Multiple Sclerosis
Kristen Meyer
Indroduction
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Definition
Epidemiology
Symptoms
Diagnosis
Tests and Evaluations
Complications
Treatment
Effects on Exercise
Medications
Effects of Exercise
Exercise Prescription
Summary
Definition
• Autoimmune disease that damages the
insulating myelin of the CNS.
Epidemiology
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First diagnosed between the ages of 16-60
Peaks at age 30
More common in women- 2 or 3:1 ratio
Benign and rapidly progressing
Symptoms
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Spasticity
Incoordination
Impaired balance
Fatigue
Muscle weakness, partial paralysis, paralysis
Sensory loss and numbness
Cardiovascular dysautonomia
Tremor
Heat sensititivy
Diagnosis
• 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
Example of onset of cases
• Case 1: 26 year old woman
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Decreased vision in the right eye in 9/05
Left leg numbness in 1/06
Right face numbness, right arm and leg weakness in 4/06
Left leg weakness in 8/06
• Case 2: 45 year old man
– Left arm weakness in 2/93
– Numbness below the waist in 4/07
Diagnosis
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No single test, only accepted criteria
Imperfect system
Neurologist evaluates symptoms
Based on medical history
Neurological Exam ( function of brain and spinal
cord)
• Skill of doctor to ask the right questions to
uncover info to
• 10% of MS cases are misdiagnosed
Tests
• MRI
• Spinal taps
• Lumbar punctures ( exam of cerebrospinal
fluid)
• Evoked potentials
• Lab analysis of blood samples
Accepted Criteria for Diagnosis
• Age 20-60
• Signs and Symptoms idicate disease of brain or
spinal cord
• Evidence of ≥ 2 leasions—or abnormal areas on
the brain (from MRI scan)
• Objective evidence of disease of brain or spinal
cord on doctor’s exam
• ≥ 2 episodes lasting at least 24 hrs. at least one
month apart
• No other explanation for the symptoms
Complications
Treatment: Disease-Modifying Agents
Disease-Modifying Agent
Side effects that may effect exercise
Interferon beta-1a (Avonex, Rebif)
Flu-lik symptoms, injection site irritation
Interferon beta-1a (Betaseron)
Flu-like symptoms, injection site irritations
Glatiramer acetate (Copaxone)
Injection site irritation
Mitoxantron (Novantrone)
Fever or chill, swelling of legs, cough or
shortness of breath
Natalizumab (Tysabri)
Fatigue, joint pain, depression
Treatment: Symptom Management
Symptom Management
Side effects that may effect exercise
Amantadine, modafanil (Provigil)
May reduce fatigue
Baclofen (Lioresal), tizandidine (Zanaflex)
May cause muscle weakness and fatigue
Amitriptyline (Elavil), fluoxetine (Prozac)
May cause muscle weakness
Prednisone
May cause muscle weakness reduced
sweating, hypertension, diabetes,
osteoporosis
Treatment