Download Multiple Sclerosis

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. White matter
is below the top layer of our brain and spinal cord. Plaques
block a signal from being passed from the body to the spinal
cord and brain.
 Currently in the US, 250,000-300,000 people have been
diagnosed with MS and there are 200 new cases diagnosed
every week.
History of Multiple Sclerosis
Multiple Sclerosis, also known as MS, was given its name,
multiple because of the numerous sites of demyelination and
‘sclerosis’ which means scarring. “There are accounts of
probable MS dating back to the 14th century but the history
of the disease really begins in the 19th century with the first
illustrations and clear clinical description of the disease
beginning to appear in 1838” (Barnes 16). It was in Holland
on August 4, 1421, that the earliest descriptions were seen.
Even though the previous description, the first actual case
was first diagnosed in 1849. It was Jean-Martin Charcot
who is credited with giving us the first signs and symptoms
of Multiple Sclerosis.
What Causes MS?
“Despite extensive research, we still don’t
know what causes MS” (O'Connor 8).
However they have found associations
and links between many factors including
genetic and environmental.
Genetic
Environmental
Sex
Racial Group
Family history
Latitude
SES
Migration
Infections
Genetic Factors
Sex:
Women are more likely to have MS than men by a 2:1
ratio. They also think that this is true because women are in
general more likely to have an Auto immune Disease.
Racial Group:
“Whites are more than twice as likely
as other races to develop MS” ( Hope 2).
Family History:
In a normal population the chance
of someone to exhibit the symptoms of MS is only 0.1%. Now if
someone in your family has MS, the risk increases. If your parent,
brothers, or sisters (your first-degree relatives) have MS your
chance increases to 3%. If a second-degree relative has it, you
only have a 1% chance of having MS. If both of your parents have
the disease you have a risk of 20%. Other percentages are if you
have a half sister/brother, identical twin, or fraternal twin your
risks are as follows, 1.5%, 30%, and 3-4%.
***Remember that women have a slightly higher risk and that if
one identical twins has MS it is not 100% positive that the other
twin will have MS due to the environmental factors.
Environmental Factors
Latitude:
As you increase latitude, mainly above and below
40° latitude, MS is more common. These are temperate and cooler
climates. It is five times more likely in these regions.
SES:
Your socioeconomic status can also affect the occurrence of
MS. It is least common in the lower class and in rural residence.
Migration:
The age at which you may move may also be an
important factor. “If you move before the age of 15, your risk is that of
the people in the country you move to. If you move after the age of 15,
your risk stays fixed at that of the country you grew up in” (O’Connor
15).
Infection:
“They believe MS is a delayed reaction to a viral
infection contracted during childhood by a genetically susceptible
person” (O’Connor 13). The viral infections may include shingles,
chicken pox, measles, or certain herpes. An idea they also have is the
age at which you get the infection. The older you are the higher the risk
for MS.
***Remember that in warm countries, children contract viruses at a
younger age.
What actually happens in the
Immune System?
“The immune system – a complex network of specialized cells and organs –
defends the body against attacks by “foreign invaders such as bacteria,
viruses, fungi, and parasites” (Hope 3). It goes out looking for the invaders
and kills them. In our body we have different antigens, which cause an
immune response, for different invaders. When the right invader and
antigen met, the antigen multiples to destroy the invader. T-cells are also
important in the role of MS. They help keep the immune system in order
and directly destroy the infected or damaged cell. How do these T-cells
know that the cell they are attacking is an invader? Well on each of our
cells there are markers that let our immune system know it is our own cell
or a foreign body. Since MS is a autoimmune disease that persons body
does not know the difference between self and non-self cells. Another
aspect ofthe immune system that they are looking at is the blood-brain
barrier (bbb). The bbb is a membrane that surround the brain and allows
substances to cross from the blood to the central nervous system. Some
feel that the bbb is breached and some of the immune system defense cross
over and cause damage to the CNS.
Diagnosing MS
• “The most important principle to consider when
diagnosing MS is whether the person fulfils the diagnostic
criteria on clinical grounds” (Barnes 29).
• To date there is no diagnostic or blood test for MS.
• Family physician will send you to a neurologist who goes
over your symptoms and history.
• You can be given one of four test to help the doctor see if
there is damage to the spinal cord and brain. These test are
only half of the diagnostic process. The tests you can take
are MRI, MRS, evoked potentials, and lumbar puncture.
• These tests may be able to rule out a viral infection that
can exhibit the same symptoms as an MS attack.
• Remember that these tests are just as important as a
clinical evaluation.
Diagnostic categories of MS
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“The phrase ‘multiple abnormalities in space and time’ sums up
what a physician needs to find a diagnosis of MS” (O’Connor 32).
There are three categories of MS; Definite, Probable, and Possible
MS.
Definite MS: “Consistent course (relapse-remitting course with at
least 2 bouts separated by at least 1 month or slow or stepwise
progressive course for at least 6 months) of documented neurological
signs of lesions in more than one site of brain or spinal cord white
matter” ( Hope 7). The age of onset is between 10 and 50 years of
age.
Probable MS: Here the signs are not previously documented and
there is one current sign of MS. There is more than one site of
lesions, they have a good recovery and have a history of relapseremitting symptoms.
Possible MS: There is no documented signs of MS and more than
one lesion. There is also a history of one relapse-remitting
symptoms.
Courses of MS
Listed below are the different paths that MS can take.
• Relapse-remitting MS (RRMS): • Secondary-progressive MS
(SPMS): This stage of MS
Here you have an attack, go
starts with RRMS symptoms
into complete or partial
and continues on to show signs
remission, then have the
symptoms return.
of PPMS.
• Primary-progressive MS
• Progressive-relapsing MS
(PPMS): Here you continually
(PRMS): This is a rare form
decline and have no remissions.
but here it takes a progressive
There may be a temporary relief
route made worse by acute
in symptoms.
attacks.
• A few patients have malignant
MS which is where they have a • 20% of the people with MS
have a benign form. Here they
quick decline which leaves
show little progression after the
them severely disabled or even
lead to death.
first attack.
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
Speech disturbance
Bladder/Bowel/Sexual
dysfunction
Is disability inevitable?
As mentioned above there are numerous
different paths that MS can take you on.
“Although MS as a disease is much feared,
the prognosis in general is not as poor as
commonly thought” (Barnes 15).
5-20% of all patients will develop benign
MS, and another 33% will have little to no
disabilities allowing them to live
independently while not in relapse.
Only 33% of MS patients will have a
severe disability.
Can I still have children?
This question is important to many sufferers. This
question is mainly for women though. It was once
thought that women should not have children at all if
she was diagnosed with MS. Actually during the
mothers’ last trimester there is a 70% reduction in the
relapse rate. The thought behind this process is that the
mother’s immune system changes so her body does not
reject the unborn child who has a different genetic
makeup. Although there is a brief decrease in
symptoms, within three months after the child is born,
there is a similar increase in the relapse rate. Also, be
aware of the medication and the effects it will have.
Some drugs are not to be taken if you are going to
become pregnant, are pregnant, or are nursing.
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.
Disease-Modifying Drugs (con’t)
• Glatiramer Acetate ( Copaxone):
“is a
small fragment of a protein that resembles a protein in
myelin” ( O’Connor 106). It decrease the reoccurrence of
relapse. It is injected just under the skin every day. There
is no flu like symptoms but occasional redness may occur at
the injection site. A few amount of people do experience
brief shortness of breathe.
• In summary all three of these drugs decrease relapses by
33%, have manageable side effect, are injected, stabilize the
disease, and tend to be costly.
Alternative Treatments
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Acupuncture
Aromatherapy
Cannabis (Marijuana)
Chiropractic
Cold Immersion
Dietary Supplements
Herbal Medication
• Homeotherapy
• Injection of Venom
such as snake and bee
• Massage
• Meditation
• Reflexology
• Tai Chi
• Yoga