MS

• Multiple sclerosis


  An inflammatory disease characterized by remission and exacerbation
• Multiple sclerosis


  • It is an autoimmune or neurodegenerative disorder of the central nervous system (CNS) causing scattered and sporadic demyelination (plaques) and axonal damage (atrophy and black holes)
• Myelin sheath


  Fat and protein that surrounds the central nerve fiber. Once it is destructed, there is an impairment of the transmission of the nerve impulse which causes problems on the connectivity and transmission from the brain into the spinal cord
• Multiple sclerosis occurs on any age, but it is more common around young adulthood (20-40 years old) and affects more women than men
• The main cause of multiple sclerosis is still unknown, meaning it is still considered idiopathic, however, autoimmune activities and other factors cause demyelination of the myelin sheath
• Predisposing and precipitating factors of multiple sclerosis

  • Genetic predisposition (haplotype)
  • Virus (measles, Epstein-Barr virus)
  • Location or environment (living near a tower)
  • Occupation (gamma ray exposure)
• In a healthy individual, the myelin sheath would permit nerve impulses to travel quickly through the nerve pathway of the central nervous system, however, with the exposure to the predisposing and precipitating factors, there is an inflammation or a myelin scar which would degenerate and separate the axon cylinder
• Demyelination interrupts the electrical nerve impulse and cause a variety of symptoms which would manifest in our sensory and motor systems
• Fatigue


  The cardinal sign of multiple sclerosis
• Diplopia


  A common manifestation of multiple sclerosis
• Less severe cases of multiple sclerosis would eventually result in the resolution of the myelin sheath function meaning that it would be able to regenerate and enable the electrical nerve impulses to transmit over a period of time
• Scarring of the myelin sheath is considered permanent which would lead to the destruction of the nerve fibers and involve the replacement of dense, glial scar tissues that form patchy areas (sclerotic plaque)
• Multiple sclerosis is a slow, progressive disease, it is usually detected late as manifestations occur later in life and are irreversible
• Multiple sclerosis mainly affects the brain stem, cerebellum (which coordinates movement and control balance), spinal cord, and optic nerves
• As more lesions develop in the white matter of the brain, nerve fibers can creak and become damaged. As a result, the electrical impulses from the brain does not flow smoothly to the target nerve
• Clinically Isolated Syndrome (CIS)


  A single, first episode, with symptoms lasting at least 24 hours. If another episode occurs at a later date, a doctor will diagnose relapse-remitting multiple sclerosis
• Relapse-Remitting Multiple Sclerosis (RRMS)


  The most common form affecting around 80-85% of the people with multiple sclerosis. RRMS involves episodes of new or increasing symptoms, followed by periods of remission, during which symptoms go partially or totally
• Primary Progressive Multiple Sclerosis (PPMS)


  Symptoms worsen progressively, without early relapses or remissions. Some people may experience times of stability and periods when symptoms worsen then get better. Around 10-15% of people with multiple sclerosis have PPMS
• Secondary Progressive Multiple Sclerosis (SPMS)


  At first, people will experience episodes of relapse and remission, but then the disease will start to progress steadily. It is the least common type of multiple sclerosis and approximately only 5% of the total population would acquire this disease
• Sensitized T- and B lymphocytes cross the blood–brain barrier; their function is to check the CNS for antigens and then leave. In multiple sclerosis, sensitized T cells remain in the CNS and promote the infiltration of other agents that damage the immune system
• The immune system attack leads to inflammation that destroys myelin (which insulates the axon and speeds the conduction of impulses along the axon) and the oligodendroglial cells that produce myelin in the central nervous system
• Demyelination interrupts the flow of nerve impulses and results in a variety of manifestations, depending on the nerves affected
• Plaques appear on demyelinated axons, further interrupting the transmission of impulses. Demyelinated axons are scattered irregularly throughout the central nervous system

  
• The areas most frequently affected are the optic nerves, chiasm, and tracts; the cerebrum; the brainstem and cerebellum; and the spinal cord
• The axons themselves begin to degenerate, resulting in permanent and irreversible damage
• Early symptoms of multiple sclerosis


  • Fatigue
  • Weakness
  • Heaviness
  • Clumsiness
  • Numbness and tingling
• Optic neuritis


  The most common presentation of a multiple sclerosis diagnosis
• Symptoms of damage to motor nerve tracts


  • Weakness
  • Paralysis
  • Spasticity
  • Diplopia
  • Fatigue leading to depression and "heat" anemia
• Symptoms of damage to cerebellar or brain stem regions


  • Intention tremor
  • Nystagmus
  • Other tremors
  • Incoordination
  • Ataxia
  • Weakness of facial and throat muscles resulting in difficulty chewing
  • Dysphagia
  • Dysarthria
  • Dizziness
  • Nausea and vomiting
• Symptoms of damage to sensory nerve tracts

  • Allodynia
  • Paresthesia
  • Mood swings
  • Inappropriate affect
  • Euphoria
  • Apathy
  • Irritability
• Main symptoms of multiple sclerosis

  • Fatigue
  • Depression
  • Weakness
  • Numbness
  • Difficulty in coordination
  • Loss of balance
  • Spasticity
  • Pain
  • Visual disturbances (blurring of vision, diplopia, scotoma, total blindness)
• Fatigue mainly occurs due to the degree of axonal damage that correlates with this symptom
• Anemia is prevented through medications, food rich in iron and vitamin B complex, especially vitamin B12
• Pain is caused by the lesions in the sensory pathway which leads to the aggravation of the patient's condition
• Loss of proprioception may lead to ataxia. Involvement of the cerebellum or basal ganglia can produce ataxia (impaired coordination of movements) and tremor
• Spasticity (muscle hypertonicity) occurs in 90% of patients with multiple sclerosis, most often in the lower extremities, and can include loss of the abdominal reflexes
• Additional complications of multiple sclerosis

  • Urinary tract infections
  • Constipation
  • Pressure ulcers
  • Contracture deformities
  • Dependent pedal edema
  • Pneumonia
  • Osteoporosis
  • Emotional, social, marital, economic, and vocational problems
• Exacerbations and remissions are characteristic of multiple sclerosis. During exacerbations, new symptoms appear and existing ones worsen; during remissions, symptoms decrease or disappear
• Relapses may be associated with emotional and physical stress
• Spasticity


  Occurs in 90% of patients with multiple sclerosis, most often in the lower extremities, and can include loss of the abdominal reflexes. Results from involvement of the main motor pathways (pyramidal tracts) of the spinal cord.