Conditions MS

Incidence and Prevalance

- 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 - European ancestry - Scottish and Scandinavian Rare - Mongolian, Japanese, Chinese, Native American, Eskimo, African, Aborigine descent - Less likely to have closer live to equator

Pseudoexacerbation

- A _______ is a temporary worsening of symptoms without actual myelin inflammation or damage, brought on by other influences. Examples include other illnesses or infection, exercise, a warm environment, depression, exhaustion, and stress. When symptoms flare, checking for a fever is important, since even a minor infection and slight increase in temperature can cause symptoms to appear.

Weakness

- Caused by decreased neuromuscular impulses secondary to demyelination

Clinical Manifestations

- Characterized by progressive disability over time - Optic neuritis frequently 1st manifestation Optic nerve extension of Cerebral Cortex and track of CNS Decreased visual field,color field, clarity of vision - Each case can present differently Due to the ability of the brain to adapt to the lesions

Definitions

- Debilitating, immunological, neurodegenerative disease -Attacks myelin sheath surrounds brain and spinal cord neurons

Secondary Progreesive MS

- Following an initial period of relapsing-remitting non progressive MS, many people develop a ________ disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.

Treatment

- Immune Modulation Understanding the inflammatory proccess - Drug Therapy: Diminish Attacks by 1/3 - Corticosteroids - shorten recovery period - ABC: Antiinflammatory A - Interferon beta-1a (Avonex) B - Interferon beta-1b (Betaseron) C - Copaxone - fools the immune system by blocking damage to the myelin - Medications For relapsing-remitting forms Beta interferons Possibly reduce lesions - For progressive type Corticosteroids Muscle relaxants Medications to reduce fatigue Other medications Muscle stiffness Depression Pain Bladder control problems

Relapsing Remitting MS (RRMS)

- Most CommonPeople with this type of MS experience clearly defined attacks of worsening neurologic function. - These attacks—which are called relapses, flare-ups, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. - Approximately 85% of people are initially diagnosed with relapsing-remitting MS.

Fatigue

- Most common and disabling symptom - Often occurs mid-afternoon sleepiness, motor weakness with effort, mental fatigue

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 - A pseudoexacerbation is a temporary worsening of symptoms without actual myelin inflammation or damage - Treatments are available to reduce the severity and duration of a relapse - Relapses, also referred to as exacerbations, attacks, flare-ups, episodes, or bouts, are initially experienced by most people diagnosed with multiple sclerosis (MS). - Relapses occur with relapsing-remitting, progressive-relapsing, and sometimes secondary-progressive forms of MS. - Relapses do not occur with primary-progressive MS, although patients may experience day-to-day fluctuations in how they feel.

Diagnosis

- Rule out other causes AIDS, B12 deficiency, RA - No specific tests - combination of - Clinical symptoms - Nervous system, coordination, cognitive - Radiological studies -MRI - lesions due to myelin loss Laboratory studies (plaques) whole spinal cord can be imaged as well as brain atrophy of both white matter and grey matter - Spinal tap - check for proteins - Evoked potential tests -measures electrical signals sent by brain

Overview of MS

- Sclerotic plaques on the CNS are the hallmark of the disease - Lesions found on the brain and spinal cord - Lesions block transmission or signals that produce motor movement - Chronic Illness

Symptoms

- Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision

What happens?

- The body's own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers in the central nervous system. - MS is Thought to be an Autoimmune Disease

Primary Progressive MS (PPMS)

- This disease course is characterized by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. - The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with ___________

Cause

- Virus triggers immune system Attack nerve cells People genetically susceptible - Demyelination Scar formation - sclerosis Decreased ability of axon's to conduct impulses - Location of demyelination varies Affects: Visual Motor Sensory Cognitive Psychological Bowel and bladder

Causes

- While it is not known what causes MS, it is known that MS is not a result of lifestyle choices and it's not contagious. - The current theories about causes of the disease include: - Immunology. The body's immune system responds in an abnormal way by attacking the myelin in the central nervous system. Although it's not known what target the immune cells are attacking, scientific research has identified which immune cells are doing the attacking and some of the factors for doing so. - Infections. Viral and bacterial infections may trigger MS. Research is being done on many viruses to see if any play a role in MS. - Genetics. Although people with MS do not inherit the disease, there is some increased risk of its occurrence among family members. Scientists are looking at certain genes that are shared within families affected by MS or found in patient populations with higher rates of MS. - Environment. Variations in geography, demographics (age, gender, and ethnic background) are being studied. - Studies suggest that low levels of vitamin D, which is thought to aid proper functioning of the immune system, as well as exposure to certain agents, may play a role in the development of MS.

Neuromuscular or short-circuiting fatigue

-Demyelinated nerve fires repeatedly, then shorts out when asked to perform a task -Frequent breaks and energy conservation important

Classification

-May shift from one type to another -No predictors 80% have one of the relapsing-remitting forms of MS -Neurological symptoms followed by partial or complete recovery - 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 -Recurring infections or complications from inactivity

MS

-Multiple sclerosis (MS) can cause a variety of symptoms -For many, symptoms can flare-up and then subside over the course of days, months, or even years -MS is not contagious and its causes are not yet fully understood -MS is most frequently diagnosed in young adults -Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.

Spacticity

-symptoms from mild to severe -result of unbalanced ascending/descending excitatory and inhibitory pathways in the brain and spinal cord. -May use spasticity for functional use -Spasm may accompany spasticity more severe at night leading to decreased sleep/fatigue - Cognitive skills - 50 % experience some change: Short term memory Attention Processing speed Visuospatial abilities Executive functions - Bowel/bladder dysfunction - Sexual dysfunction - Emotional - Depression, euphoria, liability

Progressive Relapsing MS (PPMS)

A rare form of MS (5%), PRMS is characterized by a steadily worsening disease state from the beginning, with acute relapses but no remissions, with or without recovery

Prognosis

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

Sensory disturbances

May lead to loss of stereognosis, body scheme, kinesthesia

Signs/Symptoms

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

immune system

With MS, the body's own system of defense, known as the __________, malfunctions ________ cells that are misdirected to attack myelin, must cross the blood-brain barrier to enter the central nervous system (CNS) Once in the CNS,________ cells cause inflammation and damage to the myelin (the protective covering to the nerves) 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

Visual disturbances

earliest signs May subside after 3-6 weeks with no residual effects 80% have some loss of visual acuity