Multiple Sclerosis

  • MS is a demyelination of nerves

  • The most common chronic progressive disease of the CNS among ages 20-50

  • Diagnosed by ruling out everything else

  • Etiology: no clue why it is caused

  • Symptoms:

    • *Clinical symptoms depend on lesions

      • fatigue

      • Balance issues

      • Tremor

      • Weakness or paralysis

      • Spasticity and high tone

      • Ataxia- drunk gait

      • Diplopia

      • Dysphagia

      • depression

      • dysfunction sexual

      • optic neuritis- one of the first symptoms often, visual field cuts

      • bladder problems

      • sensory disturbances

      • bowel problems

      • forgetfulness

      • visual changes

      • immunocompromised- get illnesses for longer

  • Medication:

    • Baclofen pump- for spasticity, side effect is fatigue

    • Drugs

    • Rehabilitation Services

    • Experimental studies

    • Steroids

    • Anti-spasticity drugs (baclofen)

    • Chemotherapy agents

    • Pain Modulators

    • Disease-modifying Medications

  • Myelin cells: fatty covering of nerves

    • Oligodendrocytes: CNS (So MS affects this)

    • Schwann Cells: PNS (GBS affects this)

      • MS does not go away effects CNS

      • Guillain-Barré effects PNS

  • STATS

    • more common in women to men

    • Is found in places with all 4 seasons

  • Pediatric

    • 3-10% of cases are pediatric

    • more frequent relapses

  • Dignosis process

    • MRI

    • Evoked Potential

    • Lumbar puncture/Spinal tap

    • Health history

    • Neurological exam

    • A MINIMUM of: 2 separate flare-ups, 2 neurological signs, 2 + lesions in the white matter

    • Kurtzke Expanded Disability (0-10 scale) (10 is death) (1.0-4.5 high degree of ambulatory ability, 5-9.5 loss of ambulatory ability)

  • Classification of MS

    • Clinically Isolated Syndrome (CIS)

      • First episode of neurological symptoms that last at least 24 hrs

      • Average age is 30

      • 60-80% to develop MS

    • Relapsing-Remitting MS (RRMS)

      • Most common form

      • 20-40 yrs old

      • Periods of acute attacks with near 100% recovery

      • Attacks may last weeks or months

    • Primary Progressive MS (PPMS)

      • Steady increase in disability from onset

      • Less that 15% of cases

      • Most common form of pts dx > 40 y.o.

  • Secondary Progressive MS (SPMS)

    • Generally, starts with RRMS

    • Variable degree of recovery then neuro disability progresses over time

  • Sensory Disturbances

    • paresthesia

    • numbness

    • decreased pos & vibration sense

    • dysesthesia (MS sensory pain)

    • trigeminal neuralgia

    • chronic pain

    • vertigo

    • pain

  • pain management

    • relaxation

    • correct muscle imbalances

      • splinting

    • seating & positioning

      • splinting

      • postures

    • Biofeedback

      • pressure relief wheelchair

    • assistive

    • medication

  • motor systems

    • paresis/weakness

    • high tone & spacitity

    • intention tremours

    • dysmetria

    • incoordination tremors

    • dysmetria

    • inccordination

    • ataxia

    • poor balance

    • dysphagia

  • spasticity management

    • static stretching

    • splinting

    • relaxation

    • posture

    • positioning

    • cooling

  • tremors

    • weights

      • works for some not others

    • stabilization

    • bracing

    • adaptive equipment

    • meds

  • fatigue aka lassitude

    • individualized

    • Provigil-fatigue meds

  • Discrete symptoms

    • psychosocial

    • denial

    • paranoia

  • visual disturbance

    • optic nurtits

    • double vision

    • socotoma

    • pain with eye movement

    • hues of colors

  • bladder & bowel

    • ether have to go to bathroom all the time

    • incotance

    • need to go NOW

    • UTI

    • Consipation

  • depression

    • organic

    • from fear of unknown

    • Serotonin is linked to lesions tho and can lead to depression symptoms