Multiple Sclerosis

What is Multiple Sclerosis?

 It is an Auto Immune Disease which is when the body
starts to destroy itself.
 It is a life-long disease with no cure.
 In MS, the body attacks and destroys the fatty tissue called
myelin that insulates an axon/nerve, and is called
demyelination.
 If damage is severe it can also destroy the nerve/axon itself.
 MS affects the central nervous system and inflames the
white matter in the brain which creates plaques.
.
 What is Multiple Sclerosis?
• Multiple Sclerosis (MS) is an chronic
inflammatory demyelinating disease of the
brain and spinal cord.
 The Human Nervous System
• Areas affected by MS
– Brain
– Spinal cord
– Optic nerves

(http://web.lemoyne.edu/~hevern/psy340/lectures/psy340.04.2.ns.structure.html)
 MS is a Demyelinating Disease

Blood vessel Inflammation

Myelin – provides
insulation to nerve
processes (axons)
Blood vessel
Inflammation

Blood vessel
Inflammation
 How Common is MS and Who Gets It?

• 8,000 – 10,000 new cases are diagnosed annually

• Affects nearly 500,000 individuals in the U.S.
• Occurs most frequently between ages 25 - 35
• Female: male ratio = 2:1
• More frequent in populations native to areas further
away from the equator
 What Causes MS?

• Genetics
• Environmental factors
 Family Studies
Up to 19% of patients have an affected relative

• Monozygotic (identical) twins 25 – 30%

• Dizygotic (non-identical) twins 3 – 4.5%
• Child of parent with MS 1.9%
• Sibling of person with MS 0.9%
Groups for Which MS Genetic Traits Have
Been Identified:
• Japanese
• African American
• Mexican
• Arabian
• Sardinian (Italy)
• Swedish
• Norwegian
• French Canadian
• Finnish
Not Everyone with a Genetic Risk Will
Develop MS – Why?

• Risk is modified by Environmental

factors
– Sunlight
– Diet (e.g., vitamin D)
– Other lifetime experiences (infections?)
 Symptoms of MS
• Fatigue • Weakness
• Depression • Dizziness/Unsteadiness
• Memory change • Numbness/Tingling
• Pain • Ataxia
• Spasticity • Euphoria
• Vertigo • Speech disturbance
• Tremor • Bladder/Bowel/Sexual
• Double Vision/Vision Loss dysfunction
Multiple Sclerosis Clinical Subtypes
Relapsing-remitting Secondary-progressive
Disability

Disability
Time Time
Primary-progressive Progressive-relapsing

Disability
Disability

Time Time
 How Is MS Diagnosed?
• At least two episodes of symptoms
– Occur at different points in time
– Result from involvement of different areas of
the central nervous system
• Absence of other treatable causes for the
symptoms
• Results of neurological testing
 How Is MS Diagnosed?
• Neurological examination
• Magnetic resonance imaging (MRI) Scan
• Blood tests
• Lumbar Puncture (spinal tap): occasionally
performed
• Other testing: infrequently performed
Magnetic Resonance Imaging in MS

Optic nerve
Spinal cord

Brain
Brain Atrophy (Shrinkage)
in Untreated MS

Images acquired over the course of 7 years

from a single person with untreated MS
 How is MS Treated and Managed?
• Drug therapy
– Treat new attacks (exacerbations)
– Prevent the occurrence of future attacks
– Slow or prevent disease progression
– Treat the chronic symptoms of the disease
• Psychosocial support
 Medications used for MS

• Spasticity- Baclofen, Tizanidine, Diazepam, Dantrolene

• Optic Neuritis- Methlyprednisolone, Oral steroids
• Fatigue- Antidepressant, Amantadine
• Pain- Codeine, Aspirin
• Sexual Dysfunction- Viagra, Pravatine
• Tremor- Isoniazid, Primidone, Propranolol
• Disease-Modifying Drugs- Interferon beta 1a and
1b, and Glatiramer acetate
 Disease-Modifying Drugs
• Interferon Beta 1b
• Interferon Beta 1a
(Avonex and Rebif): is
a protein that is a replica of
human interferon. It suppress
the immune system and helps
to maintain the blood-brain
barrier. You inject Avonex into
the muscle once a week and
Rebif is injected under the skin
three times a week. This drug
is useful to people who have
definite progressive MS. One
side effect of the drug is a flu
like symptom.
(Betaseron): is slightly
different from our own
interferon. This medication does
the same thing as beta 1a, but is
injected just under the skin every
two days. Side effects include
irritation, bruising, and redness at
the site of injection and the flu
like symptoms. This is also given
to people who have definite
progressive MS.
 Physiotherapy assessment
• Strength • Swallowing
• Tone • Speech and communication
• Range of motion impairment
• Balance • Visual status
• Coordination • Sensory impairment
• Cardiovascular and respiratory • Activities of daily living
status • Cognition
• Bed mobility and transfer • Physical environment
• Bowel and bladder impairment • Medical stability.
 Measurement tools

• Barthel index
• Kurtzke scale
• Multiple sclerosis quality of life inventory
 Setting goals
• Helping the patient solve problems
• Problem solving and education are key aspects
 fatigue
• Modified fatigue impact scale
• Due to sleep deprivation-
• urinary incontinence
• Muscle spasm
• Poor diet
• Depression
 fatigue
• Energy conservative techniques
• General exercises
• Breathing exercises
• Stretching
• Adaptive equipments
 weakness
• Pnf
• Stretching
• Ankle Foot Orthrosis
• Strengthening strong muscles.
 Balance
• Cerebellar problem is common
• Wide base to narrow base
• Low to high COG.
• Weighted cuff and weighed canes reduce
tremors.
• Collar to reduce tremor of neck
 Sensory deficit
• Compensating for the loss
• Routine safety instructions
• Wheelchair cushioning
• Pressure relief techniques.
 Ambulation and mobility
• Wheelchair mobility training.
• Electric wheelchair.