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Multiple Sclerosis[1]

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Multiple Sclerosis[1]

  1. 1. <ul><li>Lena Horne </li></ul><ul><li>Richard Pryor </li></ul>
  2. 2. <ul><li>Montel Williams </li></ul><ul><li>Clay Walker </li></ul>
  3. 3. <ul><li>What do all of these celebrities have in common? </li></ul><ul><li>They all have Multiple Sclerosis </li></ul>
  4. 4. Multiple Sclerosis Peter Valenzuela, MD, MBA Assistant Dean for Clinical Affairs/Assistant Professor Texas Tech University Health Sciences Center at the Permian Basin
  5. 5. Overview <ul><li>Description including prevalence and possible causes </li></ul><ul><li>Signs and Symptoms </li></ul><ul><li>Diagnosis including differential </li></ul><ul><li>Treatment </li></ul>
  6. 6. Incidence/Prevalence <ul><li>Affects 400,000 Americans; 2.5 million people worldwide </li></ul><ul><li>2-3 times more common in Caucasian women </li></ul><ul><li>Most often in people between 20-50 years old </li></ul><ul><li>Greater frequency in higher latitudes (above 40 degrees) </li></ul>
  7. 7. Description <ul><li>Myelin-covers axons and improves conduction between neurons </li></ul><ul><li>Auto-immune destruction of myelin results in scarring or sclerosis </li></ul><ul><li>Symptoms depend on location of myelin destroyed </li></ul>
  8. 8. Cause/Risk Factors <ul><li>Cause- Unknown, immune-mediated </li></ul><ul><li>Genetics? </li></ul><ul><ul><li>Northern European descent </li></ul></ul><ul><ul><li>Higher incidence in direct relatives </li></ul></ul><ul><li>Infection? </li></ul><ul><ul><li>Chlamydia pneumoniae, HSV, EBV </li></ul></ul>
  9. 9. Cause/Risk Factors <ul><li>Geographic location? </li></ul><ul><ul><li>40 degrees latitude above equator </li></ul></ul><ul><ul><li>Risk level varies with length of time spent in area </li></ul></ul>
  10. 10. Cause/Risk Factors <ul><li>Hormones </li></ul><ul><ul><li>More common in women </li></ul></ul><ul><li>Exposure </li></ul><ul><ul><li>Clusters- Lead, Arsenic, Zinc </li></ul></ul>
  11. 11. Signs and Symptoms <ul><li>Neuro: </li></ul><ul><ul><li>Paralysis, altered sensation </li></ul></ul><ul><ul><li>Tremors, poor coordination </li></ul></ul><ul><ul><li>Visual loss, optic neuritis </li></ul></ul><ul><li>Musculo-skeletal: </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Spasticity </li></ul></ul>
  12. 12. Signs and Symptoms <ul><li>GI: </li></ul><ul><ul><li>Constipation </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Incontinence </li></ul></ul><ul><li>Gu: </li></ul><ul><ul><li>Urgency </li></ul></ul><ul><ul><li>Hesitancy </li></ul></ul><ul><ul><li>Incontinence </li></ul></ul>
  13. 13. Signs and Symptoms <ul><li>Cognitive and Emotional </li></ul><ul><ul><li>Poor memory </li></ul></ul><ul><ul><li>Delayed processing </li></ul></ul><ul><ul><li>Depression- 50% of patients </li></ul></ul><ul><li>Sexual Dysfunction </li></ul><ul><ul><li>Impaired libido </li></ul></ul><ul><ul><li>Sexual inadequacy </li></ul></ul><ul><ul><li>Sexual dysfunction </li></ul></ul>
  14. 14. Differential Diagnosis <ul><li>Auto-immune </li></ul><ul><ul><li>Polyarteritis Nodosa, Systemic Lupus </li></ul></ul><ul><ul><li>Sjögren's, Sarcoidosis </li></ul></ul><ul><li>Infection </li></ul><ul><ul><li>Lyme Disease, Neurosyphilis </li></ul></ul><ul><ul><li>HIV, JC Virus-Progressive Multifocal leuko-encephalopathy </li></ul></ul>
  15. 15. Differential Diagnosis <ul><li>Genetic Disorders </li></ul><ul><ul><li>Leukodystrophy, Mitochondrial disease </li></ul></ul><ul><li>Compressive Disorders </li></ul><ul><ul><li>Tumor, Herniated disc, Chiari malformation </li></ul></ul><ul><li>B12 Deficiency </li></ul>
  16. 16. Diagnosis <ul><li>MRI: </li></ul><ul><ul><li>Multiple white matter lesions (plaques) in different areas of CNS at different points in time </li></ul></ul>
  17. 17. Diagnosis <ul><li>CSF Analysis </li></ul><ul><ul><li>Oligoclonal bands by electrophoresis </li></ul></ul><ul><ul><li>high IgG levels </li></ul></ul><ul><ul><li>Increased WBCs (>5 cells/µL) </li></ul></ul><ul><li>Evoked Potentials </li></ul><ul><ul><li>VER, BAER, SER </li></ul></ul><ul><ul><li>VER is most sensitive </li></ul></ul>
  18. 18. Diagnostic Criteria for MS <ul><li>Clinical Presentation </li></ul><ul><li>Additional Data </li></ul><ul><li>McDonald’s Criteria </li></ul>
  19. 19. Course/Prognosis <ul><li>Benign: 10% </li></ul><ul><li>Relapsing-Remitting: 40% </li></ul><ul><li>Secondary Chronic Progressive: 40% </li></ul><ul><li>Primary Progressive: 10% </li></ul>
  20. 20. Treatment <ul><li>Immune modulators </li></ul><ul><ul><li>Avonex, Betaseron, Copaxone, Rebif </li></ul></ul><ul><li>Anti-spastic drugs </li></ul><ul><ul><li>Stretching & Exercise (Yoga, PT) </li></ul></ul><ul><ul><li>Lioresal, Neurontin, Zanaflex </li></ul></ul><ul><li>Dysesthesias </li></ul><ul><ul><li>Dilantin, Elavil, Neurontin, Tegretol </li></ul></ul>
  21. 21. Treatment <ul><li>Bladder and Urine </li></ul><ul><ul><li>Ditropan, Detrol, Cardura </li></ul></ul><ul><ul><li>Self-catheterization </li></ul></ul><ul><li>Tremor </li></ul><ul><ul><li>INH, Neurontin, Inderal, Xanax </li></ul></ul><ul><li>Fatigue/Depression </li></ul><ul><ul><li>Eldepryl, Symmetrel, Provigil </li></ul></ul><ul><ul><li>Prozac, Paxil </li></ul></ul>
  22. 22. Treatment for Relapses <ul><li>Treat source of exacerbation </li></ul><ul><ul><li>Sinusitis, bronchitis, UTI </li></ul></ul><ul><li>Steroids </li></ul>
  23. 23. Annual Cost for Medications <ul><li>Immune Modulators- $18,000 </li></ul><ul><li>Anti-spastics- $1,700 </li></ul><ul><li>Dysesthesia- $2,600 </li></ul><ul><li>Tremor- $1,200 </li></ul>
  24. 24. Annual Cost for Medications <ul><li>Fatigue- $3,100 </li></ul><ul><li>Depression- $300 </li></ul><ul><li>Bladder and Urine- $2,160 </li></ul>
  25. 25. Total Annual Cost for Medications Could Reach over $30,000!
  26. 26. Summary <ul><li>Description including prevalence and possible causes </li></ul><ul><li>Signs and Symptoms </li></ul><ul><li>Diagnosis including differential </li></ul><ul><li>Treatment </li></ul>
  27. 27. Questions?
  28. 28. References <ul><li>Calabresi P. Diagnosis and Management of Multiple Sclerosis. American Family Physician 2004; Vol. 70:10, 1935-43. </li></ul><ul><li>Dynamed website (Accessed October 2, 2006) </li></ul><ul><li>National Multiple Sclerosis Society at www.nationalmssociety.org (Accessed October 2, 2006) </li></ul><ul><li>www.jsumption.com (Acessed October 3, 2006) </li></ul>
  29. 29. References <ul><li>www.msfocus.org (Accessed October 4, 2006) </li></ul><ul><li>http://www-medlib.med.utah.edu / (Accessed October 6, 2006) </li></ul><ul><li>Epocrates database (Accessed October 10, 2006 </li></ul><ul><li>http://www.mult-sclerosis.org/famous.html </li></ul>

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