Is there any disability for multiple sclerosis? Treatment of multiple sclerosis at the Yusupov hospital

Diseases of the human central nervous system are spreading more and more with the modern, unnatural way of life. Constant stress, overwork, poor and sedentary lifestyle – all this increases the risk of neurological pathologies, which can be fatal. One of the most common diagnoses in this area, which in the European part of Russia in terms of quantitative indicators is at least double the world level: the disease is diagnosed in 25-50 people per 100 thousand, is.

It has its own cycle associated with the gradual fading of the ability to work and, unfortunately, to live. For working people, disability due to multiple sclerosis is becoming the norm. In today's review, we will look at what disability group is assigned to multiple sclerosis, how it is established and confirmed, and also answer other common questions about life activity and risk associated with this diagnosis.

Origin and development of the disease

Multiple sclerosis is a chronic disease classified as autoimmune. As the disease progresses, it inevitably leads to disability, destroying human health in many ways. The main violations appear:

• loss of vision;
• hearing loss;
• paralysis of arms and/or legs;
• a general decrease in sensitivity to all stimuli.

MS can begin to appear in people of almost any age. The average starting age range is from 15 to 45 years; both children and old people can suffer from multiple sclerosis. In the initial stages, the disease is asymptomatic. Therefore, you need to monitor the manifestations of certain signs:

• blurred vision;
• problems with vestibular apparatus: dizziness, loss of balance and stability;
• problems with coordination of movements;
• slower reaction;
• general weakness;
• the presence of spasms and/or convulsions in the body.

All this may indicate the onset of MS, which cannot be stopped - the disease will progress and worsen. The presence of multiple sclerosis can be diagnosed based on the results of a brain procedure under the supervision of a neurologist. The presence of the disease can be assumed, but the diagnosis must be confirmed clinically. The disease can develop according to several scenarios, depending on the form of its course:

• relapsing or remitting. Remissions (can last a year or even several years) are interspersed with acute phases. “Gray matter” after damage is capable of both partial and complete restoration of the functions of the affected areas;
• primary progressive. A smooth but non-stop tendency of health to deteriorate, which in the absence of acute phases, on average, makes a person incapacitated twice as quickly;
• secondary progressive. On early stages very similar to the typical recurrent form, which subsequently develops into a continuously progressive one;
• progressive-remitting. It is the least common and combines the first two types. Parts of the brain that survive the attack do not regain their functions.

The disability group for multiple sclerosis is almost directly dependent on the stage at which the disease is located. There are four of them in total and are called ordinal numbers (from 1 to 4):

1. The human central nervous system shows initial signs of a functional disorder, while continuing to operate generally stably;
2. lesions of the central nervous system partially affect the organs of vision, reduce hearing, and impair coordination of movements;
3. The central nervous system exhibits malfunctions of its basic functions, a person loses attention and fine motor skills, above average gets tired;
4. terminal stage of central nervous system depression. The patient is almost or completely unable to see, hear, or move. Can move around in a wheelchair and requires constant care.

Concentrated therapy

MS is incurable, but competent therapy will help prolong remissions and reduce the manifestations of the disease. The adequacy of treatment directly affects the duration and quality of life of patients with multiple sclerosis; it is selected individually (depending on the severity, stage, form, manifestation of MS). The most common treatment methods are:

• taking steroids and cytostatic drugs;
• blood plasmapheresis;
• use of immunosuppressants and immunomodulators;
• use of interferons;
• suppression of symptoms (taking antioxidants, amino acids, vitamins, nootropic drugs, enterosorbents, muscle relaxants, vascular therapy, etc.);
• hormone treatment;
• rehabilitation in remission (physical therapy, massage, sanatorium treatment courses).

Reducing to disability

Multiple sclerosis definitely implies disability, starting from the third stage, but which group - the decision is made based on the results of a comprehensive study.

The first stage of the disease is not a sufficient basis for registration of disability, but it is already recommended to choose easier work, minimizing eye strain, joints and physical overload.

Whether disability is due to multiple sclerosis - the answer is given by a collegial decision of an expert commission (medical and labor) based on the results of the examination. The commission may allow a disabled person to work in professions allowed with MS, or assign a “non-working” group. The commission may award one of three degrees designed for disability:

• Group III – “working”. Assigned for minor impairments in the ability to move;
• Group II – with obvious symptoms of damage;
• Group I – with the appearance of extreme impairments and loss of the ability to move independently.

The nature of the disability is established as indefinite if doctors determine the impossibility of improvement in the condition of a patient who is unable to work.

To convene a VTEK, criteria are needed, which are usually:

• the patient's inability to perform his or her job fully;
• lack of effect from treatment for multiple sclerosis (a person may receive inpatient or ambulatory treatment, but show no improvement);
• disease progression;
• temporary disability due to MS for four months or more.

Depending on the situation and the patient’s condition, the commission carries out its work in medical institution, at the patient’s home or in his hospital room. The conclusion on the need for examination for disability is given by the attending physician.

Examination rules

The development of MS led to the inability to work in the same place. Do multiple sclerosis provide disability in this case - we discussed above. Now let’s present a confirmation mechanism, a list of reasons for the work of VTEK. For a commission examination there must be:

1. Diagnosis confirmed. MS is determined based on the results of a comprehensive examination required in such cases, including (at a minimum):
   • identification of affected areas of the central nervous system - MRI of the head and spinal cord;
   • determination of the state of immunity - analysis of capillary and venous blood;
   • determining the condition of the spinal cord - performing a lumbar puncture;
   • determination of the state of hearing and vision - the conclusion of an ophthalmologist and otolaryngologist;
   • determining the reaction to an injection of the Margulis-Shubladze composition (a positive reaction can be confirmation of the presence of the disease).
2. The treatment course intended for the patient has been completed.
3. The attending physician's verdict on the need for MSA was issued. This conclusion is due to the low effectiveness of treatment, poor recovery of damaged areas, and a negative prognosis for the development of MS.

The commission itself evaluates the person’s condition based on the results of studying the research results. The following are taken into account: problems with the patient’s speech and swallowing reflex; the functioning of internal organs and the presence of enuresis/involuntary bowel movements; mental state, etc. Each indicator is the basis for assigning points on a scale designed specifically to determine disability, including for patients suffering from various forms of a disease such as multiple sclerosis.

The process of making a decision on assigning disability takes from 4 months to a year, and it is necessary to overcome acute phase illness. Upon re-examination, neurologists can increase the category of disability or, on the contrary, remove restrictions - it all depends on the course of MS and changes in the patient’s condition.

Labor Relations

In addition to the medical aspect of disability with MS, there is also an “urgent” one associated with obtaining income from work. In order not to lose their jobs, patients with multiple sclerosis can themselves refuse to be assigned a disability and not undergo VTEC. But if you do not take into account the work restrictions required even in the initial stages, you can significantly increase the risk of accelerating the development of the disease. For MS of any degree, it is better to refuse or at least strive to minimize:

• mental and physical overload;
• night work, irregular working hours, overtime;
• strong feelings, stress, anxiety;
• exposure to vibration;
• work involving contact with toxic substances;
• overheating and working in the sun.

The progression of MS imposes new restrictions, and at later stages the following are excluded:

• standing work;
• lifting weights;
• work with increased concentration and strong visual load;
• work associated with strict coordination and rhythm of movements.

Working conditions necessary for patients with multiple sclerosis (must be observed by both employer and employee):

• workplace in good transport accessibility from home;
• lack of responsibilities related to walking;
• favorable psychological climate in the team;
• presence of breaks in work;
• no overtime standards;
• sedentary work;
• calm mental work.

If these conditions are met, the patient will be able to remain able to work and work without further accelerating the course of MS.

MULTIPLE SCLEROSIS
Definition
Multiple sclerosis (multiple sclerosis) is a demyelinating disease with multiple foci of damage to the nervous system, occurring with exacerbations and remissions or steadily progressively, affecting mainly individuals young.

Epidemiology
Multiple sclerosis (MS) accounts for 4.7 to 10.5% of organic CNS diseases. Number of patients in different countries ranges from 5 to 70 per 100,000 population. A high incidence is clearly visible in the northern and western regions (25-50 cases per 100,000 in the European part of Russia, the Baltic states, and Belarus). Women are 1.5-2 times more susceptible to PC than men. The frequency of PC among close relatives is 15-20 times higher than in the general population. It is generally accepted that the age limit for PC is 20-40 years. When the first symptoms appear after 40 years, the diagnosis is most often doubtful. The lower limit is more labile: MS can begin at 15-17 years of age or earlier, and in these cases it often progresses quickly.
The social significance of PC is determined by the relative frequency (2-3%) in the structure of primary disability caused by neurological diseases. Disability, often severe, occurs early (in 30% of cases within the first two years from the onset of the disease), in young patients.

Etiopathogenesis
The etiology of PC still remains unclear. The autoimmune theory of the occurrence of MS, the role of persistent viral agents, and genetically determined inferiority of the immune system in certain geographical conditions are widely discussed. From a clinical point of view, the concepts of the pathogenesis of MS proposed by I. A. Zavalishin (1990) and Poser look logical.

Pathogenesis of PC
(after Poser, 1993; with some modifications)
Genetic susceptibility (presence of histocompatibility system antigens HLA-AZ, B7, DR2 - possible markers of the gene that determines sensitivity to PC)
I
Primary antigenic stimulus (nonspecific viral infection, vaccination, trauma, etc.)
I
Production of antibodies, particularly against myelin basic protein
I
Formation of immune complexes (promoted by deficiency of T-suppressors, possibly genetically determined)
I
Vasopathy and BBB damage
I
Swelling and inflammation in areas of damage to the nervous system
I
Formation of foci of demyelination

Some clinically significant features of pathogenesis and pathomorphology:
1. Complete and partial restoration of functions can occur even before the formation of the demyelination zone due to the reversibility of edema and inflammation in the lesion, which explains the rapid and complete early remissions).
2. The possibility of asymptomatic MS in the presence of foci of demyelination, detected, in particular, by CT and MRI methods, if the minimum conduction of impulses necessary for the implementation of a specific function is maintained.
3. The possibility of manifestation or exacerbation of the disease under the influence of additional factors (infections, anatomical damage, physiological effects active substances, metabolic and endocrine dysfunctions).
4. As a consequence of demyelination - a decrease in speed and disruption of strictly isolated conduction of excitation along a neuron, the possibility of its transition from one nerve structure to another (ephaptic transmission). Clinically, it is a phenomenon of dissociation.
5. The influence of the temperature factor: deterioration of the patient’s condition, increase in paresis, coordination and other disorders after a hot bath, often when eating hot food. The phenomenon appears to be based on partial blockade of neuromuscular transmission under conditions of demyelination and temporary disturbances in the permeability of the BBB.
6. Clustered foci of demyelination (PC plaques) in various departments brain (white matter of the hemispheres, usually the periventricular zone, brainstem, cerebellum), mainly thoracic spinal cord, in the intracerebral part of the cranial and, less commonly, spinal nerves. The ability to detect lesions and areas of edema around them, as well as brain atrophy using imaging methods.

Risk factors for occurrence, progression
1. Age up to 40 years.
2. Frequent viral and bacterial infections in the anamnesis (measles, chicken pox, hepatitis, etc.).
3. Hereditary (genetically determined) predisposition (close relatives of the patient, consanguineous marriages).
4. Past retrobulbar neuritis.
5. Exposure to adverse factors during work and at home (physical stress, insolation, overheating, allergy, exposure to neurotropic poisons, etc.).
6. Pregnancy is one of the likely risk factors for exacerbation of the disease, especially in patients with severe spinal and cerebral symptoms.

Classification
MS refers to demyelinating diseases proper, in which, unlike myelinopathy, destruction of properly formed myelin occurs. It is included in the group of predominantly central demyelinations along with acute primary disseminated encephalomyelitis, para- and post-infectious encephalomyelitis, leukoencephalitis and some other diseases.
The PC classification is based on topical criteria and reflects
clinical features and the dynamics of the process (Zavalishin I.A., 1987). There are 3 forms: 1) cerebrospinal; 2) cerebral; 3) spinal.
Regardless of the primary location, the lesion spreads to other parts of the nervous system, forming the cerebrospinal form.

Forms characterizing the flow of PC: 1) remitting; 2) primary progressive (without clear exacerbations from the onset of the disease); 3) secondary progressive (after previous exacerbations).

1. History. Data on the first symptoms (onset of the disease): double vision, decreased vision, staggering when walking, weakness or paresthesia in the limbs, attacks of dizziness, paresis of the facial nerve, imperative urge to urinate, etc. They can be isolated (in 60% of patients) or multiple. The duration of the first attack is from one day to several weeks. In 16% of patients, the first manifestation of MS is retrobulbar neuritis, in 5% - acute transverse myelopathy.
2. Analysis of medical documents. Information about previous diseases, the nature of the course, and the characteristics of neurological symptoms is important.
3. In the advanced stage of the disease, clinical manifestations are very polymorphic. The most typical combination of symptoms caused by damage to the pyramidal, cerebellar, sensory tracts, and individual cranial nerves:
- movement disorders(occur in 60-80% of patients), in typical cases they manifest as paraparesis or paraplegia of the lower extremities, less often the upper. Tendon and periosteal reflexes are usually high, especially in the legs, and occasionally low. An early decrease or loss of superficial abdominal reflexes is characteristic; pathological reflexes are also typical. The phenomenon of clinical dissociation in the motor sphere: pronounced muscle weakness without increased reflexes, clear pathological signs without convincing changes in muscle tone and strength in the limbs, muscle hypotonia against the background of high reflexes;
- coordination disorders (in 60% of patients): ataxia in the limbs with asynergia, dysmetria, ataxic gait, intentional tremors, scanned speech, changes in handwriting (megalography);
- damage to the cranial nerves. In the foreground are visual disturbances due to retrobulbar neuritis (diagnosed in 50% of patients during the course of the disease): decreased visual acuity, central and peripheral scotomas, concentric narrowing of the visual fields, atrophy (blanching of the optic discs, often of the temporal halves). The phenomenon of dissociation: blanching of the discs with normal visual acuity and, conversely, a drop in visual acuity in the absence of changes in the fundus. Vestibular and auditory disorders: dizziness, vestibular hyperreflexia, instability, sinking feeling, nystagmus, rarely hearing loss. Dissociation manifests itself in normal tuning fork hearing and impaired perception of whispered speech. Paresis of the facial, oculomotor and abducens nerves occurs; the latter are characterized by transient diplopia;
- sensitivity disorders. They occur frequently, but are usually subjective: paresthesias of various localizations. Actually
vibration sensitivity decreases early and constantly, especially on the legs, less often muscle-articular;
Disorders of sphincter function often manifest themselves in the form of urinary retention, urgency, and constipation. Pronounced disturbances occur only in the final stage of the disease;
- violations mental functions(in 93% of patients): neurosis-like (asthenia, hysteroform syndrome, sometimes obsessive-compulsive disorder); affective (the most typical is euphoria with patients’ inadequate assessment of their physical and intellectual capabilities), depression, psychoorganic syndrome, dementia;
- rare and atypical manifestations of MS: epileptic seizures in 1.5% of patients, usually generalized convulsive seizures during exacerbation of the disease; paroxysms of dysarthria and ataxia; paresthesia in the form of Lhermitte's electrical discharge phenomenon; chronic pain syndrome and paroxysmal trigeminal pain; extrapyramidal hyperkinesis (in reality, only dentrubral hyperkinesis is observed - large-scale intention tremor when attempting a purposeful movement); vegetative and endocrine (amenorrhea, impotence) disorders.
4. Additional research data:
- lumbar puncture (for diagnostic purposes, to clarify the degree of activity of the process). In the CSF during exacerbation there is a slight hyperproteinorachia (0.4-0.6 g/l) with a more distinct increase in the amount of gamma globulin; in 95% of patients the content of oligoclonal immunoglobulins of group G is constantly increased. Determination of myelin basic protein (its content in 2-3 times higher than in other organic diseases of the nervous system);
- immunological studies (determination of indicators of cellular and humoral immunity in the blood). Markers of PC activity can be: depression cellular immunity(decrease in the number of T-suppressors), increase in the content of immune complexes in the blood serum;
- electrophysiological study: visual and auditory evoked potentials in the cerebral form of MS and somatosensory in the spinal and cerebrospinal. It is possible to determine the presence and localization of the pathological process along the corresponding pathways, subclinical lesions. EEG - mainly for the purpose differential diagnosis, identification of an epileptic focus, and oculography - initial (subclinical) oculomotor disorders;
- brain imaging methods (CT and MRI) have the greatest diagnostic value. CT scan at contrast enhancement allows you to identify lesions in the brain (mainly located periventricularly). At the same time, expansion of the ventricular system and sulci of the hemispheres is detected (indirect signs of PC). However, the capabilities of CT are limited when examining the trunk, posterior cranial fossa, and especially the spinal cord. The MRI method makes it possible to detect hyperintense foci of characteristic localization on Tg-weighted tomograms, as well as changes in the optic nerve, brainstem, and cerebellum. An increase in their number is shown with high process activity. Foci of demyelination are also identified in the spinal cord (increased signal intensity on T2-weighted sagittal tomograms against the background of its swelling or atrophy). In general, the MRI method visualizes PC foci in the brain in 95% and in the spinal cord in 75% of cases. MRI allows one to judge the dynamics of the pathological process and monitor the effectiveness of disease therapy.

Visualization methods have also been successfully used in differential diagnosis PC. Clinical limitations: 1) the possibility of asymptomatic MS in the presence of characteristic changes on MRI; 2) frequent discrepancy between the localization and volume of foci and the severity of clinical symptoms;
- ophthalmological and otolaryngological examinations.
5. Criteria for the reliability of the diagnosis depending on the nature of the damage to the nervous system and the course of the disease (Zavalishin I. A., Nevskaya O. M., 1991):
1) undoubted MS - multiple lesions of the nervous system (including according to anamnestic data) with a remitting or progressive course with a fractional appearance of symptoms and instability of some of them, without clear age restrictions;
2) doubtful PC: a) the first attack of the disease with several lesions (including isolated retrobulbar neuritis) and a regressive course; b) patients with multiple lesions nervous system without clear progression or signs of remission; c) patients with one lesion, remitting or progressive course.

Clinically reliable diagnosis according to Poser (1983):
1) two exacerbations and clinical signs of at least two isolated lesions;
2) two exacerbations and clinical signs of one lesion in the presence of typical changes on MRI and positive results of the study of evoked potentials. In addition, an important diagnostic test is the detection of oligoclonal antibodies of the IgG group in the cerebrospinal fluid.

Differential diagnosis
The range of differentiated diseases depends on the stage of development, features of the clinical picture and course of MS. A thorough examination is required using additional methods, sometimes long-term observation.
1. Acute disseminated encephalomyelitis (primary encephalomyelitis). Presents significant difficulties for differentiation from PC. Some authors consider the border between these diseases to be arbitrary. However detailed analysis clinical
ical picture and observation of patients over time, as a rule. allow us to clarify the diagnosis, which has essential to resolve issues medical and social examination. Unlike MS, primary encephalomyelitis is characterized by an acute infectious onset with the development of focal cerebral, sometimes meningeal, symptoms within 1-4 weeks. Impaired consciousness, epileptic seizures, lesions of the cranial nerve nuclei, chiasmatic syndrome, pelvic and conduction sensory disorders are common. Characterized by the absence of the phenomenon of clinical dissociation. Lesions detected by CT are often of cortical localization. In the future, the recovery period is long (from 3-4 months to 1-2 years), it is shorter with the rapid development of the process. Residual manifestations (usually persistent): sensory, motor, mental disorders, epileptic seizures, etc. A rare progressive course, exacerbations force us to reconsider the diagnosis in favor of PC.
2. Cerebral or spinal (craniospinal) tumor, cranio-vertebral anomalies with neurological manifestations. Particular difficulties arise with tumors of the brainstem (pons) and cerebellum, acoustic neuroma, and intramedullary spinal tumor. Lumbar puncture, contrast methods, CT, and in spinal localization - MRI are often decisive.
3. Cervical ischemic myelopathy.
4. Progressive spinocerebellar degenerations, especially hereditary cerebellar ataxias, spastic Strumpell's paraplegia, Friedreich's ataxia in the case of the cerebellar or spinal variant of the onset of PC.
5. Hepatocerebral dystrophy (shaking form) with the hyperkinetic variant of MS.
6. Retrobulbar neuritis (differentiation is especially difficult due to the possibility of PC onset), Leber hereditary optic atrophy and other types degenerative diseases optic nerve (with the optical version of PC).
7. Tick-borne borreliosis(late neurological manifestations- chronic encephalitis). Difficulties, in particular, due to similar changes on MRI.
8. Some other diseases and syndromes (vestibulopathy, hysteria, consequences of traumatic brain and spinal trauma, optochiasmatic arachnoiditis, neurosarcoidosis, drug addiction).
Course and prognosis
In general, there are chronic and acute (subacute) forms of MS. The latter - with the stem variant of the disease, deaths are frequent.

Chronic course options:
1) remitting: a) benign form with a relatively favorable slow course, long-term (often many years and deep) remissions (10-20% of cases). More common with late onset. A distinct dysfunction after 10-20 years, the ability to work remains for a long time, sometimes until retirement age; b) a relatively favorable option with short-term unstable remissions, multiple short attacks. A clear dysfunction is detected 5-10 years after the onset of the disease. Working capacity may be maintained for a long time or limited; c) an unfavorable course (usually at a young age) with rapid progression, severe exacerbations and incomplete remissions ( malignant form). Severe dysfunction for 2-5 years. Remissions vary in degree (complete, partial) and duration: short (up to 3 months) and long;
2) progressive without remissions (in 15-20% of patients), more often with slow progression. It is more typical for the later onset of the disease (after 30 years).

The clinical and labor prognosis is generally more favorable with a remitting course and late onset. However, an increase in the frequency and duration of exacerbations is an unfavorable prognostic sign. Approximately, during the first two years of the disease, 20-30% of patients become disabled, after 5-6 years, about 70%, and 30% remain able to work for 10-20 years or more. The duration of the disease ranges from 2 to 30-40 years. The prognosis for life is uncertain. Death occurs at a late stage of the disease from intercurrent diseases (with the exception of the acute table form of PC).

PC severity criteria(according to Leonovich A. A., Kazakova O. V., 1996; as amended). It should be assessed taking into account the course of the disease.
1. First degree. Clear signs of organic damage to the nervous system (usually in the reflex sphere), without dysfunction. Working capacity is usually preserved.
2. Second degree. Moderate deficiency of motor, coordination, visual functions. Work ability is often limited.
3. Third degree. Persistent pronounced motor, coordination and other disorders that significantly limit the patient’s life activity, leading to the impossibility of professional activity.
4. Fourth degree. Sharply expressed motor, visual, pelvic, mental disorders, causing the need for constant outside care and assistance.
MS, spinal form (grade I), stage of prolonged remission, favorable course.
MS, cerebrospinal form (II degree of severity), quickly
progressive course, exacerbation.
MS, cerebrospinal form (grade III), progressive course.

Principles of treatment
At the first manifestations of MS, patients require hospitalization in a neurological hospital. Further hospital treatment preferably in a situation of exacerbation, with a clear progression.
1. Pathogenetic therapy (based on the immune-mediated nature of the process). The main goal is to stop or slow down demyelination, and therefore stabilize the neurological defect.
1) Immunosuppression. Corticosteroids: prednisolone, preferably methylprednisolone (metipred), which has almost no side effects. In tablets at a dose of 1 mg/kg body weight, according to the schedule daily or every other day. Maximum daily dose during
2 weeks, with a gradual decrease over 4-6 weeks. Metypred can also be used using the pulse therapy method: intravenous drip - large doses(up to 1000 mg daily for 3-7 days). The main indication for corticosteroid therapy is a relapsing-remitting form of MS (exacerbation), with obvious progression.
ACTH and its synacthen-depot fragment are less effective and are usually used in progressive cases. Cyclophosphamide (together with ACTH) can be used in patients with severe MS, and dexamethasone can be used for isolated retrobulbar neuritis (retrobulbar).
2) Immunomodulation. The use of beta interferons (Rebif, Betaferon), which can enhance the activity of T-suppressors, which is reduced during exacerbation of MS, and have antiproliferative and antiviral effects, is promising. They are used in the early stages of MS, in patients with a relapsing course of the disease who are capable of independent movement. It is possible to stop exacerbations (in 50% of patients) and slow down the progression of the disease. Continuous (at least a year) subcutaneous injections of the drug are required.
Plasmapheresis, enterosorption methods, and UV irradiation of CSF are also used to activate immune processes.
The effectiveness of levamisole, tactivin and other immunostimulants is questionable.
2. Symptomatic therapy: muscle relaxants to reduce muscle tone - baclofen, mydocalm, sirdalud; essentials, nootropics, antioxidants to reduce metabolic
logical disorders, stimulation of the nervous system; correction mental disorders- psychotherapy, antidepressants, sedatives.
3. Therapeutic exercises (carefully), prevention of joint contractures, skin care, catheterization if necessary.
4. Outside of exacerbation (in remission) - maintenance therapy 2 times a year (biostimulants, nootropics, symptomatic remedies). Hormonal therapy is not used.

Medical and social examination Criteria of VUT
1. At the first manifestations of the disease, especially acute or subacute, when patients need examination for the purpose of diagnosis and treatment (VL period is at least 3-4 weeks).
2. With a remitting course (during an exacerbation). The duration of VL depends on the severity of exacerbation, its duration (can be 2-3 months), in case of repeated exacerbations, more often than not less than 1.5-2 months. Lingering until
4 months of exacerbation at 2-3rd degree of severity of MS gives grounds for referring the patient to BMSE. Continuation of treatment on sick leave is indicated only if the labor prognosis is favorable (the patient will be able to return to work in full or with limitations, being a group III disabled person). Minor improvement does not provide grounds for continuing VL.
3. Chronic progressive course. VN if hospitalization is necessary for the purpose of treatment (including for disabled people of group III), as well as inpatient examination in order to clarify the diagnosis, nature and severity of dysfunction (terms of VN are determined by the time of hospital stay).

Main causes of disability
1. Motor disorders caused by a combination of central paresis and ataxia most often lead to limitation of life activity:
1) a pronounced motor defect makes it possible to move only within the apartment or completely immobilize the patient. Impairment of the ability to self-care of the third degree leads to severe social impairment, the need for constant care and assistance;
2) pronounced defect - the patient moves independently, usually with the help of a crutch or stick. It is difficult to get up and down stairs, the ability to overcome other obstacles, use public transport, and drive is reduced. household, writing, personal care;
3) moderate motor defect - the patient can move relatively long distances, but the gait is changed (spastic-atactic). Decreased ability to lift
carry heavy loads, manual activity (performing fine, precise movements). Due to ataxia, there may be difficulties in providing personal care and in daily activities;
4) mild motor impairment. Movement is free, difficulty only during physical activity and carrying heavy objects. There may be difficulties in performing arbitrary operations and, if necessary, writing (mainly due to coordination disorders);
5) pyramidal insufficiency syndrome (hyperreflexia, asymmetry of reflexes, pathological signs without paresis of the limbs). It often occurs in patients with MS as a manifestation of the phenomenon of clinical dissociation. Makes it necessary to limit physical activity, in particular long walking, standing, carrying heavy objects, exposure to adverse household and production factors(insolation, overheating, etc.) due to the possibility of temporary and long-term deterioration of the patient’s condition, the appearance of a motor defect.
2. Visual impairment leads to limited life activity varying degrees due to a decrease in the ability to orientate and perform actions that require adequate visual acuity both during work and at home.
3. Mental dysfunction can significantly limit life activity only at the late stage of MS. However, euphoria (less often depression) requires an adequate assessment to determine the patient’s real work capabilities (the phenomenon of clinical-labor dissociation).

Contraindicated types and working conditions
1. General: significant or moderate physical stress, exposure to toxic substances, general vibration, adverse meteorological factors (primarily insolation, overheating).
2. Due to the characteristics of dysfunction and the course (progression) of the disease in a particular patient: inaccessibility of professions that require long periods of standing, moving heavy objects, strictly coordinated movements, a certain rhythm, visual strain.

able-bodied patients
In the stage of long-term remission with minimal or no organic symptoms, rationally employed.
2. With MS of the first severity (clear signs of organic damage without dysfunction): in the absence of general and individual contraindications to work in the main profession, long-term remission, rare exacerbations or slow progression (taking into account the effectiveness of therapy). In some cases, it is necessary to exclude unfavorable factors of work activity on the recommendation of the CEC.
3. Patients with the second degree of severity of MS (moderate motor, visual defect), with rare exacerbations, a generally favorable course of the disease and rationally employed in professions of the humanitarian, administrative type.

Indications for referral to BMSE
1. Persistent and severe dysfunction, significantly limiting the patient’s life activity.
2. Progressive course with repeated exacerbations, incomplete remissions or steady progression.
3. Long-term temporary disability (at least
4 months) due to exacerbation of the disease.
4. Loss of profession or the need to significantly reduce the amount of work (depending on the characteristics of the dysfunction).

Minimum required examination when referring to BMSE
1. Lumbar puncture data (if possible, determination of oligoclonal globulins).
2. Results of immunological blood tests (indicators of cellular and humoral immunity).
3. CT and (or) MRI data of the brain and spinal cord.
4. Results of studies of evoked potentials of various modalities (visual, etc.).
5. Data from an ophthalmologist, otolaryngologist.

Disability criteria
It is necessary to take into account the clinical and social features of assessing work capacity in patients with MS:
a) progressive course of the disease as a whole (despite the above options);
b) the frequency of exacerbations cannot be the only criterion - it is necessary to evaluate the duration, as well as the depth of remissions;
c) frequent discrepancy between the severity of organic symptoms and the degree of dysfunction (the phenomenon of clinical dissociation);
d) young age and active work attitude of patients. At the same time, one must keep in mind the lack of criticality and underestimation by many patients of their work capabilities (the phenomenon of clinical-labor dissociation).

Group III: social insufficiency due to the second (less often first) degree of severity of the disease, if dysfunction and (or) a rapid rate of progression leads to loss of profession, qualifications, a significant reduction in the amount of work (according to the criteria of limited mobility, work activity of the first degree ).
Group II: third degree of severity, rapid progression, in particular in the stem form of the disease, leading to severe limitation of life activity (according to the criteria of impairment of the ability to move, orientation of the second degree, work activity of the second, third degree).
Group I: fourth degree of severity of MS due to the need for constant outside care and assistance (according to the criteria of limited ability to move, orientate, and self-care of the third degree).

Persistent severe dysfunctions with the impossibility of reducing social impairment after observing a disabled person for 5 years are the basis for establishing a disability group without a re-examination period.

Causes of disability: general illness, sometimes disability due to an illness acquired during military service.

Disability prevention and rehabilitation
Only secondary and tertiary prevention and partial rehabilitation are possible.

1. Secondary prevention: a) timely diagnosis;
b) differentiated therapy (depending on the nature of the course, the patient’s age and other factors); c) compliance with the terms of VN, especially in the period of exacerbation; d) dispensary observation (according to accounting group III, with a frequency of examinations at least 2 times a year). When acute form and malignant course, patients should be observed at least once a quarter; e) rational and timely employment at the initial stage of the disease and in complete remission (transfer to another job after clarification of the diagnosis and completion of the VL).

2. Tertiary prevention, professional and social rehabilitation: a) modern definition of disability group III, change in working conditions or employment in a new profession, taking into account contraindicated factors; b) organizing the work of disabled people of group II in specially created conditions, including at home (advisory, literary, small-scale administrative and economic work and PD); c) in the case of stable remission, with mild impairment of motor functions, training and retraining in some technical, humanitarian, and administrative professions can be carefully recommended, taking into account contraindications and the real prospects for further work activity; d) in case of severe disability, the following are important: psychological support for the patient, correction of emotional disorders; symptomatic therapy in case of pelvic disorders, severe spasticity; provision of a bicycle stroller and other measures social assistance and protection.

Multiple sclerosis is one of the common diseases of the central nervous system. According to global statistics, it occurs in 5-70 patients out of 100 thousand people. In the European regions of Russia, the incidence is slightly higher than the average and is approximately 25-50 cases per 100 thousand.

Men and women aged 20 to 45 are at particular risk. In older people, multiple sclerosis (MS) is diagnosed much less frequently, and with similar symptoms, other pathologies are usually detected.

Characteristic of the disease chronic course with periodic exacerbations and, conversely, a decrease in symptoms. However, MS is constantly progressing and very often, even at relatively early stages, leads to a significant limitation of a person’s ability to work.

Multiple sclerosis as a basis for disability

Very often, MS leads to serious damage to certain areas of the brain and spinal cord. In humans this manifests itself:

• in violation speeches;
• deterioration coordination movements;
• numbness limbs up to complete loss of motor function;
• problems with mental condition and in the form of other symptoms that do not allow him to continue working.

Therefore, in MS at certain stages, one or another disability group is assigned. However, in some cases, the disease may manifest itself in the form of symptoms only periodically, no more than once or twice a year. However, such symptoms can only slightly affect the ability to work.

Thus, the very fact of detection of MS does not necessarily mean the assignment of a disability group. In each individual case, this must be decided by a medical commission by conducting a medical and social examination (MSE). At the same time, in the decision-making process, doctors pay attention primarily to the coordination of the patient’s movements.

In this regard, there are following criteria select one of the groups:

• III gr.– the presence of mild or moderate impairment of motor function while maintaining ability to work;
• II gr. – pathological condition The central nervous system has pronounced symptoms;
• I gr.– serious violations lead to severe upset coordination of movements up to the complete loss of the patient’s motor ability.

Thus, disability requires serious diagnosis, and various shapes RS can become the basis for assigning any of the groups, starting from the third and ending with the first.

Indications for medical and social examination

To obtain a group of limited work ability, you must pass the Medical Labor Expert Commission (VTEK). It is convened after the patient contacts his therapist or the head physician of the medical institution.

If specialists consider the existing grounds sufficient for the work of VTEC, then the patient’s personal file will be transferred to representatives of the commission to prescribe the tests and studies necessary for this procedure.

A meeting of the commission on the issue of assigning a disability group can take place:

• in management VTEK;
• on home in a patient suffering from MS;
• V hospital, where the patient is being treated.

In this case, the following factors may be the basis for convening a medical and labor commission:

1. Due to symptoms of the disease, the patient is unable to perform work in accordance with their job responsibilities or there is a forced need to significantly limit the workload.
2. After a person contacts medical care and the diagnosis was made, the prescribed course of treatment did not provide significant results. The patient's condition did not improve. Multiple sclerosis leads to serious pathologies that severely limit the life of the patient.
3. The patient's condition is noticeable getting worse due to a progressive disease that has become permanent chronic nature.
4. Due to pathology, a person is temporarily disabled for more than 4 months.

It should be noted that the list of these grounds may be subject to correction depending on the patient’s condition and the attending physician’s conclusion about the need for a VTEC meeting or its absence.

List of studies and analyzes required for medical and social examination

Modern medicine offers several ways to detect MS, but the disease is still not detected in all cases and is considered difficult to diagnose. Not the least role in this is played by the fact that the clinical signs of the disease resemble many other pathologies of the central nervous system.

That is why the diagnosis of “multiple sclerosis” is made by doctors only after a comprehensive study of the patient’s condition:

1. Lesions nerve cells are identified during MRI studies areas of the head and spinal cord.
2. The development of MS can also show the condition immune system, which is determined through a blood test from a finger and a vein.
3. Lumbar examination is also performed puncture.
4. Symptoms of MS can be detected ophthalmologist and a physician specializing in diseases of the neck, ear, head, nose and throat.
5. A patient with suspected MS is given an injection with the composition Margulis-Shubladze. If the test gives a positive reaction, then the suspected diagnosis can be confirmed. However, doctors never make a final decision without comparing the test results with other studies.

If after conducting these studies and passing necessary tests it is confirmed that the condition of a person with MS gives him the right to be granted a disability group, the experts included in the commission make an affirmative decision. Its details will depend on more specific details.

Determination of disability group for multiple sclerosis

This procedure is carried out on the basis of regulations governing the work of VTEK regulatory documents. However, if a patient has MS, doctors often deviate from general rules disability, since the peculiarities of the symptomatic manifestations of this disease do not allow them to be followed.

When determining a patient’s disability group, members of the medical expert commission must take into account clinical features and take into account the social factor:

1. An important clinical basis for disability in MS is deterioration patient's condition: more frequent attacks, symptoms that appear more intense, etc.
2. Researched essence attacks: how severe the symptoms are during an exacerbation, how long this condition lasts and to what extent it improves during periods of remission.
3. Experts take into account psychological factor: how much the patient underestimates or overestimates his work capabilities.
4. The assignment of a disability to a particular group may depend on professions, the patient's qualifications and lifestyle in general.

Based on these criteria, the following forms of disability are determined.

Disability group III

It is assigned if the following factors are present:

• disease has outgrown to the second degree of severity;
• due to sustainable deterioration condition and severe symptoms, the patient cannot perform his work and must change his occupation;
• a person has a noticeable decrease mobility.

Disability group II

This form is assigned after:

• transition MS in the third degree of severity;
• outgrowing diseases in stem form;
• progressive pathological condition;
• losses ability to work with the exception of performing short and simple work;
• violations motor activity And orientation in space.

Disability group I

The most severe degree is assigned if the patient cannot live without outside help. At this stage of the disease, partial or complete paralysis may occur.

Patients often go blind and have impaired normal operation digestive organs. Mental deviations are also quite possible, up to the most severe pathologies associated with the destruction of a person’s personality.

It is known that disabled people of all groups, with a few exceptions, must annually confirm their status. In practice, persons who have group I due to the last stage of MS, after a five-year observation period, no longer undergo re-examination and the benefits they are entitled to are secured for life.

Contraindicated work and necessary working conditions

Patients with MS, even at the very initial stages of the pathology, can no longer perform certain types of work, otherwise this could significantly affect their health. In general, the more severe a person's disease, the greater these restrictions will be.

General contraindications include:

• mental or physical overvoltage, night shifts and overtime work;
• strong excitement and work under constant stress;
• professions related to exposure vibrations per person;
• work with toxic substances;
• impact solar rays and overheating of the body.

In the future, as the disease progresses, those that require:

• permanent stay at legs;
• rise weights;
• strong concentration attention;
• voltage eye;
• strict coordination movements and maintaining a certain rhythm.

A patient with MS must create the following working conditions:

1. It should be as much as possible limit the number of work responsibilities associated with the need to travel on foot.
2. The employer needs to organize the workplace of a person with MS in such a way that it is easy for him get to get there by transport.
3. Favorable psychological atmosphere so that the sick employee does not experience unnecessary stress.
4. A mandatory condition for maintaining working capacity with MS is to provide him with break and exemption from overtime.
5. Persons with a diagnosed disease are predisposed to calm sedentary work and mental work.

Protection of the labor rights of people with disabilities

Many people with early stages of MS voluntarily give up disability because they are afraid of losing their jobs or believe that they will not be able to get a new job with disabilities. As a result, the condition of patients quickly deteriorates and reaches the final stages of MS, at which the patient is no longer physically able to work.

That is why everyone who is faced with this problem should be aware of the legal protection measures for people with disabilities during employment:

1. By Russian legislation Each employer is obliged to allocate a certain quota jobs for disabled people.
2. Moreover, if an applicant with limited abilities is hired beyond this quota, he cannot refuse only due to health conditions, if it does not interfere with the performance of duties and does not pose a threat to other employees.
3. Dismissal a disabled person without a reason or a refusal to employ him can be appealed in court.

If all restrictions are observed under conditions of constant supportive therapy, a person with multiple sclerosis can maintain his or her work activity for a long time. And if his condition worsens, assignment to one of the disability groups will provide him with the social guarantees and benefits necessary for his life, as well as pension provision.

Among demyelinating diseases, multiple sclerosis occupies one of the leading places both in prevalence and in the frequency of disability of patients.

As our observation data showed, in Moscow the number of patients with multiple sclerosis among people with organic lesions central nervous system, recognized as disabled for the first time, is 2.01%. According to various researchers, the number of patients with multiple sclerosis among other neurological diseases ranges from 2 to 5%.

Characteristic for all countries and geographical areas general feature: Multiple sclerosis mainly affects young people (20-35 years), i.e., the most productive age group of the population. Multiple sclerosis occurs somewhat less frequently at a later age and very rarely in children.

Etiology and pathogenesis of the disease. It is now firmly established that the basis of the pathomorphological essence of the disease process in multiple sclerosis is not primary gliosis, as Charcot and a number of other researchers believed, but foci of demyelination in the white matter of the central nervous system.

To date, the causative agent of multiple sclerosis has not been isolated. Researchers M. S. Margulis, A. K. Shubladze, V. D. Solovyov isolated several strains of the virus from patients with acute disseminated encephalomyelitis. The isolated virus, in particular the SV strain, was neutralized by the blood sera of patients with multiple encephalomyelitis in 70% of cases and patients with multiple sclerosis in 50% of cases. This gave reason to believe that in some cases, multiple sclerosis is associated with the human acute encephalomyelitis virus.

Numerous experimental studies and data clinical observations showed that foci of demyelination can occur under the influence of toxic substances (lead, arsenic, potassium cyanide, saponin, sodium taurocholate, cobra venom, tetanus toxin, diphtheria toxin, some barbiturates: Nembutal, somyafen, etc.), endogenous toxins and lipolytic enzymes ( lecithinase, cephalinase, etc.), nutritional and metabolic disorders, vascular disorders, infectious agents, parenterally administered nonspecific substances and brain tissue.

Lack of a single causative factor in the development of the demyelination process and the view of demyelination as a nonspecific process gave grounds to virologists and clinicians to believe that multiple sclerosis is an etiologically heterogeneous disease.

Since the causative agent of multiple sclerosis remains unknown to this day, there is no consensus on the pathogenesis of this disease.

Several theories have been proposed to explain the pathogenesis of the disease: endogenous, toxic, lipolytic, vascular, infectious and allergic. However, to date, none of these theories is generally accepted. IN last years The infectious-allergic theory received the greatest recognition.

Taking into account the basic principles of the infectious-allergic theory and the latest data, the pathogenesis of multiple sclerosis can be presented as follows. Active beginning(a virus or, according to supporters of the allergic theory, nonspecific factor), having neurotropic properties, spreads throughout the tissue of the central nervous system. At the point of its contact with the substance of the brain, “sclerotic plaques” characteristic of multiple sclerosis are formed, which in development go through a number of stages from demyelination to sclerosis. The number of plaques can vary from single to several hundred and even thousands.

Depending on the number of plaques, their “age” and location, one or another clinical picture of the disease is observed.

Mental disorders. Mental disorders are expressed mainly in changes in the affective sphere ( high mood, pathological sharpening of premorbid features, lability of emotions, etc.), as well as some decrease in intelligence (which almost never reaches the degree of pronounced dementia), some decrease in mental tone, mild memory impairment, as well as euphoria or depression.

Until now, it was believed that euphoria in multiple sclerosis was a specific symptom of this disease. However, as studies by Gallinek and Kalinowski have shown, the most common psychopathological symptom is reactive depression.

Thus, although mild disturbances mental activity often observed in multiple sclerosis, mainly the structure cognitive processes at the same time remains intact. Therefore, patients with multiple sclerosis remain able to work for a very long time in jobs that require mainly only neuropsychic stress, and continue to perform them, even when they find themselves bedridden due to movement disorders.

Mental changes that affect the ability to work in patients with multiple sclerosis are very rare.

Atypical cases of multiple sclerosis. There are many descriptions in the literature of multiple sclerosis occurring as a tumor of the spinal cord or brain.

Many other forms of the disease have been described: hemiplegic, epileptiform, amyotrophic, extrapyramidal, cerebellar-bulbar, etc.

Methods laboratory diagnostics . To date, there are no laboratory methods for diagnosing multiple sclerosis. Of the numerous methods proposed laboratory confirmation multiple sclerosis, only an intradermal test with the Margulis-Shubladze vaccine deserves attention. It turns out to be positive in 60-70% of cases of multiple sclerosis. However, a positive reaction with the Margulis-Shubladze vaccine cannot be considered a pathognomonic sign of multiple sclerosis. Only with appropriate clinical data does a positive vaccine test confirm the diagnosis of multiple sclerosis. However, this reaction can be negative even with clinical expressed forms multiple sclerosis.

Basic criteria for establishing a disability group for multiple sclerosis. A study of the criteria used by VTEK doctors when examining patients with multiple sclerosis and establishing disability groups showed that in this case, deviations from the basic provisions of the instructions for determining disability groups are often allowed. In 60.5% of cases, the disability criteria did not correspond to the expert provisions of the VTEC. This is due to the fact that multiple sclerosis has extensive symptoms, and examiners do not know which symptom should be considered the main one when determining disability groups.

As we showed above, the organic symptoms present in patients cannot serve as a criterion for determining ability to work, since in multiple sclerosis, pyramidal signs can be pronounced with moderate and mild impairment of body functions.

The division of the disease according to clinical forms (spinal, cerebral, ataxic, etc.) cannot be used as a criterion for disability, since, depending on the severity of dysfunction, patients with both spinal and ataxic forms can be recognized as disabled people of the first group, and able-bodied for the work performed. Medical labor examination cannot be built only on the basis of data on clinical form illness, duration of illness or the presence of exacerbations, since patients become disabled at different stages of the illness, and the duration of exacerbations, as a rule, does not exceed 4 months - a period that usually falls into the category of temporary disability. If the duration of exacerbations extends over several years (the fourth type of exacerbations), then the increase in dysfunction occurs very slowly, which makes it impossible to judge the ability to work by the exacerbation of the disease itself. Expert opinions cannot be based on the frequency of exacerbations alone. The average number of exacerbations per year in multiple sclerosis is 0.7-0.75 (in our patients it was 0.72), i.e. approximately one exacerbation every 16-17 months, and the number of examinations in most patients is one in 12 months. Therefore, the frequency of exacerbations is difficult to use as the sole criterion of work ability, although it is an indicator of the type of disease course.

The work activity of patients was most constantly and frequently influenced by various types of motor dysfunction. It turned out that there is a certain relationship between the severity of movement disorders and the ability of patients to work. Patients with pronounced movement disorders are disabled people of the first group, with severe disorders - of the second group, and with moderate and mild disorders - disabled people of the third group or are able to work (depending on their main profession). We noted a correlation between the severity of movement disorders and the degree of disability in 98% of cases.

The basis for determining the severity of motor disorders was the degree of decrease in muscle strength, range of movements, the ability of active movement, the range of ataxic oscillations, a violation of statics and the ability to perform certain types of movements. This made it possible to divide all movement disorders identified in patients into four main types: pronounced, pronounced, moderate and mild.

The severity of movement disorders is easily determined based on clinical examination data.

When making expert decisions, one must proceed not from the arithmetic sum of types of violations, but from the general functional state of the body.

Forecast. Our observations showed that the time frame for transition to disability turned out to be different, the maximum of which was 19 years.

The type of exacerbations determines the course of multiple sclerosis. Usually the first exacerbation does not provide any data for predicting the nature of the disease. However, the more severe the first exacerbation, the worse the subsequent course of the disease. The gradual development of dysfunction also indicates a poor prognosis. If patients develop severe motor disturbances in the first 3-4 years of the disease, then recovery of impaired functions is usually not observed, and remissions are insignificant. With a developed picture of the disease, the more acute the exacerbation begins, the faster and more completely it ends; the longer the exacerbation, the less chance of full recovery impaired functions. The most benign exacerbations are visual disorders, since in almost 100% of cases, visual functions are restored to normal or almost normal.

If the work activity of patients is not associated with significant physical stress, prolonged standing on their feet and performing precise coordinated movements, then such patients continue to work for years,

The prognosis for multiple sclerosis consists of three parts:

1. Prognosis for the preservation of life: is, as a rule, favorable, since patients do not die directly from multiple sclerosis, with the exception of acute cases and bulbar forms of multiple sclerosis.

2. Prognosis for work ability: in most cases remains long-term favorable if the patient performs work that is not associated with significant physical stress and prolonged standing and does not require precise coordinated movements.

3. The prognosis for recovery is usually unfavorable; We have not observed a single case of recovery in patients, and if there are remissions that last for decades, then even after them an exacerbation of the disease process is possible.

Most patients are poorly informed about what is required by law in the presence of certain diseases. Therefore, the question of whether multiple sclerosis gives disability is extremely relevant for many. This pathology, which affects the central nervous system (CNS), leads to severe hearing and vision impairment, as well as decreased sensation in the limbs or paralysis.

As a result, a person may almost completely lose the ability to self-care and perform daily duties. The onset of the disease often occurs at working age - up to forty-five years, so patients need to undergo an examination and receive disability for multiple sclerosis. After that, he is entitled to monthly payments and subsidies from the state.

Degrees of the disease

Multiple sclerosis is chronic in nature

The diagnosis is made by a neurologist based on laboratory and instrumental examination. Today it is customary to distinguish four degrees of severity of multiple sclerosis.

1. There are initial signs of damage to nerve fibers with mild clinical symptoms. Performance is completely preserved, and with adequate treatment it is possible to achieve a certain stabilization of the patient’s condition.
2. Marked transient disturbances various functions of the central nervous system - vision, hearing, movement. The ability to work may be somewhat limited, especially when it is necessary to perform high-precision manipulations.
3. The third degree is characterized by partial loss of ability to work. There are pronounced and constant degenerative changes in neurons, which is manifested by impaired motor skills, the inability to concentrate on completing the task, high degree fatigue. It is difficult or completely impossible for a person to remain in the same position long time.
4. At the last stage, the ability to self-service is completely lost. Receiving disability at the 4th stage requires passing an examination, after which group 1 is assigned, since the ability to work is completely lost. Such patients often cannot walk independently, moving in a wheelchair.

With the first two degrees of the disease, it is impossible to obtain disability. The basic functions of the central nervous system are preserved, although not in full. It is advisable for a person to move to an easier job that does not require a long stay in a forced position or constant concentration.

Criteria taken into account by the medical commission

MS severity criteria are assessed taking into account the course of the disease

The ITU commission consists of several neurologists, and the procedure for assigning a specific group requires the patient to undergo full examination, often in a hospital setting. As a rule, before receiving disability due to multiple sclerosis, the patient will have to undergo the following tests:

• immunological studies that determine indicators of humoral and cellular immunity of the blood;
• CT scan or more informative MRI;
• magnetic resonance spectroscopy;
• superposition electromagnetic scanning;
• laboratory test cerebrospinal fluid.

Consultations with an otorhinolaryngologist and ophthalmologist are mandatory. In the presence of mental disorders the patient is additionally referred to a psychiatrist. As a result, the medical commission will operate and evaluate such criteria as the degree of preservation of the ability to self-care, the percentage of vision loss, and the severity of damage to the central nervous system.

Multiple Sclerosis Disability Scale

The severity of multiple sclerosis is determined using a special scale

In order to more quickly assess the degree of existing violations and give an appropriate conclusion, our country has a unified scale on which the commission’s doctors rely. It quite accurately assesses the condition of the main functional systems person:

• vision;
• brain stem;
• condition of the cerebellum;
• functional state of the pelvic organs;
• sense organs;
• pyramid system;
• cognitive abilities.

If you suspect multiple sclerosis, it is important to immediately register with a neurologist and undergo regular examinations. This will allow you to prescribe adequate treatment in a timely manner and keep the pathology under control. In addition, having a doctor's notes in your medical history will help speed up the process of obtaining disability if the disease progresses.

Multiple sclerosis often leads to early defeat organs of vision, which is caused by the destruction of the myelin sheath of the optic nerve and difficulty in conducting nerve impulses. An important diagnostic criterion is the presence of scotoma and decreased visual acuity in both eyes simultaneously.

At ophthalmological examination decreased visual acuity and scotoma may be detected

To designate a specific disability group, doctors will also evaluate the present symptoms of the cranial nerves. Pathological ones include: swallowing disorders of varying degrees, difficulties with pronunciation or constructing complex phrases, nystagmus. Muscular hypotonia, tetra - or hemiplegia - symptoms that clearly indicate damage to the pyramidal system of the brain.

Helps to formulate a group of cerebellar lesions. As a result of the disrupted functioning of this structure, a coordination disorder occurs - ataxia. As a rule, it is affected sensory system a person, which entails disorders of tactile, pain, vibration or muscle-articular sensitivity. Final stages diseases are often accompanied by disorders of the pelvic organs. There may be symptoms such as prolonged constipation or urinary retention, or vice versa - incontinence.

Multiple sclerosis often causes disability. The group can be registered at certain period or indefinitely - it all depends on the stage of the pathology and the nature of the changes that have already occurred in the central nervous system. After assignment of the appropriate disability group, the patient receives the right to free medications and benefits from the state. In accordance with the assigned group, the amount of monthly assistance can range from 4 to 9.5 thousand rubles.