Multiple Sclerosis
What is Multiple Sclerosis?
 It is an Auto Immune Disease which is when the body
starts to destroy itself.
 It is a life-long disease with no cure.
 In MS, the body attacks and destroys the fatty tissue called
myelin that insulates an axon/nerve, and is called
demyelination.
 If damage is severe it can also destroy the nerve/axon
itself.
 MS affects the central nervous system and inflames the
white matter in the brain which creates plaques.
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What is Multiple Sclerosis?
• Multiple Sclerosis (MS) is an chronic
inflammatory demyelinating disease of the
brain and spinal cord.
The Human Nervous System
• Areas affected by MS
– Brain
– Spinal cord
– Optic nerves
(http://web.lemoyne.edu/~hevern/psy340/lectures/psy340.04.2.ns.structure.html)
MS is a Demyelinating Disease
Blood vessel
Blood vessel
Inflammation
Myelin – provides
insulation to nerve
processes (axons)
Inflammation
Blood vessel
Inflammation
How Common is MS and Who Gets It?
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8,000 – 10,000 new cases are diagnosed annually
Affects nearly 500,000 individuals in the U.S.
Occurs most frequently between ages 25 - 35
Female: male ratio = 2:1
More frequent in populations native to areas
further away from the equator
What Causes MS?
• Genetics
• Environmental factors
Family Studies
Up to 19% of patients have an affected relative
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Monozygotic (identical) twins
Dizygotic (non-identical) twins
Child of parent with MS
Sibling of person with MS
25 – 30%
3 – 4.5%
1.9%
0.9%
Groups for Which MS Genetic Traits
Have Been Identified:
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Japanese
African American
Mexican
Arabian
Sardinian (Italy)
Swedish
Norwegian
French Canadian
Finnish
Not Everyone with a Genetic Risk
Will Develop MS – Why?
• Risk is modified by Environmental
factors
– Sunlight
– Diet (e.g., vitamin D)
– Other lifetime experiences (infections?)
Symptoms of MS
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Fatigue
Depression
Memory change
Pain
Spasticity
Vertigo
Tremor
Double Vision/Vision
Loss
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Weakness
Dizziness/Unsteadiness
Numbness/Tingling
Ataxia
Euphoria a feeling or state
of intense excitement and
happiness
• Speech disturbance
• Bladder/Bowel/Sexual
dysfunction
Multiple Sclerosis Clinical Subtypes
Secondary-progressive
Disability
Disability
Relapsing-remitting
Time
Progressive-relapsing
Disability
Disability
Primary-progressive
Time
Time
Time
How Is MS Diagnosed?
• At least two episodes of symptoms
– Occur at different points in time
– Result from involvement of different areas of
the central nervous system
• Absence of other treatable causes for the
symptoms
• Results of neurological testing
How Is MS Diagnosed?
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Neurological examination
Magnetic resonance imaging (MRI) Scan
Blood tests
Lumbar Puncture (spinal tap): occasionally
performed
• Other testing: infrequently performed
Magnetic Resonance Imaging in MS
Optic nerve
Spinal cord
Brain
Brain Atrophy (Shrinkage)
in Untreated MS
Images acquired over the course of 7 years
from a single person with untreated MS
How is MS Treated and Managed?
• Drug therapy
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Treat new attacks (exacerbations)
Prevent the occurrence of future attacks
Slow or prevent disease progression
Treat the chronic symptoms of the disease
• Psychosocial support
Medications used for MS
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Spasticity- 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
Disease-Modifying Drugs
• Interferon Beta 1a
(Avonex and Rebif):
is a protein that is a replica of
human interferon. It suppress
the immune system and helps to
maintain the blood-brain
barrier. You inject Avonex into
the muscle once a week and
Rebif is injected under the skin
three times a week. This drug
is useful to people who have
definite progressive MS. One
side effect of the drug is a flu
like symptom.
• Interferon Beta 1b
(Betaseron): is slightly
different from our own
interferon. This medication
does the same thing as beta 1a,
but is injected just under the
skin every two days. Side
effects include irritation,
bruising, and redness at the site
of injection and the flu like
symptoms. This is also given to
people who have definite
progressive MS.
Physiotherapy assessment
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Strength
Tone
Range of motion
Balance
Coordination
Cardiovascular and respiratory
status
• Bed mobility and transfer
• Bowel and bladder impairment
• Swallowing
• Speech and communication
impairment
• Visual status
• Sensory impairment
• Activities of daily living
• Cognition
• Physical environment
• Medical stability.
Measurement tools
• Barthel index
• Kurtzke scale
• Multiple sclerosis quality of life inventory
Setting goals
• Helping the patient solve problems
• Problem solving and education are key
aspects
fatigue
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Modified fatigue impact scale
Due to sleep deprivationurinary incontinence
Muscle spasm
Poor diet
Depression
fatigue
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Energy conservative techniques
General exercises
Breathing exercises
Stretching
Adaptive equipments
weakness
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Pnf
Stretching
Ankle Foot Orthrosis
Strengthening strong muscles.
Balance
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Cerebellar problem is common
Wide base to narrow base
Low to high COG.
Weighted cuff and weighed canes reduce
tremors.
• Collar to reduce tremor of neck
Sensory deficit
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Compensating for the loss
Routine safety instructions
Wheelchair cushioning
Pressure relief techniques.
Ambulation and mobility
• Wheelchair mobility training.
• Electric wheelchair.