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Multiple Sclerosis

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by

Emma Masse

on 30 January 2015

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Transcript of Multiple Sclerosis

Multiple Sclerosis

Overview
Multiple Sclerosis is an autoimmune disease of the central nervous system characterized by a disruption in the flow of information from the brain to the body.
Myelin, the outer covering on nerve fibers, is attacked by T cells in the immune system and scar tissue called sclerosis is formed.

The damage to the nerve fibers impedes nerve impulses causing distortion in the messages being sent by the brain.
Physical Symptoms

Fatigue:
-affects 80% of patients and is usually the most prominent symptom
Numbness/ tingling
-

often the first symptom
Weakness
Walking difficulties-
related to weakness, loss of balance, and fatigue
Muscle spasms
-

most common in legs
Vision problems
- one of the first symptoms
Dizziness/Vertigo
Bladder problems
- affects 80% of patients
Sexual problems
Bowel problems
Pain
- 55% are affected by "clinically significant pain" and 50% have chronic pain

Symptoms
Diagnoses
&Treatment

Cognitive Symptoms
50% of MS patients experience changes in :
-ability to learn and remember information
-organize and solve problems
-focus attention
-perceive the environment
Emotional changes including:
depression
mood swings
irritability
uncontrollable laughter and crying
Clinical Depression is frequent in MS patients
Types of MS
Relapsing-Remitting MS (RRMS)
Most common form -85%
Flare ups
Most diagnoses in 20s and 30s
Woman are diagnosed 2 to 3 times as often as men

Secondary-progressive MS (SPMS)
Follows RRMS- 50% within 10 years, 90% within 25 years
Progresses steadily
First diagnoses for 10%
Primary-progressive MS (PPMS)
Progressive-relapsing MS (PRMS)
Steady worsening from beginning
Continuous
Men and women are diagnosed equally
Most diagnosed in 30s to 40s
Most related to walking
Least common - 5%
Steadily worsening with flare ups
Often misdiagnosed as PPMS
Overall...
Because MS can affect neurons in any part of the brain, any neural messages can be disrupted, giving symptoms an extremely wide range.
Less Common Symptoms
Speech Problems-
25-40%
Swallowing Problems
Tremor
Seizures-
2-5% (normal avg. 3%)
Breathing Problems
Itching
Headache
Hearing Loss
- 6%
Secondary and tertiary symptoms can appear as results of primary symptoms
Symptoms can change over time as the disease progresses
Symptoms vary person to person and can be very numerous or barely present.
Diagnosis
Currently, there are no laboratory tests or specific symptoms that can determine if a person has Multiple Sclerosis.
To be diagnosed with MS...
evidence must be found to prove that these areas of damage occurred at least one month apart
evidence of damage must be found in at least two different areas of the central nervous system
all other possible diagnoses must be ruled out
Blood tests are used to rule out other conditions.
A physician gives tests to evaluate:
Mental functioning
Emotional and language functioning
Movement and coordination
Balance
Vision
Hearing
Smell
Touch
Taste
Magnetic Resonance Imaging (MRI)

noninvasive
picture of brain
used in diagnosis and monitoring of MS
reveals myelin sheath damage in 95% of patients
Cerebrospinal Fluid (CSF)
Clear, colorless liquid that surrounds the brain and spinal chord
Provides protection and shock absorbtion, circulates nutrients, and removes waste
A "spinal tap" is used to remove the CSF from the lower spine
The CSF is examined for antibody and protein levels which reveal breakdown of myelin
5-10% of patients never show any abnormalities
Evoked Potentials (EP)
measures electrical activity in brain
records speed of electrical conduction of neural messages
can identify damage that is too subtle to be physically noticed or seen in an MRI
noninvasive
3 Types:
1.
Visual Evoked Potentials (VEP)
: The patient sits before a screen on which an alternating checkerboard pattern is displayed
3.
Sensory Evoked Potentials (SEP)
: Short electrical impulses are administered to an arm or leg
2.
Brainstem Auditory Evoked Potentials (BAEP)
: The patient hears a series of clicks in each ear
Normal
Normal
Multiple Sclerosis
Multiple Sclerosis
Conditions MS can be misdiagnosed as:
(cause damage to myelin)
-Viral infections
-Lyme disease
-Syphilis
-Brain tumor
-High exposure to toxins
-Severe vitamin B12 deficiency
-Inflamed blood vessels
-Rare hereditary disorders
Treatment
As of 2015, Multiple Sclerosis is defined as incurable. There is no treatment to stop or reverse the myelin damage, but some measures can be taken to lessen the effects. Because symptoms are so individualized, a universal cure will be very difficult to create.
Treatment for Symptoms
Physical Therapy
Muscle Relaxants
Medication for:
-fatigue
-pain
-depression
-bladder/bowel problems
Treatment for Flare ups
A flare up is defined as heightened symptoms lasting at least 24 hours and being separated from the last flare up by at least 30 days. They can last up to several months.
Relapsing-Remitting MS (RRMS)
Corticosteroids
Plasma Exchange

-reduce nerve inflammation

Treatment to slow Progression
Medication
Beta interferons
Glatiramer acetate
Dimethyl fumarate
Fingolimod
Teriflunomide
Natalizumab
Mitoxantrone*
Side Effects
:

-irritation
-flushing
-nausea
-high blood pressure
-low white blood cells
-blurred vision
-liver damage
-hair loss
-infections
-blood cancer*

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