Demyelination what causes symptoms and treatment

Some nerve endings (in particular, the axons of the peripheral and central nervous system) are covered with a specific myelin sheath. This structure performs a number of important functions. In particular, myelin is responsible for the rate of transmission of electrical impulses along nerve fibers. In addition, the shell performs barrier and supporting functions, and is also responsible for nourishing the nerve endings.

Demyelinating disease of the brain is accompanied by one or another damage to the myelin sheath, which naturally affects the work of nerve cells. By the way, demyelinating diseases are a whole group of certain lesions of the nervous system, each of which has its own characteristics and is accompanied by a unique set of symptoms.

In fact, there are many diseases that are somehow related to the process of damage to myelin fibers. For example, Devik’s disease is considered quite specific, which is accompanied by inflammation and demyelination of the optic nerves and some segments of the spinal cord.

Chronic diseases include atrophic lateral sclerosis, which is most often manifested in adulthood. The list of diseases can be replenished with such pathologies as acute encephalomyelitis, Krabbe’s disease, periaxial encephalitis, as well as concentric sclerosis of Balo (more often at a young age), sclerosis Marburga and many others.

In fact, there are many diseases that are somehow related to the process of damage to myelin fibers. For example, Devik’s disease is considered quite specific, which is accompanied by inflammation and demyelination of the optic nerves and some segments of the spinal cord.

The classification of this ailment is based on highlighting the root cause of the disease:

  1. If myelin in the body is destroyed due to hereditary reasons, they speak of myelinlastia.
  2. If the membrane is produced and functions correctly, but then disappears due to the action of external factors, they speak of myelinopathy.

In addition, they identify the main diseases that are included in the concept of “demyelinating disease of the central nervous system”:

  1. The most common pathology of this kind – multiple sclerosis – affects all parts of the central nervous system. The characteristic symptoms are very diverse.
  2. Progressive multifocal leukoencephalopathy.
  3. Marburg’s disease.
  4. Acute disseminating encephalomyelitis.
  5. Devik’s disease.

The demyelinating process of the brain is a disease in which the sheath of the nerve fiber atrophies. At the same time, neural connections are destroyed, the conductor functions of the brain are disrupted.

It is customary to refer to the pathological processes of this type – multiple sclerosis, Alexander’s disease, encephalitis, polyradiculoneuritis, panencephalitis and other diseases.

The causes of demyelination are still not fully identified. Modern medicine makes it possible to identify three main catalysts that increase the risk of developing disorders.

It is believed that demyelination occurs as a result of:

  • Genetic factor – the disease develops against a background of hereditary diseases. Pathological disorders occur against the background of aminoaciduria, leukodystrophy, etc.
  • The acquired factor – myelin sheaths are damaged due to inflammatory diseases caused by infection in the blood. May be a consequence of vaccination.
    Less commonly, pathological changes cause injury, demyelination is observed even after removal of the tumor.
  • Against the background of diseases, a violation of the structure of nerve fibers, especially the myelin sheath, occurs as a result of acute transverse myelitis, diffuse and multiple sclerosis.
    Metabolic problems, a deficiency of vitamins of a certain group, myelinosis and other conditions are catalysts for damage.

For violations, the following symptoms are characteristic:

  • Increased and chronic fatigue.
  • Violations of fine motor skills – tremors, loss of sensation of limbs of the hands.
  • Problems in the work of internal organs – often the pelvic organs suffer. The patient has fecal incontinence, arbitrary urination.
  • Psycho-emotional disorders – a multi-focal brain lesion that has a demyelinating character, are often accompanied by problems in the patient’s mental state: forgetfulness, hallucinations, and a decrease in intellectual abilities.
    Until precise instrumental methods were used for diagnosing, there were cases when patients began to be treated for dementia and other psychological pathologies.
  • Neurological disorders – focal changes in the brain substance of a demyelinating nature are manifested in violations of the motor functions of the body and motility, paresis, epileptic seizures. Symptoms depend on which part of the brain is damaged.

Foci of demyelination in the cerebral cortex, in white and gray matter lead to the loss of important body functions. Depending on the location of the lesion, specific manifestations and disorders are observed.

The prognosis of the disease is unfavorable. Often, demyelination, resulting from secondary factors: surgery and or inflammation, develops into a chronic form. With the development of the disease, gradually progressive atrophy of muscle tissues, paralysis of the limbs and loss of the most important functions of the body are observed.

Single foci of demyelination in the white matter of the brain are prone to overgrowth. As a result, a gradually progressing disease can cause a condition in which the patient cannot swallow, speak, breathe on his own. The most severe manifestation of damage to the sheath of nerve fibers is a fatal outcome.

What is demyelination? The process develops as a result of the negative effects of antibody proteins on nerve tissue. This is accompanied by the development of an inflammatory reaction, damage to neurons, destruction of the myelin sheath and impaired transmission of nerve impulses.

The shells of nerve fibers are damaged by:

  1. Hereditary predisposition.
  2. Infectious viral diseases.
  3. Chronic foci of bacterial infection.
  4. Heavy metal poisoning, gasoline, solvent.
  5. Strong and prolonged stress.
  6. Excessive consumption of animal proteins and fats.
  7. Adverse environmental situation.

All these adverse conditions lead to the development of an autoimmune process, but the genetic role plays the largest role. Certain genes and their mutation lead to the production of abnormal antibodies that penetrate the barrier between blood and nerve tissue, which protects the brain from damage. As a result, the myelin protein is destroyed by the inflammatory process.

The second provoking factor is infectious diseases. The destruction of normal myelin occurs in a slightly different way. In the normal state, the immune system, after getting into the body of the infection, begins to produce antibodies to fight it. But sometimes the pathogen proteins are so similar to the proteins in the tissues of the human body that antibodies confuse them and, together with the bacteria, destroy their own cells.

In the initial stages of nerve fiber damage, when the inflammatory autoimmune process has just begun to develop, pathological changes can still be reversed. There is a chance of partial recovery of myelin, which will allow neurons to perform a certain part of their functions. But with the development of the disease, the nerve membranes are destroyed more and more, nerve fibers are exposed, and they lose the ability to transmit signals. It is impossible to get rid of nervous deficiency and restore the lost functions of the brain at this stage.

It is difficult to determine the type of demyelination based on symptoms only. Therefore, additional examinations are needed. Manifestations depend on the form of pathological changes.

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Multiple sclerosis

Foci of demyelination of the brain are most often found in multiple sclerosis. The disease is accompanied by autoimmunization, damage to nerve fibers, the breakdown of myelin sheaths and the replacement of damaged areas with connective tissue.

So far, it has not been possible to fully determine the causes of violations. It is believed that the brain is most affected by poor heredity, external conditions, infection with viruses and bacteria. The brain and spinal cord are usually affected.

Pathology may occur:

  • paresis and paralysis, increased tendon reflexes, muscle cramps;
  • imbalance and fine motor skills;
  • weakening of the facial muscles, swallowing reflex, speech function;
  • sensitivity change;
  • impotence, constipation, incontinence, or urinary retention;
  • decreased vision, narrowing of its fields, impaired brightness and color perception.

Marburg’s disease

This is the most dangerous form of brain damage. Pathology arises sharply and is accompanied by a rapid increase in symptoms. On the patient’s condition, this is reflected in the most negative way. A person can die in a matter of months.

The disease at first resembles an infection and is accompanied by fever, convulsions. With the destruction of myelin, motor functions, sensitivity and consciousness are disturbed. Characterized by the appearance of severe pain in the head and vomiting, increased intracranial pressure. With a malignant course, the brain stem is damaged, in which the nuclei of the cranial nerves are collected.

Devik’s disease

In this case, damage to the optic nerves and spinal cord occurs. The acute development of the pathological process leads to complete blindness. Due to the fact that the disease affects the spinal cord, a person suffers from paresis, paralysis, disorders of the functions of the pelvic organs, and sensitivity disorders.

Evidence

When foci of demyelination occur, symptoms can be noticed already in the initial stages. At first, they can be confused with other pathologies, or explained by external stimuli. Because of this, not all people immediately go to the doctor, because they don’t understand how serious the negative manifestations are.

The main symptoms of demyelinating diseases of the brain:

  • The appearance of chronic fatigue, a person can not rest. Fatigue is observed.
  • Problems with fine motor skills. The patient may suffer from tremor of the limbs, as well as lose their sensitivity.
  • Pathology of the internal organs. Often, demyelinating diseases of the central nervous system lead to problems with the pelvic organs. A person may suffer from fecal incontinence, or from uncontrolled urination.
  • Neurological disturbances disturb. Coordination may be impaired; seizures of epilepsy may occur. The specific symptoms will depend on which area of ​​the brain is damaged.
  • Mental disorders. When brain damage occurs, often problems arise with the patient’s emotional state. Mental disorders are easy to notice, because they are expressed in increased forgetfulness, in the appearance of hallucinations, as well as in a decrease in mental ability.

In many ways, these symptoms resemble dementia and other mental disorders, which makes it difficult to make a diagnosis.

These manifestations in combination with other symptoms give reason to suspect demyelinating diseases of the central nervous system. In order to make an accurate diagnosis, you have to go through a series of examinations.

Chronic multiple sclerosis is a demyelinating disease of the brain in which the body treats its tissues as foreign. Immunity with antibodies begins to fight them. A demyelinating process occurs during which the nerve fibers are exposed, and the patient has the initial symptoms: the occurrence of urinary retention, impaired gait or vision.

Later, a partial recovery of the myelin sheath occurs, and the first signs of the disease disappear. The patient thinks that the problems went away on their own and do not seek medical help. This is the insidiousness of multiple sclerosis or another demyelinating disease of the central nervous system.

The most common signs of the initial stage of multiple sclerosis are the following conditions:

  • numbness of limbs;
  • amyotrophy of the muscles of the hands;
  • imbalance;
  • double vision and blurred vision;
  • violation of coordination of movements;
  • blurred speech;
  • cognitive impairment;
  • sharply arising paralysis of the limbs.

Sclerosis multiplex cerebrospinalis (cerebrospinal multiple sclerosis, multiple sclerosis) is a chronic demyelinating disease in which the human immune system attacks the central nervous system. In our geographical conditions is a fairly common disease. MS affects about 60-100 / 100 (and even more) people, especially young and middle-aged people.

Sometimes it can develop in contrast – in a child (MRI shows manifestations of incomplete myelination) or, conversely, in old age. The disease is more often manifested at the age of 20-40, affects more women (the ratio of women to men is 2: 1). The exact cause of demyelinating disease is still unspecified, but MS is currently considered a chronic inflammatory autoimmune disorder, originating in impaired cellular immunity. The development of a demyelinating disease is influenced by several factors – genetic, environmental.

Symptoms

Multiple sclerosis is unpredictable, it manifests itself individually in each person. With a milder form, the symptoms may disappear for some time. In other cases, the demyelinating disease attacks quickly, leaving permanent consequences. The predominant clinical signs depend on the location of the foci of demyelination of the brain. At the beginning of the disease, the following clinical picture appears:

  • Optical retrobulbar neuritis is a one-sided visual disturbance that is usually quickly and completely corrected. Sometimes it remains central cattle (a place on the retina that is physiologically not responsive to incident light, also known as a blind spot).
  • Sensitive symptoms are mainly paraesthesia (an unpleasant sensation of tingling, itching, burning of the skin without lasting effects) in the upper and lower extremities, mainly asymmetric. Weakness or numbness of one or more limbs is the first sign of this disease in about half of patients. In younger patients, trigeminal neuralgia may be a secondary symptom.
  • The vestibular syndrome (imbalance of the vestibular apparatus) is mainly central, sometimes with severe dizziness. Nystagmus (oscillatory movement of the eye bulbs) is common even without subjective vestibular symptoms. Common symptoms are diplopia (double vision) and internuclear ophthalmoplegia (damage to the nerves of the cervical region – occipital). Sometimes MS can begin with a picture of acute disseminated encephalitis (acute inflammation of the brain).
  • Spastic motor symptoms – at the onset of the disease there is no pronounced paralysis or spasticity (increased tension of muscle fibers with more or less frequent muscle twitching). Symptoms are accompanied by increased fatigue, uncertainty in walking, weakness, clumsiness. During the examination, hyperreflexia (increased reflexes) with spasmodic pyramidal phenomena is detected, often – muffling of abdominal reflexes.
  • Cerebellar disorders are a common cerebral symptom that varies in intensity, from mild ataxia (impaired movement coordination) of one limb to severe walking ataxia, imbalances that can also be associated with ataxia of the spine (imbalance worsens in the dark and with eyes closed).
  • Disorders of the sphincters, especially the urinary tract, frequent urination, which should be performed immediately (the bladder has a low capacity, often contracts when the contents accumulate). Retention or urinary incontinence is added later. Sexual disorders (impotence) may also occur.
  • Mental symptoms – affectiveness, depressive syndromes, euphoria. Intelligence is not damaged. Fatigue is common.
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Other manifestations are very diverse. There are various options for a dangerous malignant form in which the patient is bedridden for several years. Death may occur. With benign forms, for many years the patient is mobile, has only minor symptoms. Nevertheless, in most cases, the dynamics progressively decreases over several years, spastic and cerebellar symptoms with severe ataxia, deliberate tremor, combined spastic-ataxic manifestations may predominate in it.

Demyelinating disease is also known as Schilder’s disease. It affects children and young people, has a non-hereditary character, a progressive (rapidly developing) course. The maximum survival time is 10 years.

The basis of demyelinating disease is a significant focus of myelin destruction, throughout the cerebral lobe, as a rule, spreading through the corpus callosum (caudal body responsible for joining the cerebral hemispheres). In addition, in the trunk, spinal cord and optic nerves there are numerous single small demyelinating lesions.

Symptoms

The development of Schilder’s disease leads to the following manifestations:

  • hemiplegia (paralysis of the entire left or right side of the body) or quadriplegia (complete or partial paralysis of all 4 limbs and trunk);
  • homonymous hemianopsia (dimming half of the visual field);
  • cortical blindness, deafness;
  • pseudobulbar syndrome.

Diagnosis and treatment are the same as for multiple sclerosis.

LAS begins unnoticed. The patient has difficulties with the usual actions (writing, buttoning buttons). Later, walking problems, muscle cramps, difficulty swallowing develop. At the end, the patient is completely paralyzed, depending on artificial respiration, nutrition. In fatal LAS, the patient gradually loses nerve cells. In 5-10% of cases, the disease has a hereditary form.

Demyelinating disease is characterized by selective violation of central and peripheral motor neurons (motor neuron is a nerve cell that directly innervates skeletal muscles). We are talking about the gradual disappearance of spinal cord motor neurons in the area of ​​the brain stem, degeneration of the corticospinal path.

Symptoms

Typical manifestations: muscle atrophy, fasciosis, tendonococcal hyperreflexia, spastic phenomena. The disease begins about 40-50 years of age (more often – up to 60 years). Clumsiness of hands develops, later difficulties when walking are added. Soon muscle atrophy occurs. Muscle cramps, pains may be present. Sometimes the disease begins with bulbar syndrome, difficulties with speech, swallowing.

Treatment

Demyelinating diseases of the nervous system

The following types of demyelinating diseases are:

  • Multiple sclerosis belongs to the demyelinating diseases of the central nervous system. Multiple sclerosis demyelinating disease is the most common pathology. Multiple sclerosis is characterized by a variety of symptoms. The first symptoms appear at the age of 20-30 years, women are more often sick. Multiple sclerosis is diagnosed by the first signs that were first described by the psychiatrist Sharko – involuntary oscillating eye movements, trembling, chanted speech. Also, patients have delayed urination or very frequent urination, the absence of abdominal reflexes, pallor of the temporal halves of the optic nerves;
  • ODEM, or acute disseminated encephalomyelitis. It begins acutely, accompanied by severe cerebral disorders and manifestations of infection. The disease often occurs after exposure to a bacterial or viral infection, and can develop spontaneously;
  • diffuse disseminated sclerosis. It is characterized by damage to the spinal cord and brain, manifests itself in the form of convulsive syndrome, apraxia, mental disorders. Death occurs in the period from 3 to 6-7 years from the moment of diagnosis of the disease;
  • Devik’s disease, or acute opticoneuromyelitis. The disease begins as an acute process, proceeds severely, progresses, affecting the optic nerves, which causes complete or partial loss of vision. In most cases, death occurs;
  • Balo’s disease, or concentric sclerosis, periaxial concentric encephalitis. The onset of the disease is acute, accompanied by fever. The pathological process proceeds with paralysis, visual impairment, epileptic seizures. The course of the disease is fast – death occurs in a few months;
  • leukodystrophy – this group contains diseases that are characterized by damage to the white matter of the brain. Leukodystrophies are hereditary diseases; as a result of a gene defect, the formation of the myelin sheath of nerves is disrupted;
  • progressive multifocal leukoencephalopathy is characterized by a decrease in intelligence, epileptic seizures, the development of dementia and other disorders. The life expectancy of the patient is not more than 1 year. The disease develops as a result of a decrease in immunity, activation of the JC virus (human polyomavirus 2), is often found in patients with HIV infection, after bone marrow transplantation, in patients with malignant blood diseases (chronic lymphocytic leukemia, Hodgkin’s disease);
  • diffuse periaxial leukoencephalitis. Hereditary disease, more often affects boys. Causes visual disturbance, hearing, speech, other disorders. It is rapidly progressing – life expectancy is just over a year;
  • osmotic demyelination syndrome – is very rare, develops as a result of electrolyte imbalance and a number of other reasons. A rapid increase in sodium leads to the loss of water and various substances by the brain cells, and causes the destruction of the myelin sheaths of nerve cells in the brain. One of the posterior parts of the brain is affected – Varolius bridge, the most sensitive to myelinolysis;
  • myelopathy is a general term for spinal cord lesions, the causes of which are diverse. This group includes: spinal cord, Canavan disease, other diseases. Kanavan disease is a genetic, neurodegenerative, autosomal recessive disease that affects children and causes damage to nerve cells in the brain. The disease is most often diagnosed in Ashkenazi Jews living in Eastern Europe. Spinal cord (locomotor ataxia) is a late form of neurosyphilis. The disease is characterized by damage to the posterior columns of the spinal cord and spinal nerve roots. The disease has three stages of development with a gradual increase in symptoms of nerve cell damage. Coordination is impaired when walking, the patient easily loses balance, the bladder is often disturbed, pain appears in the lower extremity or lower abdomen, and visual acuity decreases. The most difficult third stage is characterized by loss of sensation of muscles and joints, areflexion of the tendons of the legs, the development of astereognosis, the patient cannot move;
  • Guillain-Barré syndrome – occurs at any age, refers to a rare pathological condition, which is characterized by damage to the peripheral nerves of the body’s own immune system. In severe cases, complete paralysis occurs. In most cases, patients recover completely with adequate treatment;
  • Charcot-Marie-Toot neural amyotrophy. Chronic hereditary disease, which is characterized by progression, affects the peripheral nervous system. In most cases, the destruction of the myelin sheath of nerve fibers occurs, there are forms of the disease in which pathology of the axial cylinders in the center of the nerve fiber is detected. As a result of damage to the peripheral nerves, extinction of tendon reflexes, atrophy of the muscles of the lower and then upper limbs occurs. The disease refers to progressive chronic hereditary polyneuropathies. This group includes: Refsum disease, Russi-Levy syndrome, Degerin-Sott hypertrophic neuropathy and other rare diseases.

Demyelinating diseases (DZ) secrete primary (acute disseminated encephalomyelitis, clinical forms – polyencephalitis, encephalomyelopoliradiculoneuritis, opticomyelitis, disseminated myelitis, opticoencephalomyelitis) and secondary (vaccinal – develop with vaccination with parainfection, encephalitis, KDS, KDS; , chickenpox, other diseases).

Subacute forms of the disease manifest as diseases:

  • multiple sclerosis. Clinical forms – cerebrospinal and spinal, optical, cerebral, stem, cerebellar;
  • chronic forms of DZ – encephalitis Dawson, Dering, Pette, Van Bogart, periaxial diffuse leukoencephalitis Schilder;
  • DZ with the defeat of mainly peripheral nerves – infectious polyradiculoneuropathies, infectious-allergic primary polyradiculoneuritis Guillain-Barré, toxic polyneuropathies, diabetic and dysmetabolic polyneuropathy.

The treatment of a demyelinating disease depends on the type of disease and its severity, and refers to lengthy and complex processes. In addition to medical treatment, the patient is prescribed a diet, it is recommended to observe a strict daily routine, sleep and wakefulness regimen, regularly undergo a massage course, and engage in physical therapy.

Diseases of the nervous system (ICD-10 according to the international classification), which are combined in a similar way to defeat myelin, are caused by several causes – from allergic to viral agents. This group of pathologies is characterized by the fact that demyelinating diseases of the central nervous system often affect able-bodied men and women, who subsequently come to disability.

  • multiple sclerosis;
  • multifocal leukoencephalopathy;
  • acute encephalomyelitis.

Multiple sclerosis

What is multiple sclerosis, recently often found out by young people from 15 to 40 years. A feature of this disease is the simultaneous defeat of several parts of the central nervous system at once, which leads to different symptoms in patients. The disease alternates with periods of remission and exacerbation. The basis of multiple sclerosis is the occurrence of foci of myelin destruction in the spinal cord and brain, which are called plaques. Their sizes are small, but sometimes large joints are formed. Often such a pathology leads to Marburg disease or atherosclerosis.

The disease refers to a viral infection of the nervous system, which develops in the immunodeficiency state of the patient. Pathology progresses rapidly and can lead to death of the patient within a year. Often the cause of multifocal leukoencephalopathy is a reactivated virus that enters the body in childhood and is latent in the kidneys or tissues.

Multiple encephalomyelitis is a disease in which a variety of inflammatory processes occur in the spinal cord and brain. Pathology is characterized by lesions scattered throughout the nervous tissue. The name itself (encephalitis and myelitis) indicates the severity of the disease, and the prognosis of the patient’s recovery depends on the activity of the process, the adequacy and timeliness of treatment, the initial state of the body. The outcome of acute encephalomyelitis can be both recovery and disability or even death of the patient.

Multiple sclerosis

The disease refers to a viral infection of the nervous system, which develops in the immunodeficiency state of the patient. Pathology progresses rapidly and can lead to death of the patient within a year. Often the cause of multifocal leukoencephalopathy is a reactivated virus that enters the body in childhood and is latent in the kidneys or tissues.

Is there an effective treatment?

Unfortunately, today there are no tools that can quickly and finally save the patient from such an illness. Nevertheless, every year there are more and more drugs that are prescribed to patients with a diagnosis of demyelinating disease of the brain. Treatment, of course, depends on the type and stage of development of the disease.

Quite effective drugs are beta-interferons, which quite well block the further progression of the disease and the risk of disability. According to statistics, such a course of treatment at 30% reduces the likelihood of occurrence of certain complications.

Depending on the characteristics of the course of the disease, therapy also includes taking muscle relaxants, anti-inflammatory drugs (usually corticosteroids), as well as cytostatics. Nootropic drugs, amino acid complexes and neuroprotective drugs have a positive effect on the brain.

Approximately such treatment requires demyelinating disease of the brain. The prognosis for patients depends on the variety and form of the disease, as well as the rate of its progression and the quality of the care given to a person. And do not forget that the development of new drugs is still underway.

Therapy focuses on the effect on the immunoreactive process. Unfortunately, the cause of multiple sclerosis cannot be eliminated. Therefore, treatment is aimed at improving the health of the patient, mitigating his condition. The methods used can be divided into 3 groups:

  • Corticoids are the dominant agents during the exacerbation period. They are administered mainly during the attack period, mainly intravenously in infusion. Methylprednisolone is used. If the therapeutic effect is insufficient, cyclophosphamide can be used once.
  • During the period of relapse prevention, maintenance doses of Prednisone or other immunosuppressants (Azathioprine, Cyclophosphamide) are used to slow down the further attack and stabilize the process. This type of treatment is mainly used in the early stages of the paroxysmal form. Long-term use of corticosteroids is fraught with a number of possible side effects, so they are always administered in a single daily dose every other day (alternating method).
  • Symptomatic treatment is guided by clinical manifestations. With spasticity, muscle relaxants are used (Baclofen, Tizanidine, Tetrazepam). Cerebral symptoms are improved by physostigmine, tremor – clonazepam, sometimes in combination with trimepranol. Paresthesia may be relieved by carbamazepine, amitriptyline, or hydantoins. Melipramine or ditropan can be used against urination disorders. Part of the treatment is well-chosen rehabilitation. Regular targeted treatment is important in the presence of certain provocative factors and improved prognosis.

It is difficult to cure degenerative and demyelinating pathologies of the central nervous system today. Even with the development of modern medicine, there are no medicines capable of definitively and quickly rid a patient of an ailment. Therapy is aimed at preventing the formation of long-term neurological consequences. Before determining the exact diagnosis, the doctor sends the patient for differential diagnosis, during which, with similar symptoms, one needs to distinguish one demyelinating disease of the brain from another.

It is impossible to cure completely multiple sclerosis. In a clinic where there is a neurology department, the patient is first sent to do an MRI, spinal puncture, and take laboratory tests. There is no specific test that accurately determines the diagnosis. Many other diseases have similar symptoms (lupus erythematosus, stroke), so only an experienced specialist can determine the final diagnosis and treatment method. In each individual case, drugs are prescribed based on the severity of the attacks.

Medications are prescribed depending on the stage of multiple sclerosis. So, with an exacerbation of the last, cerebrospinal form of the disease, injections and tablets of adrenocorticotropic hormone and cortisone are prescribed. They prevent functional disorders, relieve inflammation, and reduce the immune attack. With interval treatment between attacks, drugs are prescribed that contribute to the normal functioning of the immune system: Immunoglobulins, Methotrexate, Cyclosporin A.

Symptomatic therapy means all treatment methods that can help alleviate the symptoms or further conditions of the patient, but do not eliminate the causes of the disease. With demyelinating pathologies of the central nervous system, rehabilitation measures such as physiotherapeutic procedures, alternative treatment methods, changing the diet, acupuncture, laser or non-oral therapy are carried out.

Non-drug treatment covers energy-saving physical exercises (using long periods of rest, prioritization, intensive morning exercises). Physiotherapy is based on training new walking options, developing balance, and, if necessary, selecting prostheses. Symptomatic therapy improves the quality of life of a patient with a brain disease.

Demyelinating disease of the central nervous system is classified as incurable. Therapeutic measures are aimed at improving the quality of life of the patient and eliminating the symptoms. For symptomatic therapy prescribed:

  • analgesics;
  • sedatives;
  • nootropics;
  • muscle relaxants;
  • anti-inflammatory drugs;
  • neuroprotective drugs.

Quite effective drugs are beta-interferons, which quite well block the further progression of the disease and the risk of disability. According to statistics, such a course of treatment at 30% reduces the likelihood of occurrence of certain complications.

For the normal interaction of neurons (nerve cells) with each other and with other structures of the body, it is very important not only their internal content, but also the membrane containing the substance myelin. Its components are lipids and proteins.

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If such a “wrapper” of neurons is destroyed for any reason, transmission of nerve impulses is impossible. A demyelinating disease of the brain can lead to such consequences, which can greatly affect the consciousness and even human vitality.

Causes of Brain Disease

Any demyelinating disease of the central nervous system can occur for various reasons. The most famous among them:

  1. Malfunctions in the metabolism. This is typical for diseases such as diabetes mellitus, thyroid disease.
  2. Paraneoplastic processes, which are the first manifestation of a malignant tumor.
  3. Intoxication with chemical components: narcotic, psychotropic, alcoholic, paint and varnish and others.
  4. The reaction of immunity to proteins that are in the composition of myelin.

Numerous studies in recent years confirm that demyelinating diseases of the brain can develop due to the negative effects of the environment, poor heredity, malnutrition, prolonged stress or bacterial infection. An important role in the spread of pathology is played by infectious diseases: herpes, measles, rubella, Epstein-Barr virus.

It is not always possible to find out the reason for the appearance of such a process. Nevertheless, in modern medicine, it is common to identify several major risk factors. For example, quite often such a disease develops against a background of hereditary diseases, including aminoaciduria, leukodystrophy, Alexander’s disease, etc.

Demielisation can have an acquired character. In some cases, damage to the myelin sheath occurs against the background of infectious inflammatory diseases, less often after the introduction of vaccines. Diseases such as diffuse and multiple sclerosis, acute transverse myelitis can also cause demyelination of nerve fibers.

Among the main reasons as a result of which demyelination of the brain begins to develop in the body, it is customary to attribute:

  1. The reaction of the human immune system to the protein that myelin is made of. As a result of irreversible processes that occur in the body, such a protein begins to be perceived by the immune system as a foreign one. Cells begin to attack it and gradually destroy it. This reason is the most dangerous. This mechanism can be triggered by the ingestion of an infection or features of the human immunity, which are hereditary. These include multiple sclerosis, multiple encephalomyelitis, etc.
  2. The demyelinating process may begin in response to the presence of a neuroinfection that specifically affects myelin.
  1. Violation of metabolic processes in the body. As a result, myelin begins to suffer from a deficiency of the substances it needs and gradually breaks down. This is possible in patients who have a history of diabetes and problems associated with the functioning of the thyroid gland.
  2. The effect on the body of toxins and chemicals, including: alcohol, psychotropic drugs, acetone, body waste products.
  3. Paraneoplastic processes that occur as a complication of cancer.

As a result of scientific research, it was possible to establish that heredity and adverse environmental conditions play a special role in the defeat of myelin (the sheath of nerve fibers). There is also information about the relationship between the likelihood of this disease with the geographical location of a person, where foci of demyelination are noted.

There are two types of brain demyelination:

  1. Myeloklastia – characterized by a hereditary predisposition to rapid destruction of the membrane of the substance myelin.
  2. Myelinopathy is a process of destruction of the myelin sheath, which has other causes.

Demyelinating diseases of the brain are characterized by damage to the peripheral and central nervous system. They most often occur against the background of a genetic predisposition. It also happens that a combination of certain genes provokes disturbances in the functioning of the immune system. Other causes of demyelinating diseases are also identified:

  • a state of chronic or acute intoxication;
  • solar radiation;
  • ionizing radiation;
  • autoimmune processes in the body and genetic pathologies;
  • complication of bacterial and viral infection;
  • improper nutrition.

The most susceptible to this pathology is considered the Caucasian race, especially those of its representatives who live in northern geographical latitudes. This type of disease can be triggered by trauma to the head or spine, depression, bad habits. Some types of vaccines can also be a trigger for starting the development of such pathologies. This applies to vaccinations against measles, smallpox, diphtheria, influenza, pertussis, hepatitis B.

On the other hand, such diseases can be caused by some metabolic disorders. In particular, the cause is often acute deficiency of vitamin B12, central pontinous myelinosis and some other conditions.

There are many reasons why a demyelinating process may appear. There are reasons that depend on a person’s lifestyle, but there are also factors that cannot be influenced.

  • Various viral infections such as measles and rubella.
  • Bad heredity. Defects are associated with the formation of the myelin sheath.
  • Hepatitis vaccination.
  • Constant stress.
  • Bad habits, such as alcohol abuse, drug use and smoking.
  • Problems with metabolism.
  • Various strong intoxications with toxic products, as well as harmful substances, such as acetone or paint.
  • The appearance and development of tumors.
  • Autoimmune disease leading to destruction of the myelin sheath.

PNS affecting polyneuropathy

Polyneuropathy is a group of demyelinating diseases of the peripheral nerves that affect both sexes. In the onset of the disease, the effects of endogenous and exogenous factors are involved:

  • inflammation;
  • metabolic disease;
  • toxic, immunopathogenic effects;
  • deficiency of vitamins, nutrients;
  • degenerative, paraneoplastic factors, etc.
  • hereditary: motor and sensory neuropathy;
  • metabolic: diabetes mellitus, uremia, liver disorders, porphyria, hypothyro >

    Mostly long nerves are affected, clinical manifestations prevail in the distal extremities (on the opposite side of the lesion). Symptoms can be symmetric and asymmetric. Often the symptoms are predominantly sensitive, motor, and vegetative in relation to the 3 main types of nerve fibers.

    Symptoms

    The first symptoms include burning, tingling, tightness, cold, pain, decreased sensitivity. These symptoms usually begin on the feet, from where they extend to the ankles. Later, when the lesions grow in volume, the manifestations reach the tibia, appear on the fingers.

    Among the motor manifestations, the most frequent are convulsions, muscle tremors (twitching), muscle weakness, atrophy, increased fatigue, and uncertain gait.

    The disorder of the autonomic nerves causes a violation of sweating, blood circulation, heart rate. There is a decrease in reflexes, a violation of smell, a defeat of deep sensitivity, etc.

    Diagnostics

    Polyneuropathy can develop acutely and chronically. Demyelinating disease requires a complete professional examination. It is necessary to examine blood and urine (to exclude the causes of diabetes, liver, kidney, etc.). A chest x-ray, EMG, cerebrospinal fluid examination (lumbar puncture), examination of family members, a nervous and muscle biopsy are performed.

    Treatment

    You can treat polyneuropathy after determining its cause. The basis of therapy is precisely the elimination of the causative factor. A significant part of the treatment process is supportive, aimed at the regeneration of peripheral nerves, but not affecting the main causes, not curing demyelinating disease. Unpleasant problems are eliminated by antidepressants, sedatives. To reduce nervous irritation, carbamazepine or phenytoin is used.

    Modern diagnostic methods

    If there is a slightest suspicion of such a disease, it is worthwhile to see a doctor. Naturally, there are many methods of diagnosis, but a kind of “gold standard” is magnetic resonance tomography of the head. The results of MRI help the doctor to determine the localization of the demyelination process, as well as the stage of the development of the disease, the features of its course and the rate of progression.

    Further studies will be required, in particular, blood and cerebrospinal fluid tests, etc. These tests provide an opportunity to find out the cause of the development of the disease, which is extremely important for drawing up an effective treatment regimen.

    It is not enough to know the manifestations of the disease in order to find out the exact diagnosis. Even an experienced doctor will not be able to unequivocally say which ailment caused a number of deviations in a person. Foci of demyelination of the brain can be identified during research. The doctor will direct you to the necessary procedures, and then, based on the results, will make a diagnosis.

    Often, patients are prescribed magnetic resonance imaging, which is a popular procedure for suspected brain pathology. With its help, you can understand whether there are pathological foci, where they are, and also how much they have.

    Electroneuromyography is also prescribed, thanks to which it is also possible to identify the localization of the disease. Also, this procedure will help determine the stage of decay of the nervous structure.

    There is also a new diagnostic method that is used for suspected brain demyelination. With it, you can analyze the process of conducting nerve impulses by recording the electrical activity of the head region. If the structure will demyelinate, then this research option will allow you to learn a lot of important information.

    ODEM = acute disseminated encephalomyelitis

    A demyelinating disease of the brain and spinal cord that occurs after acute viral infections (measles, rubella, etc.) or certain types of vaccinations (e.g., rabies, smallpox, etc.). This is rather an immunological complication of the infection than a direct infection of the central nervous system with the virus.

    The clinical picture does not differ from other encephalomyelitis. The liquorological data are either normal or show dissociation of the cytological protein.

    The main causes of the appearance of pathology

    Neurons have a specific shape that distinguishes them from all other types of cells. They have very long processes, some of which are covered with a myelin sheath, which makes it possible to transmit nerve impulses and makes this process faster. If myelin is destroyed, the process will either not be able to communicate with other neurons at all through electrophysiological impulses, or this process will be extremely difficult.

    Subsequently, the structure of the human body will suffer, the innervation of which is associated with a damaged nerve. This means that the disappearance of the myelin sheath can have a variety of symptoms and consequences. Patients with similar diagnoses, but with different localization of the pathological focus, can live a different amount of time, the prognosis depends on the importance of the affected structure.

    A very important role in the destruction of the membrane is played by the immune system, which suddenly attacks the living structures of the body.

    Some causes of this disease of the central nervous system do not depend on lifestyle (for example, heredity), while others are associated with the neglect of a person to their own health.

    Most likely, the demyelinating process of the brain occurs under the influence of several factors simultaneously.

    The development of this ailment can be associated with the influence of such factors:

    1. Defects of hereditary information associated with the formation of the myelin sheath.
    2. Harmful habits that cause poisoning of neurons by smoke, narcotic compounds, alcohol.
    3. Prolonged exposure to stress.
    4. Viruses (rubella, herpetic diseases, measles)
    5. Neuroinfections affecting nerve cells.
    6. Hepatitis Vaccination.
    7. Autoimmune disease, against the background of which the destruction of the myelin sheath is carried out.
    8. Metabolic failure.
    9. A paraneoplastic process that develops due to the growth of neoplasms.
    10. Intoxication with any potent harmful substances (including those that are used in everyday life – paints, acetone, drying oil), as well as toxic metabolic products.

    Conclusion

    The topic of demyelinating diseases reflects the medical and social significance of these ailments, pitfalls of diagnosis, new trends in treatment in a situation of a constant increase in the number of patients with such problems. This is a constant topic of most congresses, since demyelinating disorders are one of the most serious diseases of the central nervous system, mainly with serious consequences, requiring a specialized approach, not involving the use of alternative therapeutic methods.

    Such pathological changes in the central nervous system can provoke many factors, but a person must remember that in some cases it can prevent the development of a dangerous ailment. For example, avoiding hypothermia and communication with people infected with the infection, you can reduce the risk of developing violent immune reactions that can lead to the destruction of the structures of your own body. Being engaged in hardening of the body and elementary physical exercises, it is possible to increase resistance to very many negative influences at times.

    The destruction of the myelin sheath of nerve cells (neurons) of the central nervous system or peripheral nervous system is called demyelination. Demyelinating diseases occur as a manifestation of genetic disorders or autoimmune diseases.

    The treatment of demyelinating diseases is complex, depending on the stage of the disease and the individual characteristics of the body. It is completely impossible to cure them, with exacerbation and progress of the disease, drug therapy is prescribed. At the Yusupov hospital, the patient can undergo physiotherapeutic procedures, massages, and practice gymnastics with the hospital’s specialists.

    symptomatology

    Symptoms depend on the type of disease and where the foci of brain demyelination are located.

    In particular, multiple sclerosis is characterized by the following set of symptoms:

    1. Change in the ratio of the intensity of tendon and some skin reflexes, paresis, muscle cramps.
    2. Change in the characteristics of vision (distortion of the field, clarity, contrast, the appearance of cattle).
    3. Changes in the degree of sensitivity of various analyzers.
    4. Signs of impaired functioning of the brain stem and nerves anatomically associated with the brain (bulbar syndrome, facial muscle dysfunction, nystagmus).
    5. Pelvic dysfunction (impotence, constipation, urinary incontinence).
    6. Changes of a neuropsychological nature (decreased intelligence, depressive states, euphoria).

    Marburg’s disease (disseminated encephalomyelitis) is a transient, deadly disease that can kill a person in a few months. There is a classification according to which this ailment is attributed to the form of multiple sclerosis. It resembles an infectious disease in which the following symptoms appear:

    1. A rapidly developing demyelinating pathology affects the brain stem and the nerves associated with it.
    2. Intracranial pressure rises.
    3. Disturbed motor function and sensitivity.
    4. Often there is a headache, accompanied by vomiting.
    5. Convulsions appear.

    Devik’s disease is called a process of demyelination, which covers mainly the optic nerves, as well as the substance of the spinal cord. The disease is considered more dangerous for adults and less dangerous for children, especially if you start treatment with hormonal medicines on time. The manifestations of this pathology are as follows:

    1. Vision problems leading to complete blindness.
    2. Paralysis.
    3. Pelvic dysfunction.

    Another pathology, progressive multifocal leukoencephalopathy, is characterized by a combination of immune shifts caused by external factors and the appearance of demyelinated foci. You can suspect such an ailment by the following signs:

    1. Decreased visual ability.
    2. Decreased intelligence.
    3. Loss of coordination.
    4. Convulsions.
    5. Paresis.

    As you understand, such problems greatly reduce the quality of life.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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