MS

MS

1. Pathophysiology

   • Chronic, progressive, degenerative autoimmune disease of the CNS
   • Attacks myelin of nerve fibers in the brain and spinal cord
     • Causes inflammation and edema
       • Inflammation and edema resolves leaving diffuse plaques/ lesions
         • Gliosis in late stages
       • Damage (demyelination)
         • Disrupts nerve impulses

2. Treatment

   • No cure
   • Speed recovery from attacks
     • Corticosteroids
     • Plasma exchange
   • Slow progression
     • Immunosuppressants
     • Immunomodulators
     • Other drugs
   • Reduce signs and symptoms
     • Physical therapy
     • Other drugs
       • Antidepressants
       • Antispasmodic agents
       • Muscle relaxants
       • CNS stimulants
       • Anticonvulsants
       • NSAIDs, Opioids, Nerve blocks, TCAs
     • Alternative medicine
       • Yoga
       • Meditation
       • Acupuncture
       • Massage
     • Lifestyle modifications
       • Balanced diet
       • Regular exercise
       • Relaxation and stress relief
       • Cooling down body temperature
     • Cognitive rehabilitation
       • Occupational therapy
       • Speech/language pathology
       • Neuropsychology
     • Assistive devices

3. Symptoms

   • Vision problems
     • Blurred vision
     • Double vision
     • Irregular eye movements
   • Speech/ language problems
     • Slurring
     • Scanning/ disrupted speech
     • Nasal Speech
   • Cognitive dysfunction
     • Memory
     • Mood
     • Attention and concentration
     • Executive functions
     • Information processing
   • Spasticity
     • Muscle stiffness
       • Difficulty performing tasks
       • Lack of coordination
     • Muscle twitching
       • Uncontrollable spasms
     • Involuntary crossing of legs
     • Muscle and joint deformities
     • Fatigue
       • Muscle weakness
     • Inhibited muscle growth
     • Inhibited protein synthesis
   • Bladder and bowel dysfunction
   • Depression
   • Pain
   • Sexual dysfunction

4. Types

   • Clinically Isolated Syndrome (CIS)
     • Earliest form of MS
     • Single episode of neurological symptoms
   • Relapsing-remitting MS (RRMS)
     • Unpredictable but clearly defined attacks (relapses) where new symptoms appear or existing symptoms worsen
     • Complete or near complete recovery (remissions) in between attacks
   • Secondary-progressive MS (SPMS)
     • Less distinction between relapses and remission
     • Steady progression of disease, sometimes with plateaus
   • Primary-progressive MS (PPMS)
     • Slow accumulation of disability without defined relapses
     • May stabilize and have temporary period of improvement but no remission periods

5. Cause unknown

   • Suggested to be caused by a combination of lifestyle, environmental, genetic and biological factors
   • Higher incidence in women than men (2:1)
   • More prevalent in northern latitudes and caucasians

6. Diagnosis

   • Blood tests
     • To rule out other diseases with similar symptoms
   • Lumbar puncture (spinal tap)
     • To test for abnormalities in antibodies and rule out other infections and conditions
   • Magnetic Resonance Imaging (MRI)
     • Gold standard for diagnosis
     • To detect tissue damage (lesions) in brain and spinal cord
   • Evoked potential tests
     • To measure nerve impulses
   • Neurological examination

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