MS Lecture

MS is…

• an autoimmune disease

• primary targets of the autoimmune attack are the myelin coating around the nerves in the central nervous system and the nerve fibers themselves

MS is NOT…

• contagious

• directly inherited

• always severely disabling

• fatal - except in fairly rare instances

• being diagnosed is NOT a reason to stop working, stop doing things that one enjoys, and not have children

what causes MS?

• genetic predisposition

• environmental trigger

  • these cause autoimmunity → loss of myelin + nerve fiber

what happens in MS?

activated T cells cross the blood-brain barrier, launches attack on myelin & nerve fibers to obstruct nerve signals

what are possible symptoms?

• fatigue (most common)

• visual problems

• bladder/bowel dysfunction

• sexual dysfunction

• emotional disturbances

• cognitive difficulties

• sensory changes

• pain (neurogenic, MSK)

• spasticity

• gait, balance, and coordination issues

• speech/swallowing problems

• tremor

• symptoms vary between individuals and are unpredictable

Common clinical manifestations

• fatigue - most common symptoms 1 or 2 degree causes

• weakness - 70% had LE weakness

• spasms/spasticity/stiffness - 60-90% life time occurrence; can be local effecting one muscle or general involving a limb or limbs, and/or the trunk

• Ataxia - up to 80% affected at some point in their disease progression

• Pain/Dysesthesia - 53 -79% of people with MS report pain within the past month

• bladder/bowel - 80% incidence, with stress or urge incontinence, hesitancy, dribbling

• temperature intolerance - see increase in symptoms with 1 degree increase body temp

most common types of pain in MS

• pain in extremities (legs most common)

• spasms/spaticity

• aching, throbbing, burning, sharp/stabbing

• headache

• L’hermitte’s sign - barbershop sign

what certain characteristics predict a better outcome of MS?

• female

• onset before age 35

• sensory symptoms

• monofocal rather than multifocal episodes

• complete recovery following a relapse

what are the different patterns (courses) of MS?

• Relapsing-Remitting MS

• Secondary-Progressive MS

• Primary-Progressive MS

• Progressive-Relapsing MS

Management of MS falls into which categories?

• treatment of relapses (aka exacerbations, flare-ups, attacks - that at least 24 hours)

• symptom management

• disease modification

• psychosocial support (at risk for depression)

• rehabilitation (to maintain/improve function)

How are relapses treated?

• not all require treatment

  • mild, sensory symptoms are allowed to resolve on their own

  • symptoms that interfere with function (e.g. visual or walking problems) are usually treated

• 3-5 day course of IV methylprednisolone - with/without an oral taper of prednisone

  • high-dose oral steroids used by some neurologists

• rehabilitation to restore lost function

• psychosocial support

what do the disease-modifying drugs do?

reduce attack frequency and severity, reduce scarring on MRI, and probably slow disease progression

• they’re not designed to cure, make ppl feel better, or alleviate symptoms

• they can be taking orally, injected, or infused**

Treatment of relapsing MS is most effective during…

early, inflammatory phase

• & least effective during later neurodegenerative phase

MS can limit activity. Consequences of inactivity…

• bowel dysfunction

• de-conditioning

• circulatory problems

• pressure sores

• disuse atrophy

• fear of falling

• increased falls

• obesity

• osteoporosis

• respiratory disturbances

• type 2 DM

• weakness

what do we need to identify in our PT examination for someone with MS?

the threshold for patient’s abilities for the activity and impairment

I stopped 56, tkj stopped 140