Multiple Sclerosis

1
Multiple Sclerosis

• By Krysia Rakoczynski
• HES 100

2
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.

3
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.

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What Causes MS?

• Despite extensive research, we still dont know
  what causes MS (O'Connor 8). However they have
  found associations and links between many factors
  including genetic and environmental.
• Genetic
  Environmental
• Sex
  Latitude
• Racial Group
  SES
• Family history
  Migration
• 
  Infections

5
Genetic Factors

• Sex Women are more likely to have MS than men
  by a 21 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.

6
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 (OConnor 15).
• Infection They believe MS is a delayed
  reaction to a viral infection contracted during
  childhood by a genetically susceptible person
  (OConnor 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.

7
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.

8
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.

9
Diagnostic categories of MS

• The phrase multiple abnormalities in space and
  time sums up what a physician needs to find a
  diagnosis of MS (OConnor 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
  relapse-remitting 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.

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Courses of MSListed below are the different
paths that MS can take.

• Secondary-progressive MS (SPMS) This stage of
  MS starts with RRMS symptoms and continues on to
  show signs of PPMS.
• Progressive-relapsing MS (PRMS) This is a rare
  form but here it takes a progressive route made
  worse by acute attacks.
• 20 of the people with MS have a benign form.
  Here they show little progression after the first
  attack.

• Relapse-remitting MS (RRMS) Here you have an
  attack, go into complete or partial remission,
  then have the symptoms return.
• Primary-progressive MS (PPMS) Here you
  continually decline and have no remissions.
  There may be a temporary relief in symptoms.
• A few patients have malignant MS which is where
  they have a quick decline which leaves them
  severely disabled or even lead to death.

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Symptoms of MS

• Fatigue
• Depression
• Memory change
• Pain
• Spasticity
• Vertigo
• Tremor
• Double Vision/Vision Loss

• Weakness
• Dizziness/Unsteadiness
• Numbness/Tingling
• Ataxia
• Euphoria
• Speech disturbance
• Bladder/Bowel/Sexual dysfunction

12
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.

13
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 mothers 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.

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Medications used for MS

• 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

15
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.

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Disease-Modifying Drugs (cont)

• Glatiramer Acetate ( Copaxone) is a small
  fragment of a protein that resembles a protein in
  myelin ( OConnor 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.

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Alternative Treatments

• 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

18
A personal story

• My boyfriends father, Jim Gasior, has progressive
  Multiple Sclerosis. He was diagnosed in 1986,
  but Jim believes that he had it ten years prior,
  but doctors could not determine what caused his
  aliments. At the beginning of his disease, he
  was plagued with shooting pains in his arms and
  legs along with blurry vision. During the
  progression of his disease, he had to quit his
  job as a machinist for ATT, began to drink, and
  got divorced. At the start of this life altering
  disease, he had relapses that would last four
  months and then go into remission for just over a
  month and then it would start all over. During
  these relapses, mainly his motor skills were
  affected to the point of not being able to move
  the left side of his body. He said that he took
  every drug that the doctor prescribed to him only
  to have it changed within two weeks. After
  attending physical therapy to improve his
  mobility, his relapses slowed to once a year..

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A personal story (cont)

• Now Jim is in remission and has been for a couple
  of years. He does not take any medication
  because he feels that the relapses will happen
  and nothing the drugs do will stop them. He said
  that he could feel them coming on and he would
  just relax them away. Even though today Jim is
  in remission he has not fully recovered from
  previous relapses. His left side is still weak.
  One day we went to the lake and Jim came with my
  boyfriend and I.
• We were walking over rough terrain and even
  though Jim is strong, he was not strong enough to
  keep himself stable. He fell and was very
  embarrassed when I rushed to help him. Beside
  that one slip I witnessed, Jim is still a
  brilliant man who can accomplish anything he sets
  his mind to.

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Works Cited

• Barnes, David. Multiple Sclerosis Questions and
  Answers, Merit Publishing International,
  Florida, 2000.
• Multiple Sclerosis Hope Through Research,
  lthttp//intelihealth.com/IH/ihtIH/WSIHW000/8320/2
  1151/195415.html?ddmtcontentgt, 06 April 2003.
• OConnor, Dr. Paul. Multiple Sclerosis The Facts
  You Need, Firefly Books Inc., New York, 1999.