5. Nystagmus – Involuntary Mov't of
eyes,fast (may be: side-side, up-
down, rotary)
*Termed as “sclerosis in plaques”
6. Epidemiology
Ratio of 2:1, > in women
Affects white population
Areas of frequencies:
High - N. US & Europe, S.
Canada & AUS, New Zealand
-rates of 30-80 /100k pop.
Medium - S. US & Europe, rest of
AUS
-rates of 10-25 / 100k pop.
7. Low – Tropical Area,ASIA, Africa
& S. America
- rates <5 / 100k pop.
8. Etiology
Precise theory is Unknown
Widely accepted theory:
autoimmune dse. Induced by
viral/other infectious agents (33%).
In particular, herpes V. - I (oral),II
(genital),IV & chlamydial
pneumonia
> young adults bet. 20 – 40
9. f/hx st
– 15% (1 degree relative)
3-5 % fraternal co-twinm, but rises
to 26% for identical co-twin.
10. Pathophysiology
Immune response triggers the
prod. Of T – lymphocytes,
macrophages, and antibodies
(IgG).
Antigen is activated producing
autoimmune cytotoxic effects w/in
the CNS.
11. BBB fails & myelin synthesized T-
lymphocytes enter & attack the
myelin sheath surrounding the
nerves.
Eventually oligodendrocytes
becomes involved.
12. Demyelinated areas eventually
become filled w/ fibrous astrocytes
and undergo gliosis.
Axonal loss varies from 10-20%
(milder forms), and as much as
80%(severe)
Primarily affects white matter early,
w/ lesions of gray matter in
advance cases.
13. Main patterns of disease progression
are recognized:
RELAPSING AND REMITTING MS
– lesion often occurs in diff. parts of
the CNS at diff. times
SECONDARY PROGRESSIVE MS
– char. by initial RRMS course,
followed by progression at a
variable rate that may also include
occasional relapses & minor
remissions.
14. PRIMARY PROGRESSIVE MS –
in w/c there is little or no recovery
from relapse. With a cumulative
disability
PROGRESSIVE – RELAPSING –
char. by progressive dse. From
onset but w/o clear acute relapses
that may that may or may not have
some recovery ; commonly seen in
people who develop the dse. After
40 yrs. Of age.
15. Benign MS
- fully funct'l in all neurological
system 15 yrs. After onset.
- affects 20% of cases
Malignant MS (Marburg Variant)
- rare dse. Course, char. by rapid
onset & almost continual
progression leading to significant
disability / death w/ short time after
onset.
16. Exacerbating factors
Viral/bacterial infections (cold, UTI)
Dse. of major organs-hepa,asthma
Stress (major - divorce, death,
minor- exhaustion,dehydration)
Pseudoexacerbation
*sx/s tend to get worse with heat (eg.
In the bath or during hot weather) –
Uthoff's phenomenon
17. Differential Dx.
Investigations
no diagnostic test but the clinical suspicion
is suported by the ff. Three tests:
MRI
CSF
Evoked Potentials
- visual evoked potentials (VEP's)
- Somatosensory Evoked Potentials
(SSEPs)
- Brainstem Auditory Evoked Potentials
(BAEPs)
20. prognosis
74 % survives after 25 of onset of
symtoms.
Minority are still in the workforce
after 10 yrs. Onset.
15 yrs. – 50% uses asst. devices
20 yrs. - 50% requires w/c
21. Prognostic Factors
Symptoms
Course of dse.
Age-younger > 40 yrs. old
Neurological findingd at 5 years
MRI findings
22. Medical Mx.
Dse. Modifying agents
- interferons (interferon beta – 1b,
inteferon beta 1a)
-reduce relapse by about 30 %
Glatiramer acetate & novatrone
-clogs T – cell receptors.
Limited lifetime dose to prevent
heart problems.
23. Mx. of Relapse & symptoms
Corticosteroid therapy – treat acute disease
relapse,shortening duration of episodes.
- 1000 mg/day, IV (3-5 days) followed by
dosage of oral medication over a period of
10 days,5-6 weeks
ACTH- long term supression of the immune
system, alone/with steriods
25. Clinical manifestation of inactivity
Psychosocial – anxiety/depression
Neuromuscular – dec. sensory input,
motor control, poor coordination
Renal – inc. urinary infections, renal calculi
Cardiovascular – inc. HR,
thrombophlebitis, OHPN
Integumentary – skin atrophy,decubiti
Respiratory – inc. resp. infection
Digestive – anorexia, constipation
Musculoskeletal- osteoporosis, atrophy
26. Preventive intervention
includes:
-Primary prevention
-Secondary prevention
-Tertiary prevention
Compensatory inervention
Maintetnance Therapy – series of
occassional ,clinical, educational and
admiinistrative services defined to maintain
the Px's current level of function.
29. Standardized tests & measures
Expanded Disability Status Scale (EDSS)
(Kurtyze, 1955)
Minimum Record of Disability (MRD) (Int'l.
Federation of MS Soceities, 1985)
Modified Fatigue Impact Scale (Fisk et.
al.,1994)
MS Functional Composite (MSFC)
MS Quality of Life – 54
MS Quality of Life inventory (MSQLI)
Functional Exam. Of the MS (FAMS)
Multiple Sclerosis Impact Scale (MSIS-29)
30. Goals & outcomes
Impact of pathology/pathophysiology is
reduced
Impact of impairment is reduced
Improved ability to perform physical
actions, tasks, activities
Reduced disability assoc w/ chronic illness
Improved health status & quality of life
Enhanced px./client satisfaction
32. PT Interventions
Mx. of Sensory Deficits & Skin
Care
Mx. of Pain
Exercise Training
33. strength and conditioning
Prescription based on four
interralated elements:
-Freq. Of exercise
-Intensity of exercise
-Type of exercise
-Time/Duration
34. Guidelines
Exerise session should be
alternate (non endurance).optimal
time such as morning.
Submaximal exercise (moderate
intensities 50 – 70% MVC)well
tolerated,maximal(not)
Resistance training modes
Circuit training
Balance exercise w/ rest periods
44. Examples
half-lying:hip & knee flexion &
extension each limb, foot flat on
mat
Sitting: alternate foot placing to a
specified target (floor markings)
Standing: up & down to a specified
count
Walking: sideways or forward to a
specified count (floor marking)
