Multiple Sclerosis (MS)

Prognosis?

- First signs between 20-40 - 60% fully functional for up to 10years after 1st incident 30% for up to 30 years after 1st attack Does not decrease life expectancy - Few become severely disabled and/or die

What are four attributes of the cause of MS?

1. immunology (immune system attacks the myelin in CNS) 2. infections (viral and bacterial infections may trigger MS) 3. Genetics (increased risk of its occurrence among family members) 4. Environment (low levels of vitamin D or exposure to certain agents may play a role in development of MS, also variations in geography)

What is the incidence/prevalence?

450,000 USA, 10,000 new cases a year Women > 2x men Typical age is between late teens to 35 Caucasians 2x vs other races. The closer you live to the equator, the less likely you are to have it.

Definition of MS

A chronic, often disabling disease. Debilitating, immunological, neurodegenerative disease.

How else can you diagnose?

Combination of clinical symptoms (nervous, coordination, cognitive) Radiological studies (MRI, Spinal Tap) Evoked potential tests - measures electrical signals sent by brain

Other treatment for progressive type?

Corticosteroids Muscle relaxants Medications to reduce fatigue Other medications Muscle stiffness Depression Pain Bladder control problems

Difference between early and late in the disease?

Early in the disease, myelin may be repaired (remyelination) Later in the disease process, and with progressive forms of MS, remyelination does not occur as frequently

What are treatment options?

Immune modulation, drug therapy, corticosteroids, antiinflammatories. Mostly medications. FOr relapse-remitting forms use beta interferons to reduce lesions

Prognosis cont. for progressive type

Life expectancy reduced Significant disability with progressive disease that results in decreased ambulation and wheelchair dependent decreased ADL's loss of job decreased life roles

Clinical manifestations

Progressive, each case presents differently, optic neuritis frequently first manifestation

Describe the relapses

Relapses are also referred to as exacerbations, attacks, or flare-ups Relapses occur with relapsing-remitting, progressive-relapsing, and sometimes secondary-progressive forms of MS During a relapse, inflammation is occurring along the nerves and the myelin, causing a temporary worsening or recurrence of symptoms. Treatments are available to reduce severity

How is MS diagnosed?

Rule out other causes such as AIDS, B12 deficiency, RA NO specific tests

What happens during demyelination?

Scar formation - sclerosis (location varies)

Signs and symptoms of MS?

Sensory Changes are often the 1st complaint: Numbness, tingling or weakness in one or more limbs one side of your body at a time the bottom half of your body Other visual deficits: nystagmus an involuntary rhythmic tremor of the eye Coordination (ataxia), Tremors Pain - 50% of all cases burning neurotathic Dysarthria, slurred speech due to brain stem involvement Fatigue (most disabling symptom), neuromuscular or short-circuiting fatigue, spasticity in 90% of cases Bowel/bladder dysfunction, sexual dysfunction, emotional (depression, euphoria, lability - emotional up and downs)

Symptoms of MS

Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.

Cause of MS

The body's own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers in the central nervous system. Immune-system cells that are misdirected to attack myelin, must cross the blood-brain barrier to enter the central nervous system (CNS) Once in the CNS, immune-system cells cause inflammation and damage to the myelin (the protective covering to the nerves)

Characteristic of MS symptoms?

They can flare-up and then subside over the course of days, months, or even years

When is MS diagnosed?

Usually young adulthood

What is a pseudoexacerbation?

a temporary worsening of symptoms without actual myelin inflammation or damage

What kind of disease is MS?

autoimmune, body attacks itself

MS classification

may shift from one type to another, 80% have relapsing-remitting (most common)

What are cognitive issues?

short term memory, attention, processing speed, visuospatial abilities, executive functions (experienced by 50%)

Identify these symptoms: stereognosis, body scheme, and kinesthesia

stereognosis - being able to know what something is by touching it body scheme - knowing where your body is kinesthesia - perception of your body moving in space

What are the affects of MS?

visual, motor, sensory, cognitive, psychological, bowel, and bladder