Download Multiple_Sclerosis_Tapper and company

Multiple Sclerosis (MS)
XXXXXXXXX
XXXXXXXXXXX
XXXXXX
Course: Biology 1407
Instructor: Dr. Nesterovitch
Semester: Spring 2010
Houston Community College
Multiple Sclerosis: An Overview


In this presentation, you will be given an
overview of the disease, Multiple Sclerosis.
The following topics will be covered:






MS: What Is It?
Possible Causes of MS
Symptoms of MS
Disease Courses of MS
Methods of Diagnosis
MS Research
MS: What Is It?


An autoimmune disease (self attacks self)
Attacks the Myelin Sheath that protects and
insulates the axon portion of neuron cells
MS: What Is It?



Axons are demyelinated and damaged
Scar tissue (sclerosis) develops in the
damaged areas
Electrochemical signals normally travelling
along the axons are hampered or blocked
MS: What Is It?
MS: What Is It?

Attacks the Central Nervous System (CNS)
only




Brain
Spinal chord
Optic nerves
Not evident in the Peripheral Nervous System.
Possible Causes of MS
Immunologic:

MS is believed to be an autoimmune
response



T-Cells attack the Myelin
Exact markers or targets on Myelin are unknown
Researchers have begun to identify the receptors
on the T-Cells
 Could possibly lead to immunotherapy that
targets specific receptor
Possible Causes of MS

Immunologic:

Weakness in
Blood-Brain
Barrier might play
a role

Allowing
uncontrolled TCell release into
the CNS
Possible Causes of MS

Environmental

MS Clusters (groups and/or time periods where
higher rates of MS occurred)


MS Clusters, and their associated environments, are
under study but have not yielded conclusive evidence
Hemispheric proximity


MS is known to occur in higher rates farther from the
equator.
Possible link to Vitamin D/Sunlight exposure levels
Possible Causes of MS
Possible Causes of MS

Genetics

Not statistically a hereditary disease
 Yet a higher rate of disease contraction in
direct family members (parents, siblings,
children) of a diagnosed patient
 1-3% in families compared to 0.1% in
general population
Possible Causes of MS

Genetics

Increased frequency of specific Human
Leukocyte Antigen (HLA) alleles found in MS
patients compared to population
 HLA: genetically determined proteins that
influence immune systems and are found on
Chromosome 6
Possible Causes of MS

Infectious



No causal link established between viruses and
the onset of MS
Studies are being conducted, however, on certain
viruses (observed to have some effect on Myelin
on their own) that may be part of a combination
of triggers that causes a patient to have MS
Epstein-Barr Virus has been observed to have a
closer relationship to MS in some patients, but no
direct cause has been established.
Possible Causes of MS
Summary of Possible Causes:
To date, the exact cause of MS has not been established.
It is thought that MS might arise from a combination
of triggers, such as both environmental and viral.
Scientists continue to work to establish causal
factors while also focusing on treatments focusing
on the known element: the immune response
(attacking the self).
Symptoms of MS (more common)

Numbness or weakness in limbs


Partial or complete loss of vision




On one side of body or on whole of lower body
Usually in one eye at a time
Pain often accompanies eye movement
Double vision or blurring of vision
Tingling or pain in parts of body
Symptoms of MS (more common)





Electric shock sensation with certain head
movements
Lack of coordination or unsteady gait
Fatigue
Dizziness and vertigo
Bladder or bowel dysfunction
Symptoms of MS (more common)




Decrease in cognitive function performance
Sexual dysfunction
Emotional changes and depression
Spasticity
Symptoms of MS (less common)







Speech disorders
Swallowing problems
Headache
Hearing loss
Seizures and tremors
Respiration/breathing problems
Itching
Symptoms of MS



Signs and symptoms of MS vary widely
among patients, depending on the location of
the affected nerve fibers in the CNS
Some symptoms will come and go, while
other symptoms are more lasting
Increases in body temperature tend to trigger
or worsen symptoms in MS patients
Symptoms Summary
Courses of MS

Relapsing-remitting (RR) MS



MS symptoms are first observed as a series of
symptomatic attacks followed by a remission
period.
After a period of stability, the symptoms later
return
Primary-progressive (PP) MS

After initial attacks, the patient experiences
clinical decline with no apparent remission phases
Courses of MS

Secondary-progressive (SP) MS


Begins with a RR MS course and then follows
with a PP MS course
Progressive-relapsing (PR) MS


Begins with a progressive path interspersed with
higher acute attacks
This course is rare in the patient population
Courses of MS

Approximately 20% of diagnosed patients
have a benign form of the disease



After the initial acute attacks, the symptoms never
return, and the patients have fully functional lives
A small percentage experience swift decline
leading to significant disability or death soon
after onset.
Overall, however, MS is rarely fatal, and
patients have a fairly normal life expectancy
Methods of Diagnosis
Note: One method alone is not a final
determination of a MS diagnosis, but
instead a combination of methods is used
to rule out the possibility of other
diseases
Methods of Diagnosis
Medical history

Investigating
family history,
places and
dates of travel,
birthplace, etc.
Methods of Diagnosis

Neurologic exam


Testing functions of
speech, vision,
balance, and other
motor skills and
sensory functions
Evaluating mental
and emotional
changes
Methods of Diagnosis

Magnetic Resonance Imaging (MRI)

Searching for locations, growth patterns, and
timeline of scarring and lesions
Methods of Diagnosis

Visual Evoked
Potential (VEP)


Used to find impaired
electrochemical
response times along
the optic nerve
pathways
Slowed or impaired
responses signify
demyelination along
the nerve fibers
Methods of Diagnosis
Cerebrospinal Fluid
analysis

Measuring levels of:



Immune response
antibodies
Proteins called
oligoclonal bands
Breakdown proteins from
damaged Myelin
Current MS Treatments



There is no cure for MS
Due to risks and side effects, many MS
patients do not use currently offered
medications
Steroids, such as prednisone, are used by
some patients to reduce severity and duration
of attacks

Not recommended for long term use due to
possible side effects of weight gain, acne,
seizures, and psychosis
Current MS Treatments

Three forms of beta interferon are currently
FDA-approved and have been observed to:





Reduce the number of exacerbations of attacks
Reduce the time and severity of attacks
May slow the progression of physical disability
Possibly decreases myelin destruction
Side effects of beta interferon: fever, chills,
sweating, muscle aches, fatigue, depression,
injection-site skin reactions
MS Research


An organization called the Myelin Repair
Foundation sums up the areas of current MS
research.
After reading each research area in the
following slides, refer to the corresponding
number in the chart following the listed
research areas.
MS Research
1.
“Understanding how
oligodendrocytes are
normally generated
from neural stem
cells and how
multiple sclerosis
perturbs this
process.”
MS Research
2.
“Understanding the underlying mechanism of
myelination and how it is perturbed in multiple
sclerosis.”
MS Research
3.
4.
“Understanding how nodes of Ranvier and
paranodes are normally formed and how they
are perturbed in multiple sclerosis.”
“Understanding the immune response in
multiple sclerosis and how inflammation
affects myelin repair. “
MS Research
5.
6.
“Understanding how the Blood-Brain Barrier
is affected in multiple sclerosis and its role in
the disease.”
“Development of better animal models for
study of multiple sclerosis and
remyelination.”
MS Research
MS Research

Research goals:




Promote myelin repair at targeted locations
Gain control of the immune response that is
currently damaging myelin
Prevent inflammation during myelin repair
Fortify the Blood-Brain Barrier
Conclusions


Multiple Sclerosis is a disease that is rarely
fatal yet causes years of pain and discomfort
for most patients.
The cause of MS in a patient is unknown.



A combination of triggers is a possibility.
The current treatments for MS focus on
symptom management.
Research scientists are aggressively pursuing
several pathways to possible cures and
treatments for the disease.
References/Bibliography

National Multiple Sclerosis Society


Multiple Sclerosis: Hope Through Research.
National Institute of Neurological Disorders
and Stroke


www.nationalmssociety.org
http://www.ninds.nih.gov
The Merck Manuals: Online Medical Library

http://www.merck.com/mmpe/index.html
References/Bibliography


Multiple Sclerosis and Epstein-Barr Virus. Lynn
I. Levin, PhD, MPH; Kassandra L. Munger, MSc;
Mark V. Rubertone, MD, MPH; Charles A. Peck,
MD; Evelyne T. Lennette, PhD; Donna Spiegelman,
DSc; Alberto Ascherio, MD, DrPH. Journal of the
American Medical Association. 2003; 289: 15331536
The Mayo Clinic


www.mayoclinic.com
The Myelin Repair Foundation

www.myelinrepair.org