Medical Academy named after S.I.

Georgievsky
of V.I. Vernadsky CFU
Department of Neurology and Neurosurgery

Class 14

Infectious diseases of the Nervous system. Poliomyelitis, myelitis,

Multiple Sclerosis, neurosyphilis, amyotrophic lateral sclerosis
(motor neuron disease).

Poliomyelitis: Causes, Symptoms, Treatment

Poliomyelitis which in normal terms goes by the name of Polio is an extremely
contagious viral infection which directly attacks the nervous system. This virus
usually attacks children below the age of 5 years. Once a deadly disease, with the
advances made by medical science most of the countries around the world have been
declared Poliomyelitis free, except for a few backward nations in the Asian and
African continents.

Poliomyelitis is an extremely serious disease condition that makes a child paralyzed

on one side of the body permanently by damaging the nervous system. Fortunately,
with increased awareness of the people and the various educational programs
organized by governments of various countries around the world the demon of
Poliomyelitis has been eradicated almost everywhere around the world. Poliomyelitis
in the United States is now extremely uncommon and rare with almost all children
being vaccinated from this disease called Poliomyelitis.

What Causes Poliomyelitis?

As stated, Poliomyelitis is caused by the Poliovirus. This virus can infect a child
through contact with the feces. Certain objects like toys that may have come in
contact with infected feces can transmit the virus to the child. Coming in close contact
with an individual who might have been infected may also cause Poliomyelitis
through a cough or a sneeze although this is less common.

Poliomyelitis is usually seen in people living in unhygienic conditions where clean

drinking water and hygienic toilets are a scarcity. The people drink water which may
have been contaminated by human waste and get infected with Poliomyelitis. The
people most at risk for getting Poliomyelitis are pregnant women, children under 5
years of age who have not been vaccinated for Poliomyelitis, people with
compromised immune system, people suffering from conditions like HIV/AIDS.

Thus it is essential for everyone to be vaccinated for Poliomyelitis if they are planning
to travel in countries where they have to encounter unhygienic living situations to
prevent them from contacting Poliomyelitis.

What are the Symptoms of Poliomyelitis?

Despite Poliomyelitis being an extremely serious medical condition, majority of the
cases of Poliomyelitis are asymptomatic even though they can still spreads the virus.
There are basically three types of Poliomyelitis, nonparalytic, paralytic, and postpolio
syndrome. All these three variations have different set of symptoms delineated below:

Nonparalytic Polio: The symptoms of this form of Poliomyelitis are:

 Fever
 Sore throat
 Frequent headaches
 Vomiting
 Fatigue
 Meningitis
 These symptoms may last for up to about a week
Paralytic Poliomyelitis: The symptoms of this form of Poliomyelitis are:

This form of Poliomyelitis is quite rare and affects about 1% of the cases of
Poliomyelitis. This may lead to paralysis of the spinal cord, brainstem, or both.
Initially the symptoms are similar to nonparalytic Poliomyelitis but as the disease
advances more symptoms start to appear and include:

 Loss of reflexes
 Muscle pain
 Floppy limbs on one or both sides of the body
 Sudden paralysis, on one side or both which may be temporary or permanent
 Limb deformity especially of the hips, ankles, and feet.

A complete or full paralysis is very rare. In about 10% of the cases of Poliomyelitis,
the virus attacks the muscles that assist in breathing and may prove fatal for the
patient.
Postpolio Syndrome: In some cases after a patient has recovered from Poliomyelitis,
after a decade or two of his or her life the symptoms tend to recur. This is what is
termed as Postpolio Syndrome. Some of the symptoms of this condition are:

 Persistent muscle and joint weakness

 Worsening muscle pain
 Getting exhausted with minimal activity
 Muscle wasting
 Problems with breathing
 Dysphagia
 Sleep apnea
 Depression
 Problems with memory.

It is estimated that about 30% of people who have had Poliomyelitis in the past may
get this syndrome. It is recommended to consult primary care physician if any of these
symptoms develop and there is a remote history of Poliomyelitis.
How is Poliomyelitis Treated?
Poliomyelitis is a disease condition that can be prevented but not cured thus
prevention is the way to treat Poliomyelitis. In case if an individual gets Poliomyelitis
then the best way to treat is to treat the symptoms and allow the infection to run its
course.

Some of the ways to treat the symptoms of Poliomyelitis are:

 Quarantine the patient to prevent risk of others getting infected

 Complete bedrest till the symptoms improve
 Pain medications for treating pain associated with Poliomyelitis
 Antispasmodics for muscle tightness and spasms associated with
Poliomyelitis
 Antibiotics for urinary tract infections associated with Poliomyelitis
 In case if the respiratory system gets affected then ventilatory system may
be required to assist in breathing till the patient is able to breathe normally
once the infection runs its course
 Aggressive physical therapy to treat muscle weakness and allow the patient
to function more normally and independently after Poliomyelitis
 Physical therapy may also be effective for problems associated with
breathing as a result of Poliomyelitis affecting the respiratory system
 For cases of paralysis affecting the lower extremities an assistive device may
be required either temporarily or permanently depending on the severity of
Poliomyelitis.
 Multiple Sclerosis? Symptoms, Causes, Diagnosis, Treatment
Multiple sclerosis, or MS, is a disease of the central nervous system that can cause
symptoms throughout the body. Most experts believe it is an autoimmune
condition, in which the immune system mistakenly attacks normal tissues in the
body.

In the case of MS, the immune system attacks the myelin sheath that normally
protects nerve fibers in the brain, spinal cord, and optic nerve. The underlying
nerve fibers can also be damaged or destroyed in this attack.

As the attack progresses, the myelin sheath becomes inflamed and gradually is
destroyed, leaving areas of patchy scar tissue (sclerosis) that disrupt the electrical
impulses between the brain and other parts of the body.

The term “multiple sclerosis” refers to the multiple areas of scar tissue — often
called “lesions” — that develop along affected nerve fibers and that are visible in
MRI scans. The literal meaning of “sclerosis” is “pathological hardening of tissue.”

The lesions caused by MS, and the resulting disruption of nerve impulses
throughout the body, are what cause most of the symptoms associated with
multiple sclerosis.

Types of Multiple Sclerosis

Scientists have long described different types of MS, the most common being
relapsing-remitting MS, primary-progressive MS, and secondary-progressive MS.
But in recent years there’s a growing consensus that these are not distinct types
of MS, but rather points along a continuum. At some points, inflammation is the
predominant characteristic of the disease, while at others, neurodegeneration —
in which old injuries to the brain and spinal cord worsen — predominates.

Nonetheless, most people with MS are still diagnosed with a particular type of the
disease.

Relapsing-Remitting MS (RRMS)

This type of MS is characterized by periods of active inflammation in the central

nervous system, during which symptoms worsen (and new symptoms may
develop), alternating with periods when symptoms are less acute.
The times when symptoms worsen are known as relapses, flares,
or exacerbations. As a relapse ends, the severity of symptoms diminishes, but a
person can be left with new, permanent symptoms.

The quiet periods between relapses are called remissions. Remissions may last for
months or years before a relapse occurs.

RRMS is the most common type of MS — estimates vary, but between 80 and 90
percent of people with MS are diagnosed with this relapsing-remitting course of
the disease, and most people with RRMS eventually develop secondary-
progressive MS.

Secondary-Progressive MS (SPMS)
This type of MS is generally considered a second phase of RRMS, in which there is
symptom progression and increased disability. People with SPMS may continue to
have relapses, although they may be less frequent than in RRMS.

Most people who are diagnosed with RRMS will eventually transition to SPMS,

but each person’s experience with it — whether or not they have relapses and
how much progression, or disease worsening, occurs — will be unique.

Primary-Progressive MS (PPMS)
In PPMS there is no initial relapse that signals the beginning of the disease.
Instead, MS symptoms gradually appear over time.

Those who have PPMS generally do not experience acute exacerbations or have

distinct remissions, but they may have temporary plateaus during which
symptoms lessen somewhat.

About 15 percent of people with MS are diagnosed with PPMS, according to the

National Multiple Sclerosis Society (NMSS

Benign MS 
A small percentage of people with MS have a benign form of the disease, in which
symptoms progress very little over the course of a person's lifetime, after the
initial attack.
There’s some controversy over how (or whether) to classify people with benign
MS, since the progress of the disease can vary over a person’s lifetime, according
to the NMSS.

Malignant MS
A small number of people with MS have malignant MS, which is marked by the
rapid formation of lesions in the brain and spine, causing severe symptoms,
disability, and possibly death.

Signs and Symptoms of Multiple Sclerosis

The nerve damage that occurs in MS can lead to a broad range of symptoms,
depending on what part of the central nervous system has been attacked. MS can
affect numerous areas of the brain, as well as the optic nerve — the nerve that
transmits signals from the eye to the brain — and the spinal cord.

It’s often said that no two people with MS have exactly the same pattern of
symptoms. In addition, an individual’s symptoms can change or fluctuate in
severity over time.

Common Symptoms

Some common early symptoms of MS include visual problems, difficulties with

balance and walking, numbness and tingling, and heat intolerance.

Other common symptoms include:

Anxiety

Bladder and bowel dysfunction

Depression

Dizziness

Fatigue

Muscle spasticity

Pain

Problems with thinking and memory

Sexual dysfunction

Sleep problems

Vertigo

Weakness

Uncommon Symptoms

Less common symptoms of multiple sclerosis include:

Breathing problems

Difficulty moving arms

Difficulty reading facial expressions

Diminished fine motor control in hands

Diminished sense of taste or smell

Headache

Hearing loss

Hypersensitivity to touch

Itchy skin or altered sensations

Lhermitte’s sign

“MS hug”

Pseudobulbar affect

Seizures

Sensitivity to cold

Speaking problems

Swallowing problems

Tremor

Trigeminal neuralgia
In many cases, MS symptoms can be treated, sometimes with medication and
sometimes with a form of rehabilitation, such as physical therapy, occupational
therapy, speech therapy, or cognitive therapy. People with MS who are depressed
can often be helped by the same types of antidepressants, psychotherapy, and
lifestyle changes that are beneficial for depressed people who don’t have MS.

Even when treatment can’t alleviate an MS symptom entirely, it can often reduce
its severity.

What Is a Multiple Sclerosis Relapse?

A relapse, or flare, is a worsening of existing MS symptoms — physical and

cognitive — often accompanied by the appearance of new symptoms. Relapses
occur because of inflammation of previously existing lesions, new areas of
inflammation in the central nervous system, or both.

Typically, relapses come on over hours or days and can last for days or weeks.

A true relapse occurs at least 30 days after your most recent relapse and lasts for
at least 24 hours. Shorter periods of symptom worsening, called
pseudoexacerbations, can be triggered by heat, stress, and fatigue, among other
things. However, once the underlying cause of a pseudoexacerbation is reduced
or eliminated, the MS symptoms should abate too.

Treatment for a relapse often includes a short course of high-dose steroids, such
as Solu-Medrol (methylprednisolone), delivered intravenously in an outpatient
clinic or infusion center. Steroids speed recovery but cannot repair any new
damage to the nervous system caused by the inflammation.

A person may recover fully from a relapse or may have lingering symptoms
afterward. While the use of disease-modifying drugs (DMDs) should reduce the
number of relapses an individual has — and therefore the amount of residual
disability — at least one study of more than 1600 people with MS who were
taking DMDs, published in November 2018 in the journal Multiple Sclerosis, found
a high rate of incomplete recovery 12 months later in those people who had had
severe relapses.
Causes and Risk Factors of Multiple Sclerosis

The cause of MS is unknown — no one knows what sets off the immune reaction
that leads to MS lesions in the first place. But it is thought that some combination
of genetic susceptibility and environmental causes is necessary to trigger the
disease.

Some researchers suspect the immune attack is triggered by certain kinds of viral
infections. Others point to low vitamin D levels as a contributing cause. Cigarette
smoking is also known to raise the risk of developing MS. (3)

Most people who are diagnosed with MS have no known risk factors.
Approximately 20 percent of people with MS have a family member who has it,
but even having an identical twin with MS increases the risk by only 20 to 40
percent. So even though having a family history of MS raises the risk somewhat,
MS is not considered a genetic or hereditary disease.

Some other risk factors for MS include being a woman, vitamin D deficiency,
obesity, having an autoimmune condition, smoking, exposure to the Epstein-Barr
virus, having multiple concussions during adolescence, and living further away
from the equator.

How Is Multiple Sclerosis Diagnosed?

MS is generally diagnosed on the basis of a person’s history of symptoms, along
with the results of a variety of medical tests, which may include:

A neurologic evaluation of physical movement and coordination, vision, balance,

and mental functioning

Blood tests to rule out other conditions

Magnetic resonance imaging (MRI) scans to detect brain lesions typical of MS

Lumbar puncture (spinal tap) to obtain cerebrospinal fluid, which may contain
substances more likely to be found in people with MS 

Diagnosing MS early is critical so that treatment can begin early, with the goal of
slowing the progression of the disease.
Prognosis of Multiple Sclerosis

Although MS can sometimes be a debilitating disease, the majority of people who

have it don't become severely disabled, according to the National MS Society.

Many people with MS are able to maintain their mobility with the help
of assistive devices, such as canes or crutches, often supplemented with scooters
or motorized wheelchairs for long distances. About one-third of people with MS
completely lose their ability to walk.

People with MS who have the best prognosis are usually those who:

Are female

Were younger than 30 when the disease started (4)

Have infrequent attacks

Have relapsing-remitting MS (RRMS)

Have few signs of disease in diagnostic scans

A study reported in August 2019 in the journal Brain may improve doctors’ ability
to give long-term prognoses to those in the early stages of MS. (5)

The researchers found that brain and spinal cord MRIs done soon after clinically
isolated syndrome (CIS), or a single episode of demyelination, predicted disease
progression 15 years later. CIS sometimes, but not always, develops into MS. In
the 166 study participants who were assessed after 15 years, certain types of
lesions on their initial MRIs were linked to development of secondary-progressive
MS at follow-up.

Rehabilitation for People With Multiple Sclerosis

Treatment for MS often includes disease-modifying medication to reduce the
number and severity of relapses in those who have them and to slow disease
progression. But these drugs don’t treat MS symptoms, nor are they effective at
shortening an MS relapse that’s in progress.

For this reason, treating MS generally involves a multipronged approach,

including:

Using high doses of steroids or sometimes plasmapheresis to shorten relapses

Using disease-modifying therapies to prevent relapses and disease progression

Treating the symptoms of MS using medication, physical therapy, other types of

rehabilitative therapies, a healthy lifestyle, and complementary treatments

Providing counseling and support for depression, anxiety, and other mood
disorders

Disease-Modifying Therapy Options

For people who have relapsing-remitting MS, a handful of disease-modifying
drugs can slow the progression of multiple sclerosis and lower the frequency and
severity of acute attacks.

For people with primary-progressive MS, only one

medication, Ocrevus (ocrelizumab), has been shown to reduce the likelihood of
disability progression.

And for people with “active” secondary-progressive MS, meaning they still
experience relapses and new lesions continue to be seen on their MRIs, two
drugs, Mayzent (siponimod) and Mavenclad (cladribine), were approved in spring
2019.

Treatments for MS Symptoms

Doctors can prescribe a wide variety of drugs to relieve symptoms related to MS,
include analgesics for pain; antispasmodics, such as baclofen, and muscle
relaxants, such as Zanaflex (tizanidine), to ease muscle spasticity; and
Ampyra (dalfampridine) to improve walking ability.
Physical therapy can also be helpful for dealing with fatigue, weakness, pain, and
spasticity. A physical therapist can prescribe exercises, stretches, and alternative
ways of performing physical tasks to improve energy levels and physical
functioning.

Occupational therapy is often used to find easier or alternative ways to achieve

tasks of daily living, including by using assistive devices and energy conservation
techniques.

Your doctor can also refer you for speech-language therapy to address problems
with speaking or swallowing, cognitive rehabilitation for help with memory and
thinking tasks, and psychotherapy for help with depression, anxiety, grief, or
simply distress related to living with a chronic condition.

In addition to formal rehabilitation and therapy, exercise and meditation have

both been shown to improve function and quality of life for people living with MS.

Learn More About Treatment for Multiple Sclerosis: Drug Therapy, Rehabilitation,
Alternative and Complementary Therapies, and More

Complications of Multiple Sclerosis

Beyond the direct effects of MS symptoms — of which there are many and of
varying severity — there can be additional consequences of some symptoms.

Urinary Tract Infections

Bladder problems are very common in people with MS, affecting at least 80

percent of them, according to the National Multiple Sclerosis Society.

Some people have trouble holding their urine in (incontinence), while others can't
fully empty their bladder (retention).

Failing to empty the bladder completely raises the risk of developing a urinary
tract infection (UTI), which can cause worsening of MS symptoms, as well as
discomfort when urinating, needing to urinate frequently, and releasing only
small amounts of urine.

If not treated quickly, a urinary tract infection can in turn lead to a kidney
infection, which is a medical emergency.
Pneumonia

Sometimes people with MS have trouble swallowing, known as dysphagia. When

the timing of a swallow is off, or the muscles involved in swallowing are weak,
foods and liquids may enter the airway instead of the esophagus, where they
belong.

If the person cannot cough forcefully enough to expel them, the food and liquid
can end up in the lungs. This can lead to aspiration pneumonia, a serious
condition that can require hospitalization.

Symptoms of aspiration pneumonia may include chest pain, fever, shortness of

breath, and coughing up foul-smelling phlegm. You should seek medical help if
you experience these symptoms.

Physical Trauma From Falling

Many MS symptoms, including balance problems, muscle weakness, fatigue,

dizziness, blurred vision, and numbness, raise the risk of falling.

Falls, in turn, raise the risk of serious injuries, such as broken bones and head
trauma. Falling can also lead to fear of falling, which typically causes a person to
become less active, weaker, and even more prone to falling.

While not all falls can be prevented, many can, through a range of strategies to
build leg strength, improve balance, fall-proof your home, and address potential
causes of dizziness.

Literature:

Mark Mumenthaler, M.D., Heinrich Mattle, M.D. Fundamentals of Neurology. –

2006 –172p.