2. What is MS?

3. Multiple Sclerosis (MS) is an inflammatory disease of the Central Nervous System (CNS) - that's the brain and spinal cord. Predominantly, it is a disease of the "white matter" tissue. The white matter is made up of nerve fibers which are responsible for transmitting communication signals both internally within the CNS and between the CNS and the nerves supplying rest of the body. In people affected by MS, patches of damage called plaques or lesions appear in seemingly random areas of the CNS white matter. At the site of a lesion, a nerve insulating material, called myelin, is lost.inflammatoryCentral Nervous Systembrainwhite matterlesionsmyelin

5. Epidemiology

6. Most people with MS have their first symptoms between the ages of 20 – 40.symptoms rarely begin before 15 or after 60. Women are almost twice as likely to get MS as men, especially in their early years.

7. Causes

8. - Genes, The risk of developing MS is higher if another family member is affected suggesting the influence of genetic factors. -Environmental factors, Role of an environmental factor is suggested by studies of the effect of migration on the risk of developing MS. Age plays an important role in determining this change In other word if a person migrate before the age of 15 he acquires the new environment’s susceptibility to MS while if he migrate after 15 he’ll retain the susceptibility of his home country. -Other causes are viral infection, trauma, electrical injury, and chemical exposure.

9. MS Types

10. -The most common pattern is the "relapsing-remitting" pattern, in which there are clearly defined symptomatic attacks lasting 24 hours or more, followed by complete or almost complete improvement. The period between attacks may be a year or more at the beginning of the disease, but may shrink to several months later on. This pattern is especially common in younger people who develop MS.

11. -In the "primary progressive" pattern, the disease progresses without remission or with occasional plateaus or slight improvements. This pattern is more common in older people. -In the "secondary progressive" pattern, the person with MS begins with relapses and remissions, followed by more steady progression of symptoms. Between 10-20% of people have a benign type of MS, meaning their symptoms progress very little over the course of their lives.

12. Symptoms

13. Primary: Muscle weakness, causing difficulty walking. Loss of coordination or balance. Numbness, "pins and needles," or other abnormal sensations. Visual disturbances, including blurred, double vision & nystagmus. Secondary: Fatigue. Muscle spasticity and stiffness. Tremors. Paralysis. Pain. Vertigo. Speech or swallowing difficulty. Loss of bowel and bladder control. Incontinence, constipation. Sexual dysfunction. Cognitive changes.(memory disturbance &depression). All these can worse with heat & increased body temp (fever, intensive physical activity, exposure to sun &hot bath).

14. Diagnosis

15. Prior to diagnosis you should ask the pt: family history of neurologic disease, 2) symptoms and findings attributable to a single anatomic location, 3) persistent back pain, 4) age of onset over 60 or under 15 years of age, or 5) progressively worsening disease. Diagnostic tools: -Magnetic resonance imaging (MRI) can reveal plaques on the brain and spinal cord. -A lumbar puncture, or spinal tap, is done to measure levels of immune proteins, which are usually elevated in the cerebrospinal fluid of a person with MS. This test may not be necessary if other tests are diagnostic

16. Cont… Evoked potential tests: electrical tests of conduction speed in the nerves, can reveal reduced speeds consistent with the damage caused by plaques. These tests may be done with small electrical charges applied to the skin (somatosensory evoked potential), with light patterns flashed on the eyes (visual evoked potential), or with sounds presented to the ears (auditory evoked potential).the nervous system of ms person often responds less actively to stimulation of optic & sensory nerves due to demylination of such pathways.

17. Treatment

18. The major drugs for the treatment of MS affect the course of the disease by slowing the disease progression in many patients. these drugs can slow the progress of physical impairment, reduce the severity of symptoms, or may decrease disability. All these drugs are administered by injection. Some studies suggest using high vit, minerals & diatery supplements to control disease progression & improve symptoms.

19. Physical therapy

20. Physical therapy helps the person with MS to: -Strengthen and retrain affected muscles. - To maintain range of motion to prevent muscle stiffening. -Exercise and stretching programs are usually taught to the patient and caregivers for use at home. *Swimming is often recommended, not only for its low-impact workout, but also because it allows strenuous activity without overheating. - Balance & coordination exs. -Teach the pt how to maintain posture.

21. - To learn to use assistive devices such as canes and walkers. - For the intentional tremors PT or OT recommends bracing to support the affected limb. But it must be used with caution, because it may increase spasticity or just simply ask the patient to hold the affected limb. -Limb cooling device can provide short term 30 to 45 minutes relieve for tremors. -Biofeedback by using computer to help people recognize & compensate for balance problem related to tremors. -To learn safer and more energy-efficient ways of moving, sitting, and transferring.

22. Prognosis

23. Less than 5% of people with MS have a severe progressive form, leading to death from complications within five years. 10-20% have a benign form, with a very slow or no progression of their symptoms. Suicide is a significant cause of death in MS, especially in younger patients.