Here is very good and amazing presentation on Multiple sclerosis ..its about brain read this carefully and work on this because the work on brain is very good for future research...

4. OBJECTIVE
• To educate the people about Multiple
sclerosis.
• To aware the people how to prevent and
control MS.

5. Contents…
• Brief Overview of disease condition
• What is MS
• Introduction of MS
• Who Can Get Multiple Sclerosis?
• History of MS
• Epidemiology and world wide distribution
• Pathophysiology
• Types of MS
• Signs and Symptoms
• Factors causing Disease
• Diagnosis
• Treatments
• Conclusion

6. Overview
• MS is predominantly a matter disease and a
neurodegenreative disorder of the central
nervous system that includes the brain, spinal
cord and nerves.

7. What Is Multiple Sclerosis?
• The body's immune system attacks its own central
nervous system (CNS). With MS, the immune system
attacks and damages or destroys the myelin, causing
a distortion in nerve impulses traveling to and from
the brain. This results in a wide variety of
symptoms.Multiple sclerosis (MS) is an autoimmune
disease

8. Multiple Sclerosis - Introduction
• It is an inflammatory and demyelinating
disease.
• Inflammation: body’s own immune cells attack
the nervous system.
• Demyelination: myelin is destroyed leaving
multiple areas of scar tissue or sclerosis.
• It is progressive disease
• Most common age of occurrence – between
20 and 40

9. Who Can Get Multiple Sclerosis?
• Multiple sclerosis is estimated to affect 2.3
million people worldwide. Most people are
diagnosed between the ages of 20 to 50,
though it can also occur in young children and
the elderly.
• It is three times more common in women than
in men, and is more prevalent among
Caucasians than other ethnicities.

10. History of Multiple Sclerosis
• The earliest description of MS was
recorded in Holland on August 4, 1421 but
the history of the disease really begins in
the 19th century with the first clear
illustrations and clinical description of the
disease beginning to appear in 1838”.
• The first actual case was diagnosed in
1849. It was Dr.Jean-Martin Charcot who
is credited with giving us the first signs
and symptoms of Multiple Sclerosis. Ref :
(Barnes, David. Multiple Sclerosis Questions and Answers, Merit
Publishing International, Florida, 2000).

11. Multiple Sclerosis - Epidemiology
• Worldwide occurrence:1.1 – 2.5 million cases
• “The disease affects 400 people a year in pakistan, but
as our diagnostic facilities have improved this ratio
could be more.
• Over 350,000 people have MS in the US.
• approximately 100,000 people live with multiple
sclerosis in the UK.
• MS in women is 2-3 times more prevalent than in
men.
• It is not contagious
• In Canada an estimated that 55,000-75,000 people
have multiple sclerosis

12. Pathophysiology
• Autoimmune response results in damage and lost fibers.
• Nerves can regain myelin, but process is not fast enough to
avoid the deterioration that occurs .
• Astrocytes form scars where myelin formerly existed.
• Inflammation, loss of myelin, and nerve fibers, and the
scarring that follows result in reduced transmission of nerve
signals within the CNS.
• Types of symptoms and severity vary widely due to the
location of the scar tissue and extent of demyelination.

13. World Distribution of MS

14. Multiple Sclerosis - Types
There are 4 types of MS
• Relapsing-remitting MS (RR-MS)
• Primary-progressive MS (PP-MS)
• Progressive-relapsing MS (PR-MS)
• Secondary-progressive MS (SP-MS)

15. Relapsing-remitting MS (RR-MS)
• More than 80% of the cases
• Defined clinical exacerbation of neurological
symptoms
• Followed by complete or incomplete
remission during which the person fully or
partially recovers from the deficits acquired
during relapse.

16. Primary-progressive MS (PP-MS)
• 10 to 20% of individuals with MS are
diagnosed with PP-MS
• Gradual progression of the disease from its
onset.
• No overlapping relapses and remissions .

17. Progressive-relapsing MS (PR-MS)
• Rare
• Initially presenting as PP-MS however, during
the course of the disease the individuals
develop true neurologic exacerbations
• Steady progression of clinical neurological
damage with superimposed relapses and
remissions.

18. Secondary Progressive MS (SP-MS)
• SP-MS is characterized by a steady progression
of neurological damage with or without
superimposed relapses and minor remissions
• Individuals with SP-MS will have experienced a
period of RR-MS, which may have lasted from
2 to 40 years
• Any super-imposed relapses and remissions
fade over time.

19. What Are the Symptoms of Multiple
Sclerosis?
• Symptoms of multiple sclerosis may be single or
multiple and may range from mild to severe in
intensity and short to long in duration. These
include:
• Fatigue
• Numbness or tingling
• Weakness
• Dizziness or vertigo
• Sexual dysfunction

20. •Pain
•Emotional instability
•Difficulty walking
•Muscle spasms
•Vision problems
•Bladder or bowel problems
•Cognitive changes
•Depression

21. What Causes Multiple Sclerosis?
• The exact cause of multiple sclerosis is
unknown, but it is believed to be any
combination of immunologic, environmental,
infectious, or genetic factors. Researchers are
examining the possible role of viruses in the
cause of MS, but this is still unproven.

22. Mode of Action
• The immune system attacks axons, causing destruction
of the myelin sheath resulting in a Conduction Block
which leads to permanent loss of function.

23. How Does it work?
The destruction of the myelin sheath leads to
impaired communication between nerve cells and
neurological symptoms such as abnormal sensations,
vision problems , and weakness

24. Factors Contributing for MS
Genetic Factors
• Gender: Women are 2 to 3 times more likely to get the
disease.
• Family history of MS: A family history increases the risk
of developing MS
• Race: MS appears more commonly in Caucasians than
in groups

25. Environmental factors
• The evidence is also growing
that smoking causes MS.
• Growing evidence suggests that vitamin
D plays an important role. High level of
Vitamin D decrease the causes of MS.

26. Infectious Factors
• Since initial exposure to numerous
viruses, bacteria and other microbes occurs
during childhood, and since viruses are well-
recognized as causes of demyelination and
inflammation, it is possible that a virus or
other infectious agent is the triggering factor
in MS.
• Epstein-Barr, and Chlamydia pneumonia are
involved in the development of MS.

27. How Is Multiple Sclerosis Diagnosed?
• Multiple sclerosis is often difficult to diagnose as
symptoms are so varied and can resemble other
diseases. It is often diagnosed by a process of
exclusion – that is, by ruling out other neurological
diseases – so the diagnosis of MS may take months
to years. A physician will do a complete history and
neurological exam, along with tests to evaluate
mental, emotional and language functions, strength,
coordination, balance, reflexes, gait, and vision.

28. How Is Multiple Sclerosis Diagnosed?
• Cerebrospinal fluid exam (spinal tap, lumbar
puncture)
• Evoked potential (EP) tests
• Optical coherence tomography (OCT)
• Blood tests
• Tests to help confirm the diagnosis of MS include:
• MRI
• Electrophysiological test

29. Diagnosis
General Physical Examination
Dawson's Fingers appearing on an MRI scan.

30. Multiple Sclerosis - Diagnosis
• MS is a clinical diagnosis.
• It is diagnosed by neurological examination
and brain MRI scans. Family history and
lumber puncture are also used for diagnosis.
• If MS is present, very high percentage of
protein IgG (oligoclonal antibody) bands can
be seen in spinal fluid which is an additional
confirmatory test. IgG banding is seen in other
diseases as well such as, Syphilis.

31. Treatment of Multiple Sclerosis
• Although no cure exists for MS, treatment aims to reduce
the number of relapses or attacks and to lessen their
severity when they do occur.
• Medications
• Chemotherapy
• MRI devoted to neurological imaging: using three-
dimensional imaging that determines whether a patient's
condition is worsening.

32. Multiple Sclerosis Treatment
• Treatment for multiple sclerosis may include
drugs to manage attacks, symptoms, or both.
• Many medications carry the risk of some side
effects so patients need to manage their
treatment with their doctors.
• Corticosteroids are drugs that reduce
inflammation in the body and affect the function
of the immune system. They are often used to
manage MS attacks, but can have numerous side
effects.

33. Interferon use in MS
• Discovered in 1957
• A protein substance naturally produced in the body and
believed to function to modulate the immune system where
one infection with one virus interferes with a subsequent
infection with another virus.
• Interferon's interact with receptors on non-infected cells to
promote the synthesis of antiviral proteins that prevent
further infection. They belong to Cytokines, which are
hormones of the immune system
• Significant antiviral agents

34. Current Treatments
0
50
100
Avonex
Rebif
Betaseron
•Avonex altered long-term course of MS in patients who began treatment
immediately after initial attack
•35% decrease in the rate of developing second attack
•42% reduction in new or enlarging T2 hyper intense lesions

35. Multiple Sclerosis Treatment
Medications
• There are currently 10 medications approved
for disease modification:
• Interferons for relapsing multiple sclerosis:
• Interferon beta-1b (Betaseron and Extavia)
• Interferon beta-1a (Rebif)
• Interferon beta-1a (Avonex)

36. Other medications approved for
relapsing multiple sclerosis
• Glatiramer acetate (Copaxone)
• Natalizumab (Tysabri)
• Mitoxantrone (Novantrone)
• Fingolimod (Gilenya)
• Teriflunomide (Aubagio)
• Dimethyl fumarate (Tecfidera)

37. Medications used for MS
• Spasticity (involuntary muscle spasms) - Baclofen,
Tizanidine, Diazepam, Dantrolene
• Optic Neuritis- Methlyprednisolone, Oral steroids
• Fatigue- Antidepressant, Amantadine
• Pain- Codeine, Aspirin
• Sexual Dysfunction- Viagra, Pravatine
• Tremor- Isoniazid, Primidone, Propranolol
• Disease-Modifying Drugs- Interferon beta 1a and 1b,
and Glatiramer acetate

38. Conclusion
World wide 2.5 million people live with MS.
• MRI as an out come of MS trials - widely used in trials
of relapsing-remitting and progressive multiple sclerosis
add little if anything independently to the clinically
relevant relapse and disability outcomes
• Disability as outcome of MS Trials
• Online tool for individual for easy assessment for
non commercial purpose -Prognosis of the individual
course of disease
• Microarray-based classification and clinical
predictors - in MS research e.g. to identify genes that
are differentially expressed depending on the disease
course or to refine the prediction of patient outcome.
• Launch of website- for treatment guidelines and
available treatments

39. Conclusion (vitamin D)
• Based on the findings from both studies, vitamin D
deficiency is significantly common in patients with
MS.
• MS is also more prevalent in environments where
vitamin D level are lowered either by lack of sunlight
or dietary intake.
• This deficiency among MS patients can be reduced
by providing them with vitamin D supplements

41. ARE THERE ANY
QUESTIONS?

42. CLAP ……