Multiple Sclerosis

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Multiple Sclerosis

• Charity, Scott, Natalia

Unless otherwise noted all information was
obtained via National MS Society and National MS
Society WA Chapter
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Multiple Sclerosis Mystery

• MS is thought to be an autoimmune disease
• Affects CNS
• Triggers are unknown, but research is focusing in
  on viruses, environmental, and genetic factors
• Antibody titers to many viruses are elevated in
  MS patients.
• Varicella zoster, vaccinia, rubella,
  Epstein-Barr, HHV-6
• HHV-6 antibodies have been detected near brain
  lesions characteristic of MS

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FACTORS INFLUENCES

• Age of diagnosis usually 20 to 50
• Patients have been as young as 2 and as old as 75
• Environment
• NW has a higher incidence
• Predominant in cooler climates and areas further
  from the equator
• Vitamin D may play a role
• Genetic Factors
• 2-3 times more likely in females than males
• Variable among races and ethnicities
• Highest in northern European Caucasians
• Lowest in Asians
• No particular gene has been identified likely
  multiple genes are involved

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PATHOPHYSIOLOGY

• Key players
• Axons
• Myelin
• Oligodendrocytes
• Blood vessels that supply oxygen and nutrients
• Cytokines
• T-cells
• Antigen-presenting cells (APCs)

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PATHOPHYSIOLOGY

• During immune response cells identify antigens
  and interpret components of myelin as foreign
• APC cells present myelin antigen to T-cells
• T-cells pass through blood brain barrier (BBB)
• Normal BBB prevents passage of potential harmful
  substances through blood vessel walls within
  brain
• MS patients BBB springs a leak
• Allows activated T-cell to cross BBB and mount
  attack on myelin
• This leads to several events that lead to
  demyelination
• Swelling
• Activation of macrophages
• More activation of cytokines

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PATHOPHYSIOLOGY

• Demyelination
• Information transmission via axon is interrupted
• Interferes with conduction of nerve impulses from
  sensory organs to CNS and from CNS to muscles
• May result in permanent loss of neuron
  transmission
• Remyelination repair process
• Myelinating oligodendrocytes are able to rebuild
  thinner, less effective myelin sheaths
• May be reason symptoms decrease of temporarily
  disappear during early part of disease
• There is still irreversible loss and nerve damage

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Courtesy of Multiple Sclerosis Research Australia
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SYMPTOMS

• Symptoms are unpredictable and vary
• Fatigue 90
• Depression 70
• Suicide 7.5 times higher
• Motor involvement muscle weakness, numbness
• Visual symptoms blurring, twitching of eyes
• Cerebellar involvement intention tremor,
  seizure
• Genitourinary symptoms constipation, urine
  frequency
• Cognitive defects short-term memory dysfunction
  

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TREATMENTS

• No cure for MS
• Treatment focused on relief of symptoms and
  slowing progression
• Patient response to disease and treatment will
  differ
• Corticosteroids most common
• Methylprednisolone IV and prednisone
• Decrease intensity of bodys defense reaction
• Prevent damage to BBB

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TREATMENTS

• Interferons
• Beta 1-a Avonex and Rebif
• Anti-inflammatory properties
• Beta 1-b Betaseron
• Diminish activity of specific WBCs causing
  disease
• Glatiramer acetate
• Believed to modify immune process that causes MS

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TREATMENTS

• Psychotherapy
• PT/OT/ST
• STICK TO TREATMENT PLAN!

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PROGNOSIS

• Life expectancy 35 years after onset
• Relatively normal life
• After 25 years, 2/3 remain mobile
• Eventually leads to physical limitations for 70
  of patients

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KEY FEATURES OF MS

• Thought to be an autoimmune disease affecting CNS
• Involves myelin damage that interrupts nerve
  conduction
• No cure treatment focused on comfort and
  slowing progression
• Response to disease and treatment will vary among
  patients

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?? QUESTIONS ??