1. Multiple Sclerosis
Faizan zaffar kashoo
Get UMSOM logo

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. .

3. What is Multiple Sclerosis?
Multiple Sclerosis (MS) is an chronic inflammatory demyelinating disease of the brain and spinal cord.

4. The Human Nervous System
Areas affected by MS
Brain
Spinal cord
Optic nerves (

6. How Common is MS and Who Gets It?
8,000 – 10,000 new cases are diagnosed annually
Affects nearly 500,000 individuals in the U.S.
Occurs most frequently between ages
Female: male ratio = 2:1
More frequent in populations native to areas further away from the equator

7. What Causes MS?
Genetics
Environmental factors

8. Family Studies Up to 19% of patients have an affected relative
Monozygotic (identical) twins
Dizygotic (non-identical) twins
Child of parent with MS
Sibling of person with MS
25 – 30%
3 – 4.5%
1.9%
0.9%

9. Groups for Which MS Genetic Traits Have Been Identified:
Japanese
African American
Mexican
Arabian
Sardinian (Italy)
Swedish
Norwegian
French Canadian
Finnish

10. Not Everyone with a Genetic Risk Will Develop MS – Why?
Risk is modified by Environmental factors
Sunlight
Diet (e.g., vitamin D)
Other lifetime experiences (infections?)

11. 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. Secondary-progressive Progressive-relapsing
Multiple Sclerosis Clinical Subtypes
Relapsing-remitting
Primary-progressive
Disability
Time
Secondary-progressive
Progressive-relapsing
Time
Disability

13. How Is MS Diagnosed? At least two episodes of symptoms
Occur at different points in time
Result from involvement of different areas of the central nervous system
Absence of other treatable causes for the symptoms
Results of neurological testing

14. How Is MS Diagnosed? Neurological examination
Magnetic resonance imaging (MRI) Scan
Blood tests
Lumbar Puncture (spinal tap): occasionally performed
Other testing: infrequently performed

16. Brain Atrophy (Shrinkage) in Untreated MS
Images acquired over the course of 7 years from a single person with untreated MS
MRI scans acquired from a single patient with MS over the course of 7 years show increasing brain atrophy.1
Brain atrophy is seen as the enlargement of the ventricle and sulcal spaces.
In untreated MS, by year 2, up to 6% of brain volume can be lost.2
1. Data on file, Biogen, Inc.
2. Rudick et al. Neurology. 1999;53:1698.

17. How is MS Treated and Managed?
Drug therapy
Treat new attacks (exacerbations)
Prevent the occurrence of future attacks
Slow or prevent disease progression
Treat the chronic symptoms of the disease
Psychosocial support

18. 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

19. 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.

20. Physiotherapy assessment
Strength
Tone
Range of motion
Balance
Coordination
Cardiovascular and respiratory status
Bed mobility and transfer
Bowel and bladder impairment
Swallowing
Speech and communication impairment
Visual status
Sensory impairment
Activities of daily living
Cognition
Physical environment
Medical stability.

21. Measurement tools Barthel index Kurtzke scale
Multiple sclerosis quality of life inventory

22. Setting goals Helping the patient solve problems
Problem solving and education are key aspects

23. fatigue Modified fatigue impact scale Due to sleep deprivation-
urinary incontinence
Muscle spasm
Poor diet
Depression

24. fatigue Energy conservative techniques General exercises
Breathing exercises
Stretching
Adaptive equipments

25. weakness Pnf Stretching Ankle Foot Orthrosis
Strengthening strong muscles.

26. Balance Cerebellar problem is common Wide base to narrow base
Low to high COG.
Weighted cuff and weighed canes reduce tremors.
Collar to reduce tremor of neck

27. Sensory deficit Compensating for the loss Routine safety instructions
Wheelchair cushioning
Pressure relief techniques.

28. Ambulation and mobility
Wheelchair mobility training.
Electric wheelchair.