This document provides information on multiple sclerosis (MS) including: - MS is a chronic, often disabling disease that attacks the central nervous system including the brain, spinal cord, and optic nerves. - Symptoms can range from mild numbness to severe paralysis or vision loss and vary between individuals unpredictably. - New treatments and research advances are providing hope for those affected by the disease.

1. CLAUDIA’S NOTES ON
MULTIPLE
SCLEROSIS
CLAUDIA CHANDLER, THE CHICAGO SCHOOL, 2014

2. • Multiple Sclerosis (MS) is a chronic, often
disabling disease that attacks the central
nervous system (CNS), which is made up of
the brain, spinal cord, and optic nerves.
• Symptoms may be mild, such as numbness
in the limbs, or severe, such as paralysis or
loss of vision.
• The progress, severity, and specific symptoms
of MS are unpredictable and vary from one
person to another. Today, new treatments and
advances in research are giving new hope to
people affected by the disease.
• Multiple Sclerosis (MS) is a chronic, often
disabling disease that attacks the central
nervous system (CNS), which is made up of
the brain, spinal cord, and optic nerves.
• Symptoms may be mild, such as numbness
in the limbs, or severe, such as paralysis or
loss of vision.
• The progress, severity, and specific symptoms
of MS are unpredictable and vary from one
person to another. Today, new treatments and
advances in research are giving new hope to
people affected by the disease.
The Invisible Side of
Multiple Sclerosis (MS)
Understanding and Treating Psychosocial Barriers
What is Multiple Sclerosis? (MS)

3. >Predominant age: 20-40
MULTIPLE SCLEROSIS AFFECT:
0.1%Worldwide incidence
Higher
incidence in
Northern
European
descent and in
temperate
climate, but the
latitude gradient
is decreasing
The ratio is
increasing
now
people in US
have MS
400, 000
1–3% risk of MS among 1st-degree relatives
worse
prognosis
Highly variable and unpredictable

5. Blood-brain barrier
breakdown
The BBB prevent entrance of T cells into the nervous system.
The blood–brain barrier is normally not permeable to these types
of cells, unless triggered by infection or a virus, which decreases
the integrity of the tight junctions.
When the blood–brain barrier regains its integrity, usually after
infection or virus has cleared, the T cells are trapped inside the
brain.
Autoimmunology The immune system attacks the nervous system, forming
plaques or lesions.
Commonly involves white matter.
Destroys oligodendrocytes- causing demyelination
Remyelination occurs in early phase but not completely.
Repeated attacks lead to fewer remyelination.
Inflammation T-cells attacks on myelin triggers inflammatory processes,
stimulating other immune cells and soluble factors like cytokines
and antibodies.
Leaks form in the BBB cause swelling, activation of
macrophages, and more activation of cytokines and other
destructive proteins
Pathophysiology

6. The most common initial symptoms
•changes in sensation in the arms, legs or face
(33%)
•Optic neuritis (20%)
•weakness (13%)
•double vision- internuclear opthalmoplegia (7%)
•unsteadiness when walking (5%)
•and balance problems (3%)
Lhermitte's sign (25-40%) is an electrical sensation
that runs down the back and into the limbs and is
produced by bending the neck forwards. The sign
suggests a lesion of the dorsal columns of the cervical
cord or of the caudal medulla.
Uhthoff's phenomenon is the worsening of neurologic
symptoms in multiple sclerosis and other neurological,
demyelinating conditions when the body gets overheated
from hot weather, exercise, fever, or saunas and hot
tubs.

7. Disconnect
Medical vs. Psychosocial
Disconnect
Medical vs. Psychosocial
Overwhelmed with diagnosis
- Overloaded by amount of
information they are given
- Depression due to isolation and
mounting losses
- Fear and uncertainty about the
future
- Loss of roles: parent, spouse,
worker, active member of society
- Concern about financial issues
- Difficulty with activities of daily

8. ““
“The quality of life in
patients with MS is not solely
determined by physical
disability, but rather by the
level of social support, living area,
depression, level of education,
employment, fatigue and religiosity…
we suggest that these should be
evaluated in every patient with MS
as they may be modified by
targeted interventions.”
(Yamout et al, 2013)

11. Bring on the
Healthcare Extenders!
(The treatment team)
Awesome!