsk

I. Introduction

Multiple sclerosis (MS) is a chronic disease of the nervous system that develops primarily in individuals aged 18 to 45 years. The prevalence of MS is growing in many countries around the world, which is associated not only with the prolongation of life of patients, but also with a true increase in morbidity.

Patients with MS first lose their ability to work, and in later stages, the ability to self-care. This determines the great social significance of this disease. The economic costs of providing medical and social care to people with MS are very high. After 10 years of MS, up to 50% of patients have difficulties in performing professional duties, after 15 years, more than 50% have difficulties in independent movement, and with MS lasting more than 20 years, problems in self-care.

The etiology of MS is still unknown. The most substantiated is the multifactorial theory, which assumes the need for the influence of an external factor, probably infectious, on individuals with a genetic predisposition. According to modern concepts, the pathogenetic process in MS is based on local inflammatory and autoimmune reactions developing in the white matter of the brain. Characteristic is the destruction of the sheath of nerve fibers - myelin. In this case, various parts of the central nervous system are affected: most often the white matter around the ventricles of the brain, in the cerebellum, trunk and cervical spinal cord. Most often, this leads to the development of disorders of movement, coordination, sensitivity, vision, pelvic functions and various neuropsychological disorders, which is the basis of transient and then permanent disability.

The course of MS is very individual - no two patients have the same clinical manifestations of the pathological process. In 85-90% of cases of MS in the initial stages there is a wave-like (remitting) course, when periods of deterioration are replaced by improvement, i.e. complete or partial remissions. The duration of remissions can vary from several months to ten years. Subsequently, in most patients, the course becomes steadily progressive (secondary progressive). 10-15% of patients have an initially primary progressive course of MS. The rate of progression of neurological deficits is highly variable. There is a typical course of MS, when after 15-20 years patients have a significant degree of disability. In 5-10% of patients with MS, a benign (mild) course is observed, in which the disease, which lasts 10 years or more, does not cause persistent severe disability. On the other hand, in 0.1-0.5% of patients the course is malignant with the rapid development of severe disorders, sometimes leading to death.

Correct and timely diagnosis of MS is of great importance. Diagnosis is based primarily on clinical criteria. The main criterion for clinically “reliable” MS is dissemination “in place and in time,” i.e. identification of signs of at least two separately located lesions in the central nervous system, the occurrence of which is separated in time by a period of at least a month. It is very important that the diagnosis of MS should always be made last, when other causes of such multifocal brain damage are excluded. In many patients, already in the early stages of the disease, magnetic resonance imaging (MRI) of the brain reveals multiple foci confirming “in situ” dissemination. These may be hyperintensity lesions on T2-weighted images and black “holes” on T1-weighted images.

II. Treatment

Difficulties in understanding the etiology of MS make prevention and etiotropic treatment impossible. Therefore, pathogenetic and symptomatic therapy comes to the fore. One of the most promising methods for treating MS is immunocorrective therapy. Significant progress has been made in this area in recent years, which allows today for the first time to talk about the possibility of partial control of the activity of the immunopathological process in MS.

The undulating course of the disease, the variety of clinical forms and course options complicate the objective assessment of treatment results. Before prescribing a specific, often expensive, treatment method, the neurologist must be absolutely sure that this drug, this dose and this duration of treatment are optimal for this patient at this particular stage of the disease.

The disappointment that comes from the incorrect use of certain methods of therapy can significantly affect the psychological state of the patient, his belief in the possibility of treating this disease and incorrectly orient him towards treatment methods that are far from scientific and evidence-based medicine. Numerous reports in the medical and popular literature about the effectiveness of a particular new method of treating MS should be assessed and recommended for implementation only taking into account how the clinical trial was organized and how clinical changes were objectified. The results of multicenter, double-blind trials are the main source of reliable information about the effectiveness of a particular treatment method.

Pathogenetic therapy

Among the entire range of pathogenetic treatment agents for MS, three groups of drugs can be distinguished.

The first is drugs that promote faster recovery from exacerbations in relapsing-remitting and relapsing-remitting MS. This group includes corticosteroids (methylprednisolone, solumedrol, dexamethasone, ACTH drugs), to a certain extent plasmapheresis, cyclosporine A, as well as angioprotectors and antiplatelet agents.

The second group is drugs that reduce the frequency of exacerbations. The leaders here are beta-interferon drugs. The second choice drugs are glatiramer acetate (Copaxone), large doses of immunoglobulins intravenously, immunosuppressants and cytostatics (cyclophosphamide, cyclosporine A, mitoxantrone, azathioprine, etc.).

The third group is drugs that slow down the progression of irreversible neurological deficit, including secondary progression.

All beta-interferon drugs and glatiramer acetate (Copaxone) affect the rate of accumulation of irreversible neurological disorders in relapsing-remitting MS. Data have been obtained on a slowdown in the rate of increase in neurological deficit in the secondary progressive course of MS using beta-interferon 1b and mitoxantrone (alone or in combination with repeated pulse doses of corticosteroids).

Treatment of exacerbations

In the early stages of relapsing-remitting MS, neurological disorders associated with exacerbation of the disease can almost completely regress without special treatment.

The duration of more severe exacerbations and the severity of residual neurological impairment depend on the timeliness of treatment with corticosteroids, which remain the main method of treatment for exacerbations of MS.

The concentration of the hormone in the body during an exacerbation of MS should reach a fairly high level, so the most widely used regimens are those that administer the drug in pulse doses. The most commonly used is intravenous administration of methylprednisolone (metipred, urbazone) 500-1000 mg per 400-500 ml of saline solution from 3 to 7 infusions daily in the morning. Solumedrol (methylprednisolone sodium succinate) may be used. The scheme for its use is similar to the scheme for metipred. Depomedrol is used only intramuscularly and is rarely used in the treatment of MS due to a wide range of side effects. In some cases, especially with severe exacerbations and their high frequency, a short course of dexamethasone intravenously (less often intramuscularly) is used. Often a wave-like scheme is used (with an increase and subsequent decrease in dose) or a gradual decrease after a loading pulse dose (64 or 32 mg), with daily administration, reducing the dose by 2 times every two days.

Courses of corticosteroids have no effect on the subsequent course of MS. It has been established that short courses give the same effect as long ones (up to 3-4 weeks). However, in the latter case, the severity of adverse reactions increases significantly.

Quite often, to treat exacerbations, a synthetic analogue of ACTH is used - synacthen-depot (1.0 ml per day intramuscularly every day for 3 days, then 1.0 ml per day intramuscularly after 2 days for the 3rd - 7 times).

Side effects of pulse doses of methylprednisolone, as a rule, are not great and can be easily controlled (peripheral edema, glucosuria, neuropsychiatric disorders, discomfort in the stomach, infectious diseases of the skin and genitourinary system, epileptic seizures, blood pressure fluctuations).

It is mandatory to accompany the course of corticosteroids with potassium supplements. In many cases, prophylactic small doses of diuretics are prescribed.

It should be noted that it is advisable to conduct courses of pulse therapy with corticosteroids in a hospital under the supervision of doctors in order to provide the necessary assistance in a timely manner in case of very rare, but quite dangerous complications. It is most rational to use no more than three courses of corticosteroids per year.

In some cases, cyclosporine A (Sandimmune) is used to treat severe recurrent exacerbations of MS that are resistant to corticosteroid therapy. This drug can be recommended both to reduce the activity of an exacerbation and to prevent subsequent severe exacerbations.

A three-month course of cyclosporine A is administered at a dose of 3 mg per kg of body weight during the first two weeks, then 5 mg per kg of body weight for up to 3 months. The main side effects are related to its potential nephrotoxicity, so weekly monitoring of serum urea and creatinine is necessary. Increased blood pressure, gastrointestinal disorders, weight changes, and hypertrichosis are possible.

The effectiveness of other methods of treating exacerbations is less convincing, and their use is most often recommended in combination with hormonal therapy.

In the pathogenesis of exacerbations of MS, nonspecific reactions characteristic of any inflammatory process are of significant importance. The biological feasibility of prescribing angioprotectors, antiplatelet agents, antioxidants and proteolysis inhibitors during exacerbation of MS is obvious. These drugs are used according to generally accepted therapeutic regimens (curantyl, trental, glutamic acid, vitamin C, vitamin E, thioctacid, berlition, nootropics, Cavinton, contrical, etc.).

Enzyme preparations (wobenzym) are often successfully used in the complex treatment of exacerbations.

Plasmapheresis may be performed during MS exacerbation or progression. Scheme: once a week with plasma exchange amounting to 5% of body weight, 4-10 sessions per course. More effective is a combination of plasmapheresis with corticosteroids or cytostatics.

The effectiveness of plasma exchange transfusion is less convincing.

Intravenous drip administration of hemodez is possible (200-400 ml per day - 3-5 days) during an exacerbation of MS.

Preventing exacerbations

After many years of intensive research, it was possible to identify a number of immunomodulatory drugs that can actually reduce the frequency of exacerbations in relapsing-remitting and relapsing-remitting MS. The results of multicenter clinical trials conducted in a double-blind manner showed that these drugs reduce the frequency of exacerbations of MS by an average of 30% and, to varying degrees, slow the rate of progression of irreversible disorders leading to disability. As a rule, positive clinical data are confirmed by MRI data in the form of a significant decrease in the number of active lesions and a decrease in the total volume of focal brain lesions. These drugs include primarily beta-interferon preparations, glatiramer acetate, as well as preparations containing large doses of immunoglobulin for intravenous administration.

Treatment of MS with drugs that prevent the development of exacerbations does not exclude the development of exacerbations, which must be promptly treated with corticosteroids, and the continuation of a gradual increase in disability. Only the frequency of exacerbations and the severity of residual symptoms (requiring symptomatic therapy) are reduced. This should be well understood by doctors, patients and their relatives. One of the main problems is the optimal selection of MS patients for this type of treatment.

Beta-interferon preparations (beta-IFN) have an immunomodulatory and anti-inflammatory effect. In Russia, Betaferon (beta-IFN-1b), Rebif and Avonex (beta-IFN-1a) are currently registered for use.

Betaferon (“Schering”) is prescribed at a dose of 8 million international units (MME or 250 mg) subcutaneously every other day for a long time (at least 12 months). Adverse reactions when administering betaferon include local reactions at the injection site, general flu-like conditions (chills, fever, joint and muscle pain), and depression.

Rebif (“Serono”) is administered subcutaneously at 44 mcg (or 22 mcg) every other day for a long time, for years (at least 12 months).

Avonex (“Biogen”) is administered subcutaneously at a dose of 30 mcg once a week for a long time.

The side effects of beta-IFN-1a drugs are the same as those of beta-IFN-1b, but develop somewhat less frequently.

In addition to beta-interferon drugs, there are other drugs that reduce the frequency of exacerbations. First of all, this is glatiramer acetate (Copaxone), produced by Teva (Israel). Used at a dose of 20 mg subcutaneously daily for a long time (at least 12 months). Side effects include moderate local reactions, flu-like conditions, general malaise, lightheadedness, pain in the epigastric region, and sometimes panic.

Positive clinical results have been obtained with the use of high doses of intravenous immunoglobulin (IVIG). The effectiveness and safety of IVIG treatment depends, first of all, on the quality of the drug used. A drug characterized by reliable purification and a high content of intact immunoglobulin is sandoglobin (Novartis). There are also domestic IVIG preparations. Various schemes are used. For example, sandoglobin 2 g per kg body weight for 3 days, then once a month 0.2 g per kg body weight for three years, in combination with a small dose of azathioprine (3 mg per kg body weight per day for 2 years , then 2 mg per kg of body weight per day for a year).

Azathioprine alone has a weak effect on the frequency of exacerbations in MS, which is combined with distinct side effects.

The use of alpha-interferon and its drugs (Reaferon, Viferon) as anti-inflammatory drugs that reduce exacerbation is discussed. However, today there is no clear data on their effectiveness in MS.

Treatment of secondary progressive MS

In the treatment of secondary progressive MS, three main trends can be identified: 1) patients with persistent exacerbations and active lesions that accumulate contrast on MRI can receive beta-IFN or methotrexate; 2) patients with gradual and steady progression can receive methotrexate or mitoxantrone; 3) patients with rapidly progressive malignancy can receive cyclophosphamide, cyclosporine A, azathioprine, methotrexate or mitoxantrone in combination with high doses of corticosteroids.

Efficacy against secondary progression has been proven only when using beta-IFN-1b (betaferon) according to the previously described regimens.

Of the cytostatics used in MS, the effects of azathioprine and cyclophosphamide have been the most studied. Chronic long-term use of azathioprine does not have a significant effect on the rate of progression, but is accompanied by numerous side effects. Cyclophosphamide has a more pronounced effect on the progression of the disease, but is also more toxic. To reduce the severity of side effects, reduce the daily dose of the drug to 100-200 mg per day or conduct short courses of pulse doses of cyclophosphamide (2 times a year) in combination with corticosteroids. In extremely malignant progressive MS, it is the drug of choice.

One of the most promising types of therapy for secondary progression of MS is the use of methotrexate (7.5 mg orally), especially when combined with courses of methylprednisolone.

Recently, mitoxantrone (novantrone, 20 mg per month) in combination with methylprednisolone (1000 mg per month) has been widely used, as a method that has shown a significant slowdown in the increase in disability and the formation of lesions on MRI, although accompanied by frequent side effects.

A slowdown in progression was obtained with the use of cladribine in secondary progression of MS.

A method of transplanting autologous bone marrow stem cells against the background of active immunosuppressive therapy is at the stage of clinical trials. Considering the threat of severe side effects, as well as the risk of death (up to 8%), this approach is preferred for malignant disease.

The main problem of pathogenetic therapy methods that affect the frequency of exacerbations and the rate of progression is their high cost. Directly related to this are the questions of to whom, when, for how long and in what dose these drugs should be prescribed. The main contraindications for all drugs are pregnancy and high severity of the disease.

Symptomatic treatment

Symptomatic therapy and medical and social rehabilitation are of primary importance in the treatment of residual neurological symptoms in all types of MS. Currently, medical and social rehabilitation includes not only methods for restoring motor and sensory functions, ability to work, and normalizing mental state, but also measures to most fully return the patient to normal social activity, maintain his independence, and really improve the quality of life.

Adequately selected symptomatic therapy can not only improve the clinical condition and quality of life of patients, but also prevent the development of complications of MS, especially in the secondary progressive course of the disease (infectious diseases, disorders of peripheral circulation and autonomic functions, the formation of contractures and bedsores, etc.) .

Depending on the area of ​​application, therapy aimed at correcting 1) motor and coordination disorders can be distinguished; 2) neuropsychological disorders; 3) dysfunction of the pelvic organs; 4) pain and other polymorphic sensitivity disorders; 5) motor and sensory paroxysmal symptoms.

1. Treatment of spasticity

An increase in muscle tone is combined with paresis, clonus, flexor and extensor spasms. The severity of pelvic disorders largely depends on the state of muscle tone. A sharp decrease in muscle tone can lead to increased weakness, while at the same time, active exercise therapy can contribute to an increase in spasticity. Increased spasticity can occur when walking, against the background of stool retention, urine retention, urinary tract infection, improper seating in a wheelchair, pain of various origins, and arthrosis.

When treating spasticity, it is necessary to clarify specific objectives: 1) reducing painful spasms; 2) improved mobility in the joints, which improves movement; 3) improvement of body position when sitting; 4) assistance in the treatment of secondary changes in joints, arthrosis, increasing the possibilities of physiotherapy and exercise therapy; 5) prevention of the development of contractures; 6) facilitating care for seriously ill patients.

A decrease in muscle tone can be achieved by non-drug methods (application of ice or chilled plates, special exercises to “stretch” or “stretch” the affected limbs for 2-4 minutes, biofeedback, hyperbaric oxygenation).

Directed drug treatment of spasticity should be strictly individual, constantly monitored by a doctor and the patient himself.

Mydocalm is a centrally acting muscle relaxant; a decrease in muscle tone is sometimes accompanied by a vasodilator effect and a decrease in blood pressure. The initial dose of 150 mg per day can, if necessary, be increased in steps of 150 mg every two days until the optimal individual dose is achieved (no more than 1500 mg per day).

Sirdalud - the initial dose can be from 2 to 4 mg, the most used dose increasing step during selection is 2 mg. A dose higher than 36 mg/day is not recommended, as dizziness and dry mouth may occur.

Baclofen – it is better to divide the daily dose into 3-4 doses. The initial dose of the drug is 5 mg per day with meals, increasing the dose by 2.5-5 mg every three days. The optimal dose is 20-60 mg per day. At high doses, hypotension, drowsiness, irritability, and disorientation are observed.

Sirdalud and baclofen have an equally strong muscle relaxant effect (more pronounced than that of mydocalm). Sirdalud is somewhat less likely to cause increased weakness. Baclofen remains the first choice drug for painful tonic spasms.

When determining the optimal dose for a given patient, after 7-14 days it is possible to reduce the dose to a suboptimal one, which is maintenance for a long time. Abrupt withdrawal of any drug can cause a significant increase in tone. A combination of several drugs is acceptable, which allows you to effectively reduce tone at lower doses of each drug.

2. Treatment of weakness of paretic muscles

Metabolic drugs are most often used in combination with rehabilitation measures.

Metabolic agents include nootropics, amino acid preparations, and carnitine.

Courses of Cerebrolysin (5.0 intravenously per 10 ml of saline once a day for 5-7 days), nootropil, piracetam or encephabol (1 tablet 3 times a day), courses of Cerebril, glutamic acid, methionine and other drugs. A course of treatment with B vitamins (especially B12) helps restore the conduction of nerve impulses.

To reduce the degree of paresis, the domestic drug aplegin (carnitine hydrochloride) is recommended. The course of treatment is 10.0 ml intravenously in 400 ml of saline once a day for 5 days.

Of great importance is the selection of a complex of physical therapy, which significantly improves the strength of paretic muscles in patients with MS.

3. Treatment of chronic fatigue syndrome (CFS)

Chronic fatigue in MS is defined as a subjective decrease in physical or mental activity that worsens performance and quality of life of patients and persists for half of the days lasting more than 6 weeks.

In the early stages of MS, repeated cool baths and showers can reduce feelings of fatigue.

A positive effect on CFS was observed with amantadine (Symmetrel) at a dose of 100 mg 2 times a day (side effects: sleep disturbance, abdominal pain, headache, dizziness).

Semax, having a neuroprotective and neurostimulating effect, can also be prescribed at a dose of 0.3 mg 3 times a day endonasally for one month. Repeated courses are recommended.

In some cases, when the mental component predominates in the formation of CFS, antidepressants, individual and group psychotherapy help against the background of depression. Planning a daily routine with mandatory periods of relaxation can significantly reduce the severity of CFS.

Optimizing the physical and mental environment at work and at home allows you to significantly correct existing disorders without medications.

4. Neuropsychological disorders and their treatment in MS

There is a wide variety of clinical manifestations of mental disorders in MS: asthenic syndrome, hysterical and hysteroform reactions, obsessive disorders (sharpening of premormidal features, usually suspiciousness, a tendency to form obsessive thoughts and fears), and among affective disorders most often - depressive syndrome and euphoria .

Patients with MS have a significantly increased frequency of depressive reactions compared to other chronic neurological diseases. Depression negatively affects all neuropsychological functions.

In addition to group and individual psychotherapy, various groups of antidepressants are used to treat depression in MS: fluoxetines (Prozac, etc.), serotonin reuptake stimulants (Coaxil, etc.), tricyclic antidepressants (amitriptyline, etc.), tetracyclic antidepressants (Lerivon, etc. .). It is necessary to take into account possible side effects (decreased potency, urinary retention, increased general weakness).

For minor depression, small doses of the antipsychotic esulperide (Eglonil) 50 mg 1-3 times a day or a combination of the tranquilizer alprozolam (Xanax) with fluoxetines (Prozac) are effective. To normalize mood and treat paroxysmal conditions in MS, the drug of first choice is carbamazepine.

In some cases, MS may cause acute psychotic states with polymorphic productive symptoms, hallucinations and delirium. In these cases, a differential diagnosis with schizophrenia and the prescription of antipsychotic and neuroleptic drugs (haloperidol 0.5-10 mg per day, azaleptin, leponex 25-600 mg per day, etc.) are necessary.

5. Treatment of ataxia and tremor

Correction of these disorders is one of the most difficult tasks of symptomatic treatment of MS.

Non-drug methods are of great importance: kinesiological compensation, stabilometry using special platforms, the use of weighted bracelets and exercises to restore coordination and the development of a new motor stereotype.

Medication options for reducing tremor and incoordination are very limited: courses of vitamin B6 (1% solution 1 ml intramuscularly every other day No. 15), beta-blockers (anaprilin up to 120-160 mg per day) in combination with antidepressants (small individual doses of amitriptyline, starting with 40 mg per day).

To relieve severe tremor reaching the degree of hyperkinesis, carbamazepine can be used (with a gradual increase in dose from 0.1 to 1.2 g per day, on average 0.6 g).

With long-term use of the drug, it is recommended to gradually reduce the dose or take breaks for 2-4 weeks.

For severe hyperkinesis, norakin 0.01 mg per day, cyclodol or nacom in small doses are occasionally used. There is evidence of successful treatment of tremor with isoniazid at a dose of 800 to 1600 mg, gradually increasing it from 300-400 mg.

The use of ondansterone or zofran (from 2 to 8 ml intravenously or 4 mg orally) for tremor is encouraging. In some patients, improvement occurs with the use of Semax and glycine.

6. Treatment of pelvic dysfunctions

A certain sequence of actions is recommended for urinary disorders in patients: 1) antibacterial treatment of urological infections under the control of urine tests and cultures; 2) correction of neuropsychological disorders, especially depression; 3) conducting a urodynamic study (including a study of the volume of residual urine), ultrasound of the bladder, and less often - contrast urography; 4) based on clinical and instrumental examination data, the type of disorders is determined - urinary incontinence (detrusor hyperreflexia), retention (detrusor hyporeflexia), combined disorders (sphincter and detrusor dyssynergia); 5) normalization of the drinking regime and sleep, modification of the daily routine and dietary habits (excluding caffeine and alcohol), conducting psychotherapeutic measures, using methods of magneto- and electrical stimulation of the bladder, training the pelvic floor muscles, correction of spastic increases in tone. Only then is it advisable to begin drug therapy.

If there is weakness or inability to retain urine, the following drugs are used: 1) anticholinergics - oxybutynin (driptan, ditropan), probanthine (propantheline bromide), methantheline bromide, tolterodine (detrusitol), trospium chloride; 2) antispasmodics (flavoxate, nifedipine); 3) a-adrenergic agonists - imipramine (Tofranil, apoimipramine, melipramine); 4) a synthetic analogue of the antidiuretic hormone - dismopressin (adiuretin, desmospray).

If there is weakness or inability to urinate, the following drugs are used: 1) cholinomimetics (bethanechol, distigmine bromide, neostigmine); 2) blockers of a-sympathetic activity (prazoline, phenoxybenzamine, reserpine, guanitidine sulfate); 3) muscle relaxants (baclofen, sirdalud).

A special group of dysfunctions of the pelvic organs are disorders of sexual function. Their most common manifestation is decreased potency in men associated with spinal cord damage. Nevertheless, in most patients, disorders in this area are primarily associated with an emotional component, so psychotherapeutic measures can have a quick and lasting positive effect. Other methods include the drug Viagra (from 25 mg to 100 mg), as well as various vasoactive ointments. Less commonly used are intracorporeal injections or suppositories with papaverine, prostaglandin E and other vasodilators. The use of various prostheses for MS, which can worsen urination disorders, is strictly not recommended.

III

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Conclusion
A modern comprehensive approach to the treatment of MS includes timely and adequate relief of exacerbations, the prescription of drugs that prevent exacerbations and slow down the progression of the disease, and the gradual implementation of symptomatic therapy based on a multidisciplinary approach and including psychophysical rehabilitation.

Carrying out neurorehabilitation measures is impossible without establishing adequate contact with the patient, teaching him the principles of “living with MS”, without relieving the manifestations of depression and other neuropsychological disorders that significantly complicate the patient’s adaptation to irreversible symptoms, as well as without forming a useful “social network” around the patient, which Society of patients and special methods of socio-psychological support can contribute.

The problem of treating MS is still very far from being resolved, but recent advances in pathogenetic and symptomatic therapy make it possible to confidently exclude MS from the list of “incurable” neurological diseases.

Rehabilitation for multiple sclerosis

• Physiotherapy.
  Exercise therapy helps improve a person’s condition with impaired motor activity. Working out on exercise machines helps restore coordination of movements. With correctly selected loads, the method demonstrated excellent efficiency.
• Physiotherapy.
  For patients with MS, electrophoresis, myostimulation, ultrasound, and magnetic therapy are recommended. These techniques help to activate the body's metabolic processes and reduce inflammation.
• Massage.
  For multiple sclerosis, this rehabilitation method can be used to relieve pain symptoms and spasms. Massage also helps improve muscle tone when it decreases.

Rehabilitation for multiple sclerosis also includes psychotherapy, which will help the patient cope with negative thoughts, as well as consultations with a nutritionist.

Disease prognosis

Multiple sclerosis is not considered a fatal disease; the unpleasant symptoms of MS can be quite successfully treated. Scientists have found that thanks to modern treatment, the life expectancy of patients today has increased significantly compared to those who fell ill even a few decades ago.

Overall, people with multiple sclerosis live on average 7 years less than the general population. Often, a decrease in life expectancy is associated with complications of other pathologies: cancer and cardiovascular diseases. For many patients, quality treatment can prevent a decline in quality of life and productivity. According to the National Multiple Sclerosis Society, ⅔ of people with MS are wheelchair-free even 20 years after diagnosis.

Disability in multiple sclerosis

If multiple sclerosis has caused disability for 5 months or more within a year, the patient can apply for disability registration.

After reviewing the documents, the commission will make a decision on incapacity for work, which gives the right to receive a pension and preferential working conditions. The establishment of a disability group is influenced by:

• the period for which the ability to work was lost;
• the period when the patient was registered with this disease;
• frequency, duration and severity of exacerbations;
• therapy results;
• changes in the course of the disease, the rate of development of symptoms.

Disability is assigned for a year, after which it is necessary to pass the commission again. Disability of groups I and II with MS gives the right to a reduced working day - 35 hours per week. In this case, wages are paid in full.

Treatment at home

In order for the treatment of multiple sclerosis with folk remedies to have a positive result, the patient should change their lifestyle.

Overheating of the body must be avoided. You should not stay in the open sun for a long time. If there is a need to go outside on a hot day, then a sun umbrella or a wide-brimmed hat should become a must-have companion.

You shouldn't take a hot bath either. It is better to limit yourself to a cool shower.

Of course, you need to give up bad habits. Alcohol and nicotine are strictly contraindicated for multiple sclerosis.

In addition, you need to reconsider your diet. Try to reduce your consumption of animal fats. Eat less sweets, but vegetables and fruits will become a reliable ally in the fight against illness.

It is best to get rid of pets if you have them. Wool can cause an allergic reaction, and as a result, provoke an exacerbation of the disease.

For the same reasons, you should not have flowering plants. In the room where the patient lives, it is necessary to carry out wet cleaning as often as possible.

An important factor in the treatment of multiple sclerosis is the patient's rest . Try to avoid stressful situations.

Under no circumstances should you attempt to relieve nervous tension with alcohol or drugs!

The best way to reach a state of peace is meditation. To do this, just sit for a few minutes in a comfortable position with your eyes closed. It is recommended to breathe slowly and deeply, and try to focus your thoughts on breathing.

Sleep is the best way to relax . Therefore, you need to stick to the regime and go to bed on time. During sleep, the body relaxes and rests as much as possible.

Talk to your doctor about exercising. Moderate stress on the muscles is a great way to get rid of nervous tension.

Even if your doctor prohibits fitness classes, try to take walks in the fresh air. Just select the average air temperature for such walks.

Parkinsonism syndrome is a symptom of many diseases of the nervous system. Find out more in our material.

Hypochondriacal neurosis can lead to hysteria and mental disorders if adequate methods are not adopted in time.

Where to buy traditional medicine for multiple sclerosis?

The online store “Russian Roots” offers natural products based on the knowledge of traditional medicine, as well as ingredients for the preparation of medicinal products. Delivery is available in Moscow, the region and all regions of the country. In Moscow, you can purchase goods in one of the herbal pharmacies in the chain. The products have all the necessary documentation.

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Causes of development of vascular atherosclerosis

Atherosclerosis of cerebral vessels does not occur due to just one factor; it is usually caused by a complex of reasons. Among them:

• Elderly age. The risk of development increases over the years; this is a natural process of aging of the body.
• Floor. Men are more susceptible. The disease begins at a younger age than in women.
• Lipid imbalance. It is believed that there are “good” lipids - HDL, high-density lipoproteins, and there are “bad” lipids - LDL, low-density lipoproteins. HDL has positive properties: it prevents the formation of cholesterol plaques. LDL, on the contrary, “attracts” cholesterol to the blood vessels.
• Genetic predisposition. Lipid imbalance is sometimes caused by genes. This is the disease familial hypercholesterolemia.
• High cholesterol levels. Cholesterol is one of the main components of plaque on blood vessels.
• Smoking. It has been established that components of tobacco smoke cause vasospasm. In addition, nicotine promotes the attachment of cholesterol plaques to the intima of blood vessels.
• Obesity. In people with excessively developed subcutaneous fat, the balance of lipids in the body is disturbed. Obesity is also a risk factor for diabetes and hypertension. They themselves significantly increase the risk of atherosclerosis. Body weight is assessed using the Quetelet index - BMI = weight, kg / height * height, m2. The normal weight window is from 18.5 to 24.9 kg/m2.
• Physical inactivity. A sedentary lifestyle also affects the body's lipid metabolism. In addition, it is a factor in the development of obesity.
• High blood pressure. Hypertension leads to impaired vascular function. They become more susceptible to atherosclerosis.
• Diabetes. All types of metabolism in the body are disrupted. The concentration of LDL increases, therefore, the risk of atherosclerosis increases.
• Alcohol. Alcohol abuse leads to hypertension and changes in all organs.
• Stress. Negatively affects the tone of cerebral vessels.

Expert opinion

Author: Elena Mikhailovna Bunina

Psychiatrist, doctor of the highest category

Atherosclerosis is considered to be a blockage of the arteries and a decrease in their volume that occurs due to atherosclerotic plaques. It is considered one of the most dangerous ailments, since the disease progresses slowly, but at the same time it strongly constricts the blood vessels, disrupting proper blood circulation, leading to their complete blockage.

Sclerosis of cerebral vessels can be avoided or at least slowed down the progression of the disease if you consult a doctor in time. The most common causes of sclerosis are:

• high blood pressure;
• smoking and excessive consumption of alcoholic beverages;
• high blood cholesterol;
• constant stress;
• excess body weight;
• sedentary lifestyle;
• diabetes;
• unhealthy diet with excess fat in the diet.

If you keep these factors under control, you can reduce your risk of developing the disease. The peculiarity of the course of the disease is that even with an individual approach to treatment and effective therapy, blockage of blood vessels cannot be completely cured. Medicines and other methods of combating the disease can only slow down the growth of atherosclerotic plaques; with more intensive treatment, they can be reduced in size.

The doctor prescribes treatment for each patient individually, based on the initial condition and severity of the disease. Doctors at the Yusupov Clinic will conduct a comprehensive examination of the patient and prescribe treatment in accordance with the diagnosis and side effects of the disease.