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Primary progressive type of multiple sclerosis. What is progressive flow

There are two types of drug addiction: congenital and acquired.
The cause of congenital drug addiction is the mother's drug use during pregnancy.
Causes of acquired drug addiction
- Heredity. Even if the mother did not use drugs during pregnancy, but throughout pregnancy she felt a craving for them, then the child has a great chance of puberty become a drug addict or substance abuser.
- The period of psychological development of personality and the influence of friends. Many people now claim that club, or soft, drugs are not addictive and are not drugs. Of course this is not true. All drugs are addictive. Only some are stronger and faster, and some are weaker and slower. The difference is whether the child has time to give up drugs before addiction develops or not. After all, as a rule, the patient always (!) switches from soft drugs to harder ones.
- Unfavorable family environment. Scandals or divorce of parents.
- Lack of attention, love and proper education from parents.

Symptoms of drug addiction

Children with congenital drug addiction They are always born very weak, with low weight, whiny, capricious, with sleep disorders. They can be calmed down only after the drug addict mother, having taken another dose of the drug, breastfeeds the baby.
Children's drug addiction is much less common than childhood alcoholism, since children are rarely offered drugs, unlike alcohol. Typically, drugs are distributed among teenagers, since they are more able to pay than young children.
Manifestations of drug addiction in adolescents may be as follows:
-Sudden mood swings during the day: from depressed and/or aggressive to cheerful, joyful, energetic, maybe even falling in love. Moreover, changes in mood are not associated with any events.
-Sleep disturbance and normal rhythm wakefulness and rest. During the day the child is lethargic and sleepy, and in the evening, returning from a walk, on the contrary, he is cheerful and full of energy. It is difficult for him to sleep, and in the morning he cannot get up. Moreover, this happens exactly when he returns home from a walk or party.
-Changes in eating habits and appetite develop. The teenager has no appetite all day, but after returning from a walk, he pounces on food, eats an unnatural amount and is very greedy. This state is typical when recovering from drug intoxication.
- Suddenly the teenager loses interest in studies, school, or hobbies, which he had, some interests, knowledge and life in the family. They don't care what happens at home or at school. But there is a passion for heavy music, which in good condition difficult to perceive. It helps them to escape from constant thoughts about drugs or, conversely, helps them achieve a certain state during drug intoxication.
- Retardation in question-answer conversation. It takes an unnaturally long time for a child to answer a question. Sometimes it can get ridiculous when the question “What is your name?” comes first: “Me?” A delay may not always be a pause. A teenager may start talking about nothing, around and around, until he comprehends the question itself.
-Aggression develops. Especially in response to parental bans on walks. Aggression can be severe. Also, the child begins to show interest in subcultures, since with their help he can express his opposition to society, because he already feels outside of it.
-The child begins to speak in a peculiar slang. They need slang not for self-expression, but to hide and encrypt communication. So that no one understands what we are talking about.
- Those who use injection drugs will always wear long sleeves and/or long pants to hide the injection sites. Those who smoke marijuana will always emit a specific smell. Especially after he smoked the drug. Also, when smoking anasha, a peculiar redness of the nose and cheeks appears in the form of a butterfly.
- The change in pupils is very indicative. In a state of drug intoxication, they are either greatly narrowed, or, conversely, greatly expanded and react very slowly to light.
- And finally, the children begin steal from home and from people things, to sell them and use the proceeds to buy another dose of the drug. Gradually, personality degradation occurs.

Diagnosis of drug addiction

-Chromatography- determination of the presence of drug breakdown products in biological fluid.
-Enzyme immunoassay - precise definition availability of quantitative and quality composition one or another narcotic substances or their breakdown products or antibodies to them in the blood.
- Chromatospectrometry- determination of the presence of drug breakdown products in urine. The method is similar to a pregnancy test.
- The method is widely used abroad immunochromatographic examination of blood serum, allowing the determination of antibodies to drugs.

Drug addiction treatment

Unfortunately, there are no 100% cures for drug addiction. How longer child used drugs, the heavier they were, the more difficult the treatment. Treatment for addiction to hard drugs is usually unsuccessful, and even if successful positive result, breakdowns and relapses occur very often. Treatment includes drug and psychological therapy aimed at relieving withdrawal symptoms, developing aversion to the drug and fixing this aversion. In the treatment of drug addiction, the desire of the patient himself to get rid of addiction is very important. After treatment, a period of social rehabilitation is required.

Drug addiction prevention

Take care of your children and don't use drugs yourself. Be aware of your child's surroundings. Conduct educational programs about the dangers of drugs.

The doctor’s determination of the nature and type of the course of the disease - vertebral and vertebrogenic pathology (more precisely, the neurological manifestations of spinal osteochondrosis) - is not a “tribute to academicism” and not “clinical pedantry”, but is the “criterion” that in turn determines specific therapeutic and preventive (including medical and social) measures over time (the course of the disease is clinical characteristics, reflecting the characteristics and manifestations of the disease over time.). I will leave this statement without explanation, since the latter would look like an excuse - an explanation of an obvious truth, and it cannot look otherwise. An introduction taken before the presentation, which will narrate, as indicated, the obvious and in highest degree necessary within the framework of not only vertebrology (vertebroneurology), but within the framework clinical medicine“in general” is the first step, declaring an upcoming important “reminder” (for those who knew, but partially forgot - reminiscence), or “learning” (for those who did not know, but feel such a need - actualization). And so, let's consider possible options“course” of vertebral and vertebrogenic pathology (neurological manifestations of spinal osteochondrosis). But in order to accomplish the latter, it is necessary to explain the periods of illness, their duration and severity, which actually determine the nature and type of course.

Periods of illness- these are stages in the course of the disease, differing in a certain clinic, severity, duration and sequence of development. The periods are: debut, exacerbation, relative stabilization, remission, residual period.

Debut– the period of the first clinical manifestations, characterized by a certain phase (see below) and a duration of no more than 3 months

Exacerbation- a period of illness characterized by (the development of the most severe symptoms within a period of up to 3 weeks) or the development of clinical manifestations of any severity after a period of complete remission or an increase in manifestations by one or more degrees after a period of incomplete remission (see below) or relative stabilization. Exacerbation is also characterized by typical phasicity. Exacerbations are distinguished not only by severity, but also by frequency: more than three times a year - frequent, 2-3 times a year average, up to once a year rare. In addition, the duration of the exacerbation is noted: up to one month - short-term, more than a month - long-term.

Phases characteristic feature debut and exacerbation. They replace each other in a certain sequence. The initial phase is established from the moment the symptoms appear or intensify within one degree of severity. It is followed by an increasing phase - an increase in severity by more than one degree. After the rising phase comes stationary phase, during which the maximum degree of manifestations is noted. In most cases, the stationary phase passes into a regression phase, during which the severity of clinical manifestations decreases with the transition to a period of complete or incomplete remission (see below).

Remission- this is the period between exacerbations with the severity of the disease from 0 to 2 degrees. Accordingly, complete remission (grade 0), incomplete type A (grade 1) and incomplete type B (grade 2) are distinguished.

Relative stabilization represents a period of illness, which is characterized by manifestations of the 3rd - 5th degree in the absence of dynamics 3 months after the debut or exacerbation. Thus (taking into account the above), both “debut” and “exacerbation” go into a period of “relative stabilization” if within 3 months 1. [at debut] remission is not achieved or 2. [pre-exacerbation] is not achieved: 2.1 . remission or 2.2. incomplete remission, or 2.3. period of stabilization (that is, the stabilization that was present before the exacerbation has not been achieved, and which had a severity of symptoms of at least 3 degrees inclusive [see definition of remission] and no more than 4 degrees [see definition of relative stabilization]).

Residual period is stated in the absence of clinical manifestations of the disease (which disrupt adaptive activity) for 15 - 20 years upon reaching the age of 50 - 55 years.

Depending on the alternation of periods of illness, their duration and severity, the nature and type of course is determined.

Character of the current The disease can be recurrent, chronically recurrent and chronic. The relapsing course is an alternation of periods of exacerbation and complete remission; chronically relapsing- alternating periods of exacerbation and incomplete remission or relative stabilization. Chronically relapsing course can be primary or secondary. The latter is stated if it replaces a relapsing course. The chronic course of neurological manifestations of spinal osteochondrosis means the presence of constant clinical manifestations with fluctuations within the same degree of severity. It is stated no earlier than six months after debut ( primary chronic) or after an exacerbation in the absence of a tendency to regression ( secondary chronic). It should be remembered that first chronic course little typical for neurological manifestations of spinal osteochondrosis.

Type The course reflects the development of the “quantity” of the disease over time. The regressive course is characterized by a decrease in the severity of the disease over time: a decrease in the number of exacerbations, their duration and severity, dynamics from polysyndromic to monosyndromic, change Not complete remissions complete with a tendency to clinical recovery. Non-progressive(stationary?) flow differs in approximately the same quality and quantitative characteristics manifestations of the disease over the foreseeable period of time. The progressive course is characterized by an increase in the manifestations of the disease over time: an increase in the frequency and duration of exacerbations, the emergence of new syndromes, the change from complete remissions to incomplete ones, or the development of a period of relative stabilization after an exacerbation.

source: based on materials methodological recommendations for doctors: “Diagnosis of neurological manifestations of spinal osteochondrosis and its adaptation to ICD-10” Novokuznetsk, 2004

© Laesus De Liro

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What is progression?

The term is used in psychiatry and means development of mental illness with a gradual increase in negative and positive symptoms. In other words, this concept describes the course of diseases such as epilepsy, Alzheimer's disease, schizophrenia and senile dementia, which have pronounced phases of exacerbation and remission with increasing deterioration of the patient’s condition in the future. In addition, the progressive course mental illness can occur not only in the form of sinusoidal phases of improvement and exacerbation, but also in the form of a continuous and steady deterioration in well-being.

Progressive course of mental illness using the example of schizophrenia

Paroxysmal-progressive course

Specific feature such a course of the disease is a sudden onset of an attack that can last a significant period of time. Moreover, during remission it is impossible to predict when the next phase exacerbation, because the clinical picture of such schizophrenia manifests itself sharply, without visible prerequisites.

As a rule, first symptoms of the disease usually begin to be observed in early childhood in preschool children. You should immediately start sounding the alarm if the child behaves withdrawn, distant, does not want to communicate and conduct free time with peers. However, parents usually bring their children to specialists only when problems arise in kindergarten or school.

What do exacerbations look like?

Initially become clearly visible negative symptoms, described in the above paragraph, which, nevertheless, do not yet greatly bother the sick person or the people around him, but if they frivolously hope that everything will work out by itself and do not go with the patient to qualified specialist, who will write down the necessary medicines, for example, antipsychotics, or is referred for treatment to a psychiatric clinic, then the condition will inevitably worsen.
The deterioration is as follows: a person with schizophrenia experiences hallucinations, catatonia, or crazy ideas, for example, delusions of persecution or condemnation, behavior becomes inappropriate and unpredictable. Since the patient is not aware of his actions, he can cause physical harm to loved ones or himself, as well as spoil things from his surroundings.

After completing the appropriate course of treatment, remission occurs, when the sick person looks healthy outwardly and it is impossible to say about him that he suffers from an incurable disease. It should be noted: the lack of proper treatment or haphazard treatment leads to the fact that the phases of remission and exacerbation begin to occur more often and become shorter in time. Gradually, negative symptoms replace the positive ones that are characteristic of remission to such an extent that we can already talk about complete absence light intervals during the course of the disease.

Continuously progressive course

Schizophrenia of this type, unlike paroxysmal-progressive schizophrenia, does not affect children, but mainly adolescents and adult men. The clinical picture looks like this:: the disease progresses rapidly, sometimes at lightning speed, remissions are rare and only with quality treatment, and they are not as clearly expressed as in the paroxysmal course of the disease. If such schizophrenia is not treated, it will inevitably worsen.

The development of the disease can be slowed down if a person promptly notices the appearance of symptoms such as:

Indifference to what is happening around and indifference to oneself, one’s appearance and your destiny;
Weakening of will;
Emotions become less and less expressed and, in the end, disappear, which is why the face of the sick person becomes like a mask;
Later, excessive excitability and aggression towards people who are trying to stir up the patient, communicate with him and interest him in some activity may appear;
In the final stage, we can observe the classic signs of any type of schizophrenia: delusions, visual or auditory hallucinations("vote").

Without qualified treatment, this disease will inevitably lead to irreversible mental deformation, in which the patient simply will not be able to interact with society, since his behavior will pose a huge danger not only to himself, but also to others, he will lose everything social connections, he is declared completely incompetent and placed in a psychiatric clinic.

Attempts have been made to bring such a disease as schizophrenia to a general classification various doctors V different times. The pathology was first extensively described in 1911 by Eugen Bleuler. He described the forms and types of schizophrenia, which are still used to classify the disease today.

Types of schizophrenia

There are two main types of disease, according to clinical manifestations:

paroxysmal-progressive;
continuously progressive.

Paroxysmal-progressive type

Coat-like or paroxysmal-progressive schizophrenia is an intermediate type of course between the recurrent and continuously flowing form. Main feature pathologies in sharp, spasmodic clinical manifestations. They arise suddenly and can last indefinitely, depending on the severity of the attack.

This form of schizophrenia begins to develop in early age. As a rule, these are children preschool age, during this period the first symptoms begin to appear. They manifest themselves in the form of isolation and distance from society; the child prefers to spend time alone. I'm having problems visiting kindergarten, and then schools.

Regarding the course of fur coat-like schizophrenia, two periods are distinguished in it: phase and fur coat. The period of the phase is characterized by an increase in negative symptoms, while initial stage, the emerging signs do not greatly disturb the patient and those around him. But over time, the phase moves into another period - fur coats. It is characterized by an increase in productive symptoms, such as hallucinations, delusions and manifestations of catatonia. Patients are often in a state of agitation and may behave bizarrely.

The phase and fur coat alternate, the time of each period is individual. In some cases, one condition can last for several years without being replaced by another. In the second option, the phase change in the fur coat occurs throughout the year, and sometimes several times. The longer the disorder exists, the shorter the intervals between changes from one condition to another become. At the same time positive symptoms become less bright, and negative signs increasingly absorb the human psyche. Sometimes productive signs can develop into chronic form and not stop even during the phase.

The goal of treatment is to reduce the rate of development of negative symptoms and prevent the onset of another mental episode (fur coat). For treatment, as a rule, a combination of several antipsychotic drugs is used, if necessary, antidepressants, as well as psychotherapy.

Continuously progressive type

This type of disease may develop in at different ages, the two most susceptible age periods- teenage and after 23 years. More often from continuous flow Men suffer from pathology, while women are more susceptible to the paroxysmal type. Relatively clinical picture, it partly depends on the form of schizophrenia. Distinctive feature of a continuously progressive type in that the disease, having reached its maximum severity, remains at this level, even if it does not weaken much. Remissions are rare and only with adequate and continuous treatment. If therapy is discontinued, the situation will certainly worsen. Spontaneous remissions, as in the paroxysmal type, are not observed.

The disorder usually develops gradually, starting with personality changes and associated negative symptoms. Volitional and emotional impoverishment is observed, patients become indifferent to everything that happens around them. It may happen a little later increased excitability and even aggression towards others. After they join positive signs, they are expressed in hallucinations and delusions, during this period the disease reaches its peak. Without treatment, the pathology becomes irreversible schizophrenic defect. The most unfavorable course is observed with early start illnesses in adolescence. During this period, malignant paranoid or simple form continuous schizophrenia.

Recurrent type

According to descriptions of this type, it affects predominantly middle-aged women (20-40 years old). The pathology is characterized by the occurrence of vivid and severe mental episodes, after which a long-term remission occurs. Obligate symptoms progress slowly, and personality changes begin to be observed only after a series of mental episodes. When remission occurs after the first or second episode, the patient seems absolutely healthy, no noticeable changes are observed. Psychoses can have three development options:

Oneiric catatonia, this condition manifests itself either in a stupor. The patient may long time to be in an uncomfortable and unnatural position, this state is often accompanied by mutism, that is, complete silence. In this case, not only the body takes an uncomfortable position, but also the facial expressions are absent, it becomes like a mask. Catatonia can also manifest itself as a state of excitement, stereotypical actions and impulsive aggression appear. The patient can break and destroy everything in his path;
A depressive-paranoid state manifests itself in depression with fears and anxiety. Delusions of staging and condemnation, as well as verbal illusions, arise. During remission, ability to work remains, although slightly reduced. Remission is accompanied by a feeling of anxiety with a somewhat pessimistic background;
bipolar schizophrenia in this case, the course of the disease is characterized by sharp changes moods, emotional background. Frequent cases of suicide occur precisely with this form of development of a mental episode. Often there is an alternation between manic and depressive state. In this condition, the patient experiences speech disturbances, abruptness and incompleteness of thought, absent-mindedness and poor sleep.

An important role in the depth of recovery and aggravation of the situation in the course of schizophrenia depends on prescribed therapy. It is important how drug treatment, and psychotherapy with patients and their relatives. For everyone individual case a specific set of drugs is prescribed, depending on what clinical manifestations dominate. Antipsychotic drugs are always the basis of treatment, and depending on the symptoms, they are supplemented with antidepressants, nootropics, vitamins, psychotropic substances, etc.

The method can be used in the field of medicine, in particular in clinical neurology. The ELISA method is used to determine the level of cytokines TNF- and IL-4 in the patient’s blood serum at the end of recovery period. And when the level of TNF-cytokine is above 16.8 pg/ml, and the cytokine IL-4 is below 97.88 pg/ml, the progressive course of traumatic brain disease (TBBD) is diagnosed. The method provides diagnostics of the progressive course of TBG on early stages development of the disease, ensures timely and rational implementation of the complex therapeutic activities. 2 tables

The invention relates to medicine, in particular to clinical neurology. It can be used in the clinic to diagnose the progression of the course of traumatic brain disease (TBMD). There is a known method for diagnosing the progression of TBG by dynamic assessment of the condition immune system patients who have suffered a traumatic brain injury /TBI/, using level I immunological tests (determining the number of leukocytes and lymphocytes, immunoglobulins M, A, G, phagocytic index and phagocytosis index), less often - level II (determining T-suppressors, T-helpers , NK lymphocytes, antibodies to antigens and circulating immune complexes) [IN. I. Gorbunov and I.V. Gannushkina ( Clinical Guide. Part I. “Cranio-cerebral injuries. - M.: “ANTIDOR”, 1998, 550 pp.]. None of the tests used makes it possible to assess the degree of severity inflammatory process, with its inflammatory and anti-inflammatory components. The disadvantages of the diagnostic methods used are that none of the tests used makes it possible to assess the multi-level immune inflammatory process, with its inflammatory and anti-inflammatory components. And also the need to conduct research over time, which increases the time for diagnosis and treatment. The essence of the proposed diagnostic method is that a patient at the end of the recovery period has a TBI using the enzyme immunoassay/ELISA/ determines the level of cytokines in the blood serum: tumor necrosis factor- and interleukin-4 /TNF- and IL-4/, and at the level proinflammatory cytokine TNF- is higher than 16.8 pkg/ml, and the anti-inflammatory cytokine IL-4 is lower than 97.88 pkg/ml; patients are diagnosed with a progressive course of TBGM. TNF- is a marker of the inflammatory process, and IL-4 is an anti-inflammatory marker. Under certain conditions, in a number of patients immune reactions acquire a pathogenic nature (a high level of pro-inflammatory cytokine and a low level of anti-inflammatory cytokine persists for a long time), which aggravates the course of TBI, thereby contributing to the progression of its course and worsening the outcomes of TBI. A high level of proinflammatory cytokine in the blood serum of patients with exacerbation of postconcussion syndrome indicates the presence of a nonspecific inflammatory process in the central nervous system/CNS/. A low level anti-inflammatory cytokine - to the failure of protective immunological reactions. A method for diagnosing the progression of the course of TBGM is carried out by determining the levels of cytokines: TNF- and IL-4 in the blood serum using ELISA. In the patient at the end of the recovery period of TBI (at the end of 2 months from the onset of the disease), in the morning, on an empty stomach, 5 ml of blood is taken from the cubital vein, then serum is obtained from the blood by centrifugation, which is used in ELISA to determine the levels of TNF- and IL- 4. Methodology for determining the level of TNF-: the concentration of TNF- in blood serum is determined by enzyme-linked immunosorbent assay using horseradish peroxidase as an indicator enzyme. On the surface of plastic plates with immobilized antibodies, add 100 μl of solution to each well (buffer C, TNF-standards, test samples). Antibody sorption is carried out by incubating the plate for 1 hour at 37 o C, accompanied by continuous shaking. Unsorbed antibodies are removed from the wells by washing three times with wash buffer and once with distilled water. The remaining fluid is then aspirated. After this, 100 μl of a solution of the second antibodies is added to each well and the board is incubated for 2 hours at 18-20 o C with continuous shaking. Then the liquid is removed by washing the buffer three times and once with distilled water. The remaining contents are completely aspirated. Subsequently, a conjugate labeled with horseradish peroxidase with streptavidin, which has a very high affinity for biotin, diluted with buffer (100 μl), is added to the wells. Then the plates are incubated for 30 minutes at 18-20 o C with constant shaking. Remove liquid from the cells, wash three times with buffer, and aspirate the remaining liquid. Then the plates are washed twice with distilled water. After which the tablet is dried. Then a staining solution of orthophenylenediamine (5 mg per plate) and 1 drop of 30% perhydrol are added to the wells. The boards are incubated for 10-20 minutes at room temperature, protected from direct sun rays place, after which the reaction is stopped by adding 50 μl of sulfuric acid solution to each well. Construct an optical density/concentration calibration curve using known data on the amount of standard added. Using the resulting curve, the concentration of TNF- in the samples is calculated. The method for determining the level of IL-4 in blood serum is similar to the method for determining TNF-, with the exception of the antibodies used. It was found that the level of the proinflammatory cytokine TNF- in healthy donors ranges from 8.9 to 16.8 pkg/ml, and in patients with a progressive course of TBG from 72.6 to 287.3 pkg/ml. The level of the anti-inflammatory cytokine IL-4 in healthy donors ranges from 97.88 to 504.5 pg/ml, and in patients with a progressive course of TBI, the content of this cytokine ranges from 10.98 to 170.2 pg/ml. Example. Patient P.S.V. (case history 1264), 30 years old, admitted on January 14, 1999. Complaints upon admission to paroxysmal, diffuse, intense headache V morning hours, severe dizziness of a non-systemic nature, nausea, vomiting three times at the height of a headache. He noted 5 attacks of loss of consciousness (over the last 4 months) with severe general weakness and drowsiness upon recovery from them; 2 months ago - generalized seizure. In addition, the patient noted decreased performance, sleep disorders, and memory loss. From the medical history: a year ago he suffered a TBI, which the neurosurgeon regarded as SHM, the patient received inpatient treatment. The above complaints appeared 3 months after discharge from the hospital, for which he contacted medical care outpatient, when he underwent an immunological study, which included determining the level of cytokines: TNF- and IL-4. Before brain injury chronic diseases did not suffer, no attacks of loss of consciousness were noted. Objectively: skin pale, dry, visible mucous membranes - pink color. Pulse 72 beats per minute, rhythmic, satisfactory qualities: AdD 120/60 mm Hg, AdS 110/60 mm Hg, respiratory rate 16 per minute. Neurological status: palpebral fissures symmetrical, D=S; pupils regular form and sizes, D=S; photoreaction preserved; horizontal installation nystagmus in both directions, brighter to the left. Corneal reflexes are preserved. Movements eyeballs to the sides in full. Convergence is not broken. The exit points of the trigeminal nerve are painless. Living mandibular reflex. Insufficiency of the left nasolabial fold is revealed, S