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Multiple Sclerosis

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Fouad Maqboul

on 10 June 2013

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Transcript of Multiple Sclerosis

Disseminated Sclerosis Multiple Sclerosis Introduction Epidemology Clinical Picture Course of MS Work UP Treatment Demyelinating disorders are immune-mediated conditions characterized by preferential destruction of central nervous system (CNS) myelin. The peripheral nervous system (PNS) is spared .

Multiple sclerosis (MS), the most common disease in this category .

Multiple sclerosis (MS) is a chronic disease characterized by inflammation, demyelination, gliosis (scarring), and neuronal loss; Lesions of MS typically occur at different times and in different CNS locations (i.e., disseminated in time and space) Etiology Who gets MS ? What are the types of MS ? What are the Symptoms of MS ? - Complete History & Neurological Clinical Ex. (detect the site & the type of the lesion)

- CSF (Increased gamma immunoglobulins IgG)

- MRI (Most Sensitive)

- Evoked potential (Visual & Somatosensory) What is Multiple Sclerosis ? What Causes MS ? While the cause (etiology) of MS is still unknown, scientists believe that a combination of several factors may be involved :


- Genetic

- Enviromental Thank you for listening
Presented by :
Dr. Fouad Maqboul . - In MS, the immune system attacks the CNS ( brain, spinal cord, and optic nerves ) .

- T-cells become sensitized to myelin and cross the blood-brain barrier into the CNS .

- T-cells not only injure myelin, but secrete chemicals that damage nerve fibers (axons) and recruit more damaging immune cells to the site of inflammation.

- Conduction block occurs when the nerve impulse is unable to traverse the demyelinated segment.

- Axons can adapt initially to these injuries; with time distal and retrograde degeneration often occurs. Pathogensis - Age : While most people are diagnosed between the ages of 20 and 50, MS can appear in young children and teens as well as much older adults.

- Sex : As an autoimmune disease, MS is significantly more common (at least 2-3 times) in women than men.

- Prevalence : Globally, the median estimated prevalence of multiple sclerosis is 30 per 100,000 of population.

- Geographical : MS is more common at northern latitudes that are farther from the equator and less common in areas closer to the equator.

- Ehinic : MS is more common in Caucasians of northern European ancestry . People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe Relapsing-Remitting MS (RRMS) Primary Progressive MS (PPMS) Secondary-Progressive MS (SPMS) Progressive-Relapsing MS (PRMS) The most common clinical variant of MS about 85% of patients with MS start with RRMS, characterized by recurrent acute exacerbations of neurologic dysfunction followed by partial or complete recovery (Periods between disease relapses are characterized by a lack of disease progression ) . PPMS is characterized by progression of disability from onset, without plateaus or remissions or with occasional plateaus and temporary minor improvements . A person with PPMS, by definition, does not experience acute attacks. Of people with MS are diagnosed, only 10% have PPMS. SPMS begins with an initial RRMS, followed by progression of disability that may include occasional relapses and minor remissions and plateaus .
Typically, SPMS is characterized by:
less recovery following attacks, persistently worsening functioning during and between attacks, fewer attacks (or none) accompanied by progressive disability.
Patients with RRMS , more than 50% will develop SPMS within 10 years; 90% within 25 years. PRMS, which is the least common disease course, shows progression of disability from onset but with clear acute relapses, with or without full recovery. Approximately 5% of people with MS appear to have PRMS at diagnosis. - Cognitive Dysfunction : Memory , Attention .

- Emotional Changes : Depression , Mood swings , Euphoria
- Visual disturbances : optic neuritis , Diplopia

- Speech disorders : Slurred speech , Staccato .

- Sensory Manifestations : Pain . Hypothesia (Numbness) , Parathesia , Sensory ataxia .

- Motor Manifestations : Hemiparesis , Paraparesis , Spaticity (UMNL) .
- Cerebellar disorders : Motor ataxia (Gait, Balance, & Coordination Problems)
- Dizziness and Vertigo

- Bladder & Bowel Dysfunction (Sphincteric disturbance) How To Diagnose MS ? Although there is still no cure for MS, effective strategies are available to modify the disease course, treat exacerbations , manage symptoms, improve function and safety, and provide emotional support. In combination, these treatments enhance the quality of life for people living with MS. Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:
* Interferons and Natalizumab
* Methotrexate, Azathioprine , Intravenous immunoglobulin and cyclophosphamide may also be used .

Medications used to treat exacerbations of MS :
* Pulse Steroid therapy (Methylpredinsolone 1 gm/D for 3-5 Ds) may be used to decrease the severity of attacks.

Medications to control symptoms may include:
* Medicines to reduce muscle spasms such as Baclofen or Benzodiazepine
* Cholinergic medications to reduce urinary problems (Anticholinestrase)
* Antidepressants for mood or behavior symptoms
* Amantadine for fatigue

Rehabilitations is to improve and maintain function as
Physical therapy, speech therapy, occupational therapy
and support groups Prognosis It is generally very difficult to predict the course of MS. While the disorder varies greatly from one individual to another, most people with MS have a normal life expectancy.
Mortality as a direct consequence of MS is uncommon, although it has been estimated that the 25-year survival is only 85% of expected.
Death can occur during an acute MS attack, although this isdistinctly rare.
More commonly, death occurs as a complication of MS (e.g., pneumonia in a debilitated individual). Death can also result from suicide How MS works ?
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