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Diffuse sclerosis

 

MSis one of the most common diseases affecting the central nervous system, an inflammatory disease that removes the myelin (myelin) sheets covering the nerves, which is a fatty substance that protects and helps to quickly deliver nerve signals from the brain to parts of the body, and can be represented by protective plastic cover For electrical wires, and in response to unknown antigens, lymphocytes begin to attack the myelin plates, causing its removal, which impedes the movement of nerve signals and produces inflammation, the cause of which is called permanent formation of plaques (white spots that appear in the image of MR magnetic) I) the disappearance of myelin in the central nervous system, and these sclerotic plaques that constitute the lesion of the disease, so it is a disease of the brain and spinal cord (the central nervous system) and it affects the brain’s control ability in the functions of the body and is called stiff because the disease affects the brain tissue with hardening and replaces it with tissues (Ineffective) solid, which is not an infectious or mental illness and it is not possible to know who is at risk of it, and young people and girls are considered the most affected, millions of money were spent on this disease all over the world in order to provide health services and conduct studies and research to discover its causes and methods of treatment. This disease was formerly known as disseminated sclerosis, and this designation is not without accuracy as the main feature associated with this disease is its symptoms spread in several places of the nervous system and at different times as well (spread in place and time), where the disease usually begins in Appearance at the age of 30 years, and affects women nearly twice as much as men, and that 85 per cent of people who once have symptoms indicating multiple sclerosis of nerve fibers are confirmed to have it within two years. , And that the disease appears more in the areas of latitude higher than the equator (about 40 degrees Celsius) than in the areas near the equator. In the Arab world there are 20 thousand patients in Egypt, 200 in Lebanon, and 2000 in Jordan, and the number increased in the Gulf countries after the Gulf War, reaching 13 thousand cases. The direct and indirect cost is estimated at 40,000 euros ($ 51,000) per patient. So far, several million cases of multiple sclerosis have been registered in almost every country in the world, but disease is common in certain groups of people depending on the age, gender, geography and food they eat. That the first cause of this disease is unknown, but there is a group of factors that cause the disease, including immune disorder, smoking, chemicals, exposure to toxic fumes or environmental pollution, and genetics, where scientists found that there are genetic regions that contribute to and strengthen disease infection through exposure to an infection Viral or some environmental factors. To this day, the cause of the disease is unknown, and researchers from around the world are working to uncover the secret. It is possible that the damage that occurs to melanin in MS is caused by an abnormal reaction to the body’s immunity that protects the body from foreign bodies (bacteria and viruses) and many of the characteristics of MS indicate that it is an autoimmune disease where the body attacks its cells and tissues Represented by melanin in case of MS. Researchers do not know the cause of the body’s immune attack on melanin, but it is believed that there is a combination of factors.
one Theories say that a virus – which may be latent in the body – has an active role in the development of the disease and causes immune deficiency, directly or indirectly. There is a lot of research in place to determine this virus, but it is possible that any common virus – such as measles – could trigger the disease. This catalyst activates white blood cells (lymphocytes) that act to multiply the brain’s defenses and thus reach it. In the brain, these cells activate other elements of the immune system in a way that causes them to attack melanin. In addition to the aforementioned factors such as gender, age, geography, and food, there are some other factors that have been linked to stimulating relapses, the most important of which is the psychological factor. Several cases of relapses of the disease have been recorded that have occurred directly to individuals while they are experiencing psychological stress after deaths or accidents in the vicinity around them Also among the factors is smoking, as the percentage of patients who smoke is higher than that of non-smokers, and pregnancy has a role in accelerating relapse up to the last three months of pregnancy and the period of breastfeeding, where the rate of relapse significantly decreases. It was also observed that relapse occurs a lot in the winter and spring, especially after infection with various winter diseases such as colds, influenza and others. The attack on the nervous system is carried out on two axes, the first of which is the production of CD4 Tcells, and other lymphocytes and monocytes, all of these cells in turn adhering to special receptors located on The inner surfaces of the cerebral blood vessels and then infiltrate into the white matter in the brain to break and swallow the myelin coated nerve. The second is the production of antibodies that attack myelin, and it may attack cells that make myelin directly (these cells are called oligodendrocytes). But here comes the big question, which is what drives the body to suddenly and without prior warning attacking itself ??! To answer this perplexing question, many theories supported by the observations have been developed, the most important of which are mentioned below: A- Genetic theory: Although multiple sclerosis is not considered a genetic disease, many genes that have been linked to the disease have been identified, and the most famous of them is the genetic differences found on the sixth chromosome in the genes of HBV2, D2, and B2 cells. 7 and A3 (human leukocytic antigen HLA DR2, D2, B2, A3), and there are also differences in the genes responsible for making some receptors on cells, the most famous of which are interleukin 2 and Interleukin 7. B – bacterial theory: This theory assumes the presence of a bacterium (often a virus) that causes the existing immune imbalance. This theory is supported by laboratory analyzes that show that individuals with the disease often have – when conducting blood and the spinal fluid surrounding the brain – high levels of antibodies to some viruses such as measles, herpes virus or Epstein-Barr virus ( epstein barr virus) …. and others. Some animal viruses have also been discovered that cause – in animals – neurological diseases in which the myelin membrane is destroyed, but such viruses have not been discovered in humans yet. C – Environmental theory: the geographical distribution of the disease may give some evidence of the relationship between environmental conditions such as weather and exposure to sunlight, and thus the ratios of vitamin D composition in the body on the one hand and between the disease on the other hand. There is a strange observation, where it is observed that the rate of disease is among those who migrated from areas with a low incidence (say, for example, from the inhabitants of the equator countries) to the regions where the rates of infection increase (and suppose a country in the North of the Globe like America) provided that the migration took place before the age of 15 years, The infection rates for these immigrants rise to become close to those of the indigenous population, but if migration takes place after this age, the migrant maintains a low rate of infection as in his country of origin and vice versa.
 

These plaques may be found anywhere in the white matter of the brain and spinal cord, but they have a tendency to appear in places but not others, the most famous of which is the area around the cerebral ventricles (the ventricle is a cavity inside the brain), visual nerves, the brain stem, and the cervical part of the spinal cord And the cerebellum, and for this disease, like other autoimmune diseases, periods of activity are called relapse, followed by periods of calm called cumin (remission), and symptoms of diffuse sclerosis vary from one patient to another and from time to time, and among these symptoms are problems with the eyes Weakness or lack of control of eye movements Vision with pain in the eye, when moving, problems with speech, partial or complete weakness of any organ, a feeling of weakness and extreme fatigue. , Tremors in the hands, feeling dizzy, loss of control in urination or excretion, numbness and numbness in the limbs or face, loss of balance or ability to control movements, or heaviness in the limbs when walking. These early symptoms are often mild and disappear without treatment, but over time it may become more and more severe, and the main diagnosis of this disease may be made through its clinical (clinical) form only. Despite this, there is no specific set of symptoms of it. The disease has specific clinical patterns developed after studying the previous history of the disease to anticipate its future behavior and to determine its treatment methods because the disease often adheres to its own pattern. 1- Multiple sclerosis, relapsing-remitting M.S and constitutes 80-90% of cases, in which relapse occurs simultaneously with symptoms and is followed by a period of latency during which the progression of the disease stops and the body begins the repair phase in whole or in part. 2 – primary progressive multiple sclerosis: primary progressive M.S and constitutes 10-20% of cases, in which relapse occurs simultaneously with symptoms and is not followed by a period of calm, but the disease continues to progress gradually, and this type often comes to the person after the age of fifty. 3- Secondary progressive M.S. It begins with the disease as the first type and then turns into a condition similar to the second type and continues with progression, and this transformation is usually done after an average of 6-10 years of the disease. 4- Relapsing-progressive M.S, which is similar to the initial progressive type in that the symptoms develop gradually and continuously, but the difference in the presence of periods of relapse permeates the course of the disease where the symptoms increase significantly or new symptoms appear. There are two other types: benign MS: it is the lightest and least harmful pattern, as the disease does not leave any permanent symptoms, (fulminent MS): (less than 10%), in which the recurrence occurs and then the patient’s condition deteriorates in a way Fast, where the disease is very violent from the beginning, and in less than 5 years, the patient suffers from severe disability.

Now let’s review the different symptoms of the disease, such as: Visual problems: blurred vision (foggy), duplication of vision, optic neuritis, involuntary rapid eye movements, vision loss (very rare) Balance problems and movement symmetry: loss of balance, tremors (involuntary fibrillation), ataxia (irregularity) in walking, dizziness, asymmetry in movements (especially in the limbs), weakness: especially in the legs when walking, muscle cramps, changes in nature Muscle (loosening and contracting) and muscle stiffness can affect movement and walking, spasms Changes in nervous sensation: tingling sensation, paresthesia, burning sensation, possibly some pain related to multiple sclerosis such as facial pain (trigeminal neuralgia) and muscle pain Speech difficulties: slow pronunciation, stuttering and pronounced blurring (words and letters overlap with one another), difference in poise / frequency of speech, dysphagia Fatigue: General fatigue that weakens the body and is unpredictable and inappropriate for the activity the person has performed. Fatigue is one of the most common symptoms and one of the most disturbing to the patient. Urine and stool problems: Among the problems of urine: the need to urinate between short periods, the immediate need to urinate, not to empty the entire bladder, involuntary urination, of stool problems: constipation, involuntary discharge (rare) Sexual problems: impotence, loss of sensation, increased sensitivity to heat, and this symptom usually causes a temporary worsening of symptoms. Cognitive and emotional disorders: impairment of temporary memory, loss of ability to focus, right judgment or reasoning It is true that there is no completely cure for sclerosis until today, but this does not mean that there are no good measures to alleviate the disease and help the patient to his symptoms, especially in the last ten years after the availability of immunomodulators. The disease is diagnosed by clinical examination, visual field examination, measurement of electrical potential, laboratory confirmatory diagnosis, biopsy of the spinal cord, and use of MRI. But how can this disease be discovered in its early stages? Several years may pass from the first symptoms before a definite diagnosis, and for several reasons, including early symptoms of the disease may be mild as the patient does not notice them or consult a doctor because of them, and that other diseases of the nervous system are similar to the symptoms of diffuse sclerosis and may cause difficulty in the beginning to recognize or diagnose the disease And the absence of laboratory tests currently helps to detect the carrier of the disease with certainty, and there are two clinical characteristics to ensure the presence of diffuse sclerosis, the first of which are signs of a nervous system disorder, numbness paralysis, an unknown cause with clinical signs of infection in two or more places of the device The nervous system is discovered by the doctor upon examination, and the second is healing and relapse during periods of time that may be longer or shorter. The attending physician makes sure of the diagnosis by performing an MRI scan to examine the cerebrospinal fluid and planning the nerves, but the diagnosis of diffuse sclerosis does not have to be seen in a desperate way, although there are patients who suffer from recurrence of the disease, but few suffer from major complications of the disease, most patients live a life Active despite the relapse of the disease and adapt to the disease by adopting a positive style and a positive outlook in their lives.

Although the disease was discovered in 1870, the first drug to treat the disease was produced 120 years later, i.e. in 1990, which is “betaveron”, a drug produced by genetic engineering methods from natural interferon (and interferon is a natural protein found in the human body Helps overcome infections and diseases). Betaferon’s experience has shown that treatment helps reduce the number of relapses experienced by the patient, increase the time between relapses or attacks, reduce the intensity of attacks, and reduce the number of new infections that appear in the MRI scan. Treatment is divided into three types: attack treatment, disease treatment and complications Treating an attack: If the attack is light-weighted, and its symptoms are possible, then it may respond to rest for a day or two, while drinking sufficient cold fluids, cooling the atmosphere of the room, and many patients if they follow it at the beginning of the attack, their symptoms improve, and if the above does not work, Or the attack was very severe, and a cortisone was given, and the way to give it varies according to the attending physician, but most doctors give it for 3-5 days intravenously. The cortisone speeds up the recovery of the attack, and reduces its severity, giving cortisone does not cause any significant complications, such as those that may occur from abuse Chronic prolonged cortisone. Treatment of the disease: These are drugs called (immune rates), and they work to change the nature of the immune structure, thereby reducing the number of attacks, and reducing their severity, and may alleviate poor lesions in the brain’s magnetic images, and the severity of the disability that may occur from the disease In its advanced stages, one of these medications is always taken, all of which are closely related in effect, but some are taken intramuscularly once a week, and some are subcutaneously several times a week depending on the type of medication, and generally these medications do not have problems, but After injection, the patient may feel symptoms similar to the symptoms of the common cold from heat and fatigue, and this is usually treated with a medication such as a Pendulum before injection, given these drugs usually in the type paroxysmal (recurrent Pacific), and modified drugs are not given immunity during pregnancy and lactation. Medicines used to treat Rebif disease: (Betifron® = Interferon beta 1a) Avonex: Avonex® = Interferon beta 1a. Novantrone® = Mitoxantron. Taisabri: Tysabri® = Natalizumab. ). Other treatments: immunosuppressive drugs such as azathioprine and cyclophosphamide may be used, but some research has questioned whether they have any role in the treatment of multiple sclerosis, and the use of glatiramer acetate may be of benefit in Reducing the number of relapses, and using natalizumab But it must be emphasized that the patient must adopt healthy health habits such as balanced food, quit smoking and practicing light sports such as swimming and walking whenever possible. There is much that can be done to mitigate the effect of MS on patients to keep them highly vibrant, independent and comfortable. In this context, we must not forget the necessity of reminding the patient and his family that this disease varies in severity from one patient to another in a significant way. With almost complete disability, especially those who acquired the disease at an early age (after forty), and the resonance images showed many plaques hardening in the first 5 years of the disease. And one of the studies showed that the risk of suicide among patients with multiple sclerosis of nerve fibers is 5.7 times greater than the rest of society. In cases of untreated relapsing multiple sclerosis, the average time that elapses until a person needs a wheelchair is 20 years. And with the type of disease that develops quickly from the beginning, the average time required until the wheelchair is used is 6-7 years from the start of the diagnosis. Hope is pinned on recent developments in diagnostic methods and new treatments. Treatment has now become via daily oral tablets after all treatments were limited to injections, and the emergence of medical societies that care for patients with diffuse sclerosis have helped to raise awareness of the disease, its causes and how to live with it. Large companies pour huge sums into research based on this disease to compete in time to find the optimal treatment for each case and thus seek to the well-being of patients and improve their daily activity.

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