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Multiple SclerosisA Disease of “Many Scars” By Aaron Speller and Linda Roybal
Definition of MS:• A demyelinating disorder of the CNS in which the myelin sheaths are gradually destroyed.• Autoimmune disease: The person’s own immune system attacks the myelin.
What is Multiple Sclerosis?• The myelin sheaths in the brain and spinal cord (CNS) are damaged.• The immune system produces antibodies that attack the oligodendrocytes• Oligodendrocytes are the cells that “wrap” the myelin sheaths around the axons• This creates “plaques” or lesions in the white matter• Damage to the myelin and to the neurons/axons underneath prevent communication between the brain and spinal cord• (Lundy-Ekman, 2007)• (photo courtesy of acceleratedcure.org) 3
• When the myelin tissue is damaged, scar tissue is left behind. This scar tissue is called sclerosis.• Because scar tissue happens in multiple areas in the CNS, it is called “Multiple sclerosis”
What is going on neurologically?• Myelin can be compared to the insulating material wrapped around a wire. Myelin is the protective covering of nerve fibers in the Central Nervous System• When the myelin is damaged, it affects the nerve fibers• Nerve impulses/messages in the brain, spinal cord, and optical nerve areas become jumbled• (photo courtesy of www.everydayhealth.com)
Who discovered Multiple Sclerosis?• A French neurologist named Jean-Martin Charcot in 1868• A female patient of his suffered an unusual combination of symptoms• He tried some of the typical treatments for other neurological disorders, such as electrical stimulation and injections of silver (which helped alleviate the symptoms of syphilis), but none of them worked.• After his patient died, he dissected her brain and discovered the brain lesions. He called the disease sclerose en plaques.
Etiology• No known exact cause• Theories:• Research is finding multiple genes that may leave a person predisposed to MS• There are geographical theories (the further north/away from the equator may increase the risk)• Other research studies are focusing on Vitamin D deficiency and viruses (ex: Epstein Barr)• Environmental triggers• Blood Brain Barrier 5
Who does MS affect?• 2-3 times more women than men• Common onset is between the ages of 20- 40• Approximately 400,000 people in the US• 7000 new cases reported each year• It is not a “catchy” disease• Symptoms vary from person to person• Progressive disease, but some may have periods of remission
What are the symptoms? • Some symptoms may be mild and some severe..varies for each person • Common symptoms:blurred vision, loss of balance, extreme fatigue, poorcoordination, slurredspeech, tremors, numbness, memory/concentrationproblems, incontinence, sexual dysfunctionMS patients unable to tolerate heatOther symptoms:Severe face painBurning pain in limbsSpasticity
How is it diagnosed?• There is no specific lab test• Diagnosis begins with onset of symptoms• Detailed neurological exam/reflex testing• Blood test• Spinal Tap (to look for proteins associated with MS)• Diagnosis is difficult and may take years due to symptoms coming and going• Other illnesses need to be ruled out• Symptoms are different for each person depending on where the damage is located in the CNS• Example: Lesions on the cerebellum will affect the person’s coordination of movement/ “drunk” walk
MRI Technology• MRI is the technology used to help diagnose• 1981 MRIs were just starting to be done• In 1970, the average time to diagnose a person from their first onset of symptoms was 7 years; by using MRIs, that decreased the time to 6 months• MRIs can show the lesions that cause the symptoms• MRIs are used to track the brain as new drugs are being tested
Other MRI findings...• MRIs also show that patients with MS have a more permeable Blood Brain Barrier (makes the myelin more vulnerable) 8
Broken down to 4 types based on severity of symptoms:• Relapsing-remitting (most common 85%)• Primary-progressive• Secondary-progressive• Progressive-relapse (rare 5%)• Diagnosis is difficult (one symptom may resolve itself)• May take several years to diagnose
How is MS treated?• There are medications to help with the slowing of progressing symptoms• Some meds work by destroying the immune cells that regulate the MS attacks• Medical Marijuana (relaxant for spasticity/pain)• CCSVI (venous malformation)• ABC medications(Avonex, Betaferon, Copaxone)• Meds are being used to: o treat spasticity (high/low tone) o bladder/bowel management o fatigue o severe face pain o burning pains in limbs
...treatment (cont.)• Avoid heat which brings on exacerbations (acute attacks)• Avoid excessive exertion to prevent further fatigue• Occupational and Physical Therapy to maintain or increase function and to aid with splinting/casting for spasticity• Aids such as walkers, canes, foot braces• Diet/exercise (yoga)• http://www.msactivesource.com/ms-yoga.xml
What does it look like?• Most live functionable lives• Some may need the assistance of a walker, cane, w/c due to paralysis or extreme fatigue or imbalance• Some have cognition, or speech problems• Depression is common
Is it fatal?• Most people live a normal life span, but it can depend on the severity of the symptoms
Case Study #1• 35 year old male• Began to have sudden loss of vision in left eye• Visited an optician• Diagnosis was an age related retinal problem• Decided to see an Ophthalmologist• Was diagnosed with optical neuritis and was told he should be checked for MS
Case study #1 cont.• He made an appointment to see a neurologist• Part of the process was a Lumbar Puncture (spinal tap)• Resulted in abnormal cells and diagnosed with MS (remitting/relapsing type)• This was over a period of 10 months since his first symptom• Over the course of three years he took Methyl-Prednisolone(an IV treatment over three days)• For 8 years his symptoms came and went• Then he was diagnosed with Trigeminal Neuralgia (extreme pain in the face and jaw)...hard to chew, smile, eat• Was treated with nerve blocks to help with the pain• He was in the secondary progressive stage• He had lack of bladder/bowel control/extreme fatigue• Within ten years of his first symptom, he had to quit his job• He states that living with MS is a daily battle
Case Study #2• 48 year old mother of two• In 1997 she had numbness and tingling in her left foot• Over the course of a week the numbness spread to her left side• Lost balance/tripping• Her doctor referred her to Neurologist• MRI scan showed MS lesions• In 1992 she remembers previously having episodes of tingling in her hands and feet and had sought out natural remedies for symptoms of fatigue. Those symptoms went away until 1997 (five years later)• With her diagnosis of MS in 1997 she was placed on cortisone tablets and was started on interferon injections to slow progression• She had initial side effects from the medication such as redness and swelling at the injection site, tremors and nausea and she had pain in her legs at night.• She eventually changed to a low fat diet and began exercising• She had to stop working because the stress brought on attacks
Case Study # 2 (cont.)• She still has tingling and pain in her legs• She sees her neurologist twice a year and does blood testing throughout the year• She takes medication and self injections everyday• She states that although she is in constant pain, diet and exercise greatly helped to improve the quality of her life
ReferencesAtchison, B.J. (2007). Conditions in Occupational Therapy. Philadelphia, PA: Lippincott Williams & Wilkins.Australian Multiple Sclerosis Society (2002). Multiple Sclerosis: A Patients Perspective. AustralianPrescriber, 25, 2.Lindy-Ekman, L. (2007). Neuroscience Fundamentals for Rehabilitation. St. Louis, MI.: Saunders.Minegar, A., Alexander, J.S. (2003). Blood-brain Barrier Disruption in Multiple Sclerosis. Multiple Sclerosis Journal, 9, 540-549. doi:10.1191/1352458503ms965oaNational Multiple Sclerosis Society. The History of MS [Brochure]. Retrieved from http://msnationalsociety.org. Web.pdf.Watters, T. (1988, January 18). Joolys Joint: MS A Patients Perspective. [Web log post]. Retrieved from http://mswebpals.org