|
The multiple sclerosis is a neurological disease which touches approximately 50,000 people in France. The exact cause of the disease is not yet known but a general consensus agrees to define the mechanism: It is about an dysimmmunizing affection leading to a destruction of the sheaths of myelyn which coat fibres connecting the neurons with the central nervous system. It generally begins in the young adult between 25 and 35 years. The evolution is variable and unforeseeable. There are several forms of which here definitions:
- form evolving/moving by pushes:
- pushed: appearance of new demonstrations or clear aggravation of chronic neurological demonstrations during at least 24 to 48 H, to distinguish from transitory aggravations or the pseudo-pushes occurring at the time of an intercurrent, in particular feverish affection.
- remittent form:
- evolving/moving by thorough more or less completely regressive.
- form secondarily progressive:
- after a remittent phase, installation of an insidious aggravation.
- progressive form from the start:
- 15% of the MS: no initial remittent phase.
The diagnosis is related to clinical, para-clinical signs, and on the evolution of the disease.
Clinical Signs:
- attack of the optic nerve:
- attend revelation of the disease by a retro-bulbar optical neuritis.
- attack of the pyramidal tract:
- disorder of the functioning, falls, sharp reflexes, spasticity,
- attack of the posterior side strip:
- oculo-motor deficiences
- sensitive disorders: paraesthesias (" swarmings ")
- cognitive disorders: attack of the attention, the memory,
mood
- a constant is extremely fast fatigability in the course of
the day.
NB: The first thorough one can pass unperceived if the signs
are discrete or transitory.
Para-clinical Signs:
The MRI is an examination of choice revealing of hypersignals
and confirming the multifocal character of the disease. But the result is
not specific.
The study of the CRL (cephalo-rachidian liquid obtained by
lumbar puncture) can reveal a oligoclonale hypersecretion of
immuno-globuline characteristic of the inflammatory nature of the
disease.
Finally only the evolution will confirm a
fundamental criterion: the dissemination in the time of the
pathological process, (see various forms ).
Current Processing:
There is not only one radical processing and much of
processing were still tested or are in the course of evaluation. They
act on the inflammatory and immunizing component.
Basic processing:
- Interferon Beta 1a and 1b recombining:
- These drugs are promising, expensive, and their regulation is
regulated. They tend to be prescribed more and more early (cf last study
published in New England Journal of Medicine). They reduce the
frequency and the severity of thorough but does not seem to avoid
occurred of disability. There are many adverse effects which can lead
to the stop of the processing.
- The Glutiramere acetate (ex copolymer 1)
- used in the event of counter-indication with the interferon
(similar effect).
- Intravenous Immunoglobulins .
- Primarily Immuno-cancellers Agents:
-
- Azathioprine (Imurel)
- Mitoxantrone (Novantrone)
- Cyclophosphamide (Endoxan)
- Methotrexate
Processing of the pushes
The processing of thorough calls primarily upon the "
corticoid flashs " drug for their anti-inflammatory action. The
symptomatic processing remain the only recourse in the event of
intolerance to interferon and in the advanced progressive forms.
- Processing of the spasticity
- Antidepressant processing and / or anxiolytic
- Anti-pains processing (for example in the cordonnal
posterior syndrom)
- Processing of the infections which had with the
immobilization and the disorders of the sphincter.
Care
It utilizes the ancillary medical ones (nurse,
assistance-looking after, kinesitherapist).
Kinesitherapy
It is essential at all the stages:
- at the beginning of the driving disorders to facilitate the
maintenance of autonomy,
- in the event of aggravation and at the beginning of
disability to facilitate the chair bed transfers, to fight against the
spasticity, the articular ankylosis, and the circulatory damning up.
- and even in phase of absolute disability to avoid the
complete grabatisation and to take part in the psychological support.
The recourse to equipment can prove to be
essential in the event of aggravation of the handicap:
- initially adjustment of the place of life: ground-floor,
shower with handles, WC with rehaussor,
- then medicalized beds, raise-patient, adapted travelling
armchair.
The passage in specialized unit of neurology can be done for
short hospitalizations considering the need for certain treatments.
An annual stay in center of reeducation or center specialized for the
processing of the MS is necessary during the aggravation of the
disease, with as principal objective to relieve the families which
take part in the maintenance in residence, and to try to avoid the
grabatisation of the patient.
The General practitioner
He has a role significant to play in this disease:
- coordination with the doctor neurologist referent who
occupies more technical part
- coordination with the various ancillary medical speakers
- establishment of the certificates and the files of assistance
to the assumption of responsibility.
- correction of the various symptoms or intercurrent diseases,
- finally and especially a psychological support for the
patient and his entourage whose life is completely upset by this
affection.
Dr. Patrick Imbert
Top of the page
| 
Dr. Patrick Imbert, General practitioner, look after patients affected by the multiple sclerosis. He gives us here more details about this disease.
