1. Multiple Sclerosis

• Multiple Sclerosis is a chronic disease that affects the CNS: brain, spinal cord and optic nerves.
• Multiple Sclerosis literally means 'scar tissues in multiple areas'.
• Multiple Sclerosis is an autoimmune disease that attacks the myelin sheath causing inflammation.
• Multiple Sclerosis mainly affects the brain stem, cerebellum, spinal cord, optic nerves, and white matter in some regions of the brain.
• Clinically Isolated Syndrome (CIS) is a single first episode with symptoms lasting at least 24 hours.
• Relapse Remitting Multiple Sclerosis (RRMS) is the most common type, affecting 85% of MS patients, involving episodes of new or increasing symptoms followed by periods of remission.
• Primary Progressive MS (PPMS) is characterized by symptoms worsening progressively, without early relapses or remissions.
• Secondary Progressive MS (SPMS) starts with episodes of relapse and remission, but the disease will start to progress steadily.
• Age between 20 to 40 years old, being a woman, genetic factors, smoking, infections, vitamin D and B12 deficiency can increase the risk of Multiple Sclerosis.
• Diagnosis of Multiple Sclerosis involves physical and neurological exam, MRI scans of the brain and spinal cord, CSF analysis through lumbar puncture, and evoked potential test (EPT).
• Visual evoked response or potential (VER or VEP) is commonly used in multiple sclerosis diagnosis.
• Experimental Interventions include Plasma exchange, which removes antibodies in the blood, and Stem cell therapy, which aims to regenerate various blood body cells and restore function to those who have lost it.
• Medications for Slow Progression ➔ Disease modifying therapies have approval from FDA for the relapsing forms of MS
• Behavioral changes to Complementary treatment include Limiting screen time and resting eyes, resting when fatigued, and using assistive devices or putting weight to the limbs to reduce shaking.
• Tremor can be assisted by an assistive device or putting weight to the limbs to reduce shaking.
• Depression can be managed by reuptake inhibitor (SSRI), which causes less fatigue.
• Bladder and bowel problems can be managed by dietary changes and healthful diets with fruits, vegetables and fiber.
• Corticosteroids, such as Solu medrol (Methylprednisolone) and Deltasone (Prednisone), can treat an acute flare up of symptoms and certain types of MS.
• Pain can be relieved by anticonvulsant/ antispasmodic drugs or alcohol injections to relieve trigeminal neuralgia.
• Fatigue can be managed by getting rest and avoiding heat.
• Adverse Effects of Medications for Slow Progression include Immunosuppression and Hepatotoxicity.
• Medications for Relieving Symptoms During a Flare are taken when a person experiences a worsening of symptoms during a flare.
• Medical marijuana can be used to relieve pain, muscle stiffness, insomnia.
• Drugs are used from the early stages, the person takes them when the symptoms are not yet severe
• Abnormal response times can also be associated with other neurological diseases or with damaged optic nerves and eyes
• The immune system attacks myelin, which causes inflammation and demyelination
• Visual evoked response or potential (VER or VEP) is used when the eyes are stimulated by looking at a test pattern and is commonly used in multiple sclerosis diagnosis.
• The procedure for evoked potential tests typically takes half an hour or longer to do.
• Somatosensory evoked response or potential (SSER or SSEP) is used when nerves of the arms and legs are stimulated by an electrical pulse.
• Auditory brainstem evoked response or potential (ABER or ABEP) is used when hearing is tested by listening to a test tone.
• Visual evoked response or potential (VER or VEP) are stimulated by a strobe light or a screen with a checkerboard pattern.
• Each type of response is recorded from brain waves by using electrodes taped to the head and conducting gel applied to the scalp.
• When visual evoked potentials (VERs) are recorded, the electrodes are applied to the rear (occipital region) of the scalp over the brain areas that register visual stimuli.
• Normal results in evoked potential tests indicate that the time between the stimulation and the nerves respond within the normal range.
• The time between the stimulation and the response is called the latency, which indicates the speed at which the nerves pass a signal.
• Abnormal results in evoked potential tests indicate that some people who are free from symptoms and the nerve area tested will still have abnormal responses in that area.
• Abnormal response times in evoked potential tests can also be associated with other neurological diseases or with damaged optic nerves and eyes.
• It is impossible to predict how MS will progress.
• Lhermitte's sign is the hallmark of Multiple Sclerosis. 


  It is characterized as the sense of electricity that shoots up or down the spine; it is triggered when the chin is pointed down towards the chest.
• The three types of Evoked Potential Tests are: Visually evoked response or potential (VER or VEP), Auditory brainstem evoked response or potential (ABER or ABEP), Somatosensory evoked response or potential (SSER or SSEP).