HSC4558 Multiple Sclerosis

What is MS

What is MS

neurological condition that is characterized as an autoimmune disease/disorder that involves the deterioration of myelin. It damages the CNS (brain, spinal cord, optic nerve)

It’s cause is unknown

What is the Epidemiology of MS?

1. affects 20-50 y/o primarily

2. 3x more in females than males

3. more people being diagnosed but it is difficult due to different symptoms

4. close to normal life spam

5. most ethnic groups

   1. more common in Caucasians of N. European ancestry

   2. African american women have higher risk than reported previously

what are the environmental triggers of MS

• low levels of vitamin D in utero

• low levels of sun exposure in childhood

• high cow milk consumption

• high BMI as an adolescent

• smoking (passive as well)

• geographic areas further from the equator

what are the most common MS symptoms?

• fatigue (80% of people)

• vision problems

  • optic neuritis: inflammation of optic nerve

  • diplopia: double vision

  • partial visual loss

  • nystagmus: uncontrolled repetitive movements of the eyes

• numbness and tingling

• muscle spasms, stiffness, and weakness

  • intermittent or sudden pain

  • electric shock sensation

  • spasticity ( more common in legs)

• mobility problems

  • coordination problems

• pain

• problems with thinking, learning, and planning

  • cognitive issues (34-65%)

  • sexual dysfunction

  • loss of bladder and bowel control

• depression and anxiety

• sensitivity to heat

• dysphagia (difficulty swallowing)

• dysarthria (speech difficulty)

• dysphonia (abnormal voice changes)

What is Exacerbation? (Define relapse)

when symptoms get worse (relapse)

• lasts at least 24 hours

• separated from other attacks by 30 days

• may last several days to weeks or months

• not due to infection or other cause

relapse: sudden deterioration after a period of improvement

Define remission

when symptoms disappear or lessen in intensity

• may stay in remission

• may come and go over time

• doesn’t mean that MS has disapperared

• may return to baseline

What are the 4 stages of MS (Clinical Courses)

1. clinically isolated “ clinically isolated syndrome”

   1. first episode, eligible for disease modifying

2. Relapsing Remitting (R-R) (75% of MS population)

3. Primary Progressive (PPMS) (15% of the MS Population)

4. Secondary Progressive (SPMS)

   1. relapsing-remitting becomes secondary progressive over time

   2. 90% of people with RRMS

Describe Clinically Isolated Syndrome

1. newer category of MS

2. single demyelinating attack

3. first neurological symptoms experienced

   1. typically 24 hours or longer

4. may return later o rnot

   1. delay can be years or months

Describe Relapsing-Remitting (R-R)

• 75%-85% of cases

• exacerbations followed by remissions

• symptoms subside or recovery to baseline

• may have disease progression between attacks

Describe secondary progressive

• occurs following relapsing-remitting MS type

  • delay of years or maybe decases between R-R and secondary progressive

• progressive course of disease

  • disability gradually increases

• may or may not have relapses

describe primary progressive

• occurs in 15% of cases

• may manifest in people in their 30s or 40s

• gradual but steady disease progression from symptom onset

  • may have short periods of disease stability

• no clear relapses or remissions

How does diagnosis works for MRI

• review of clinical history

• neurological exam

• MRI is used to rule out everything out

  • lesions found in 2 seperate areas

• evoked potentials

  • measures electrical activtiy in brain (visual, auditory, sensory)

• lumbar puncture (cerebrospinal fluid)

• blood tests

• challenge to diagnose

What type of exercise is recommended for MS

• NON-FATIGUING

  • overexcising is counterproductive

  • can increase MS symptoms

  • assess what is possible and tailor

• some resistance

  • light weight/resistance bands

• maintain strength and range of motion

  • movement is essential (5days a week)

  • flexibility/ stretching- yoga, tai chi

  • swimming in a cool pool

What are some of the challenges of MS

• unpredictability of symptoms

  • hard to plan activities

  • may affect work

• adjustment to disease and flunctuations

  • exacerbations and remissions

  • possible deterioration in social relationshops

• chronic condition

  • no cure

  • various strategies to manage

What is the medication management of MS

• disease-modifying drugs

  • medications to stop exacerbations

  • injection

  • oral

  • infusion

  • BEGIN ASAP

• pharmacological treatment

  • acutely use corticosteroids

    • limited time

    • multiple side effects

What is the general management of MS

• energy conservation ( temperature of environment b/c heat is an issue)

• identify and avoid triggers

  • heat

  • stress

• work simplification and energy conservation

  • activity modification

  • assistive devices and technology

• healthy habits

  • sleep

  • rest breaks

• rehabilitation therapies

What are the goals of rehab for MS

• slow progression of MS

  • with RRMS and PPMS people can work up to 25 years past onset

• manage/reduce symptoms

• support lifestyle changes

• tailor program to address individual needs

  • address/decrease relapses

  • promote mobility

Describe the function of myelin

Myelin consists of lipids and proteins and serves as nerve insulation

it coats and protects axons in the CNS and PNS

it provides efficient impulse transmission

What is PLISSIT Model

1. permission

   1. permitting patients to raise sexual issues

2. limited information

   1. giving patients limited information about sexual side effects of treatments

3. specific suggestions

   1. making specific suggestions based on full evaluation of presenting problems

4. intensive therapy

   1. referral to intensive therapy like psychological intervention, sex therapy, and/or biomedical approaches

Why is using the PLISSIT Model important

helps address sexual functioning in a comfortable environment