1. Multiple Sclerosis Brett Glover Paramedic ’08 5/26/08

2. What is MS? MS is a chronic, often disabling disease that attacks the CNS. MS is a chronic, often disabling disease that attacks the CNS. MS is thought to be an autoimmune disease. MS is thought to be an autoimmune disease. T- cells attack myelin that protects nerve fibers. T- cells attack myelin that protects nerve fibers. T-cells also secrete chemicals that damage nerve fibers T-cells also secrete chemicals that damage nerve fibers Damaged myelin forms scars. Damaged myelin forms scars. Damaged myelin sheath or nerve fibers cause nerve impulses to be interrupted or distorted. Damaged myelin sheath or nerve fibers cause nerve impulses to be interrupted or distorted.

3. Four types of MS Relapsing-Remitting MS Relapsing-Remitting MS Primary-Progressive MS Primary-Progressive MS Secondary-Progressive MS Secondary-Progressive MS Progressive-Relapsing MS Progressive-Relapsing MS

4. Relapsing-Remitting MS ~ 85% of people who have MS are initially diagnosed with R-R MS. ~ 85% of people who have MS are initially diagnosed with R-R MS. Clearly defined attacks or worsening neurologic function (relapses) followed by periods of remission. Clearly defined attacks or worsening neurologic function (relapses) followed by periods of remission.

5. Primary-Progressive MS ~ 10% of people with MS are diagnosed with P-R MS. ~ 10% of people with MS are diagnosed with P-R MS. Characterized by slowly worsening neurologic function from the beginning of disease process. Characterized by slowly worsening neurologic function from the beginning of disease process. No periods of relapses or remissions. No periods of relapses or remissions.

6. Secondary-Progressive MS Following an initial period of R-R MS, many people develop S-P MS. Following an initial period of R-R MS, many people develop S-P MS. Diseases worsens more steadily. Diseases worsens more steadily. May have occasional flare-ups or minor remission periods. May have occasional flare-ups or minor remission periods.

7. Progressive-Relapsing MS ~ 5% of people with MS are diagnosed with Progressive-Relapsing MS. ~ 5% of people with MS are diagnosed with Progressive-Relapsing MS. Steadily worsening disease from the beginning. Steadily worsening disease from the beginning. Includes clear attacks of worsening neurologic function. Includes clear attacks of worsening neurologic function. Disease progresses with out remissions. Disease progresses with out remissions.

8. What Causes MS? Still unknown, but scientists believe that a combination of several factors may be involved. Still unknown, but scientists believe that a combination of several factors may be involved. Immunologic Immunologic Environmental Environmental Infectious Infectious Genetic Genetic

9. Immunologic It is known that T-cells attack the myelin sheath and nerve fibers It is known that T-cells attack the myelin sheath and nerve fibers It is unknown what triggers this response It is unknown what triggers this response

10. Environmental Known to occur more often in areas far from the equator. Known to occur more often in areas far from the equator. Scientists believe that MS may be associated with Vitamin D. Scientists believe that MS may be associated with Vitamin D. Vitamin D is thought to be beneficial to immune function and may help protect against autoimmune diseases. Vitamin D is thought to be beneficial to immune function and may help protect against autoimmune diseases. Produced naturally when you are exposed to sunlight. Produced naturally when you are exposed to sunlight. People who live closer to the equator are exposed to more sunlight causing them to have a higher level of vitamin D. People who live closer to the equator are exposed to more sunlight causing them to have a higher level of vitamin D.

11. Infectious Exposure to viruses, bacteria or other microbes in childhood may increase your chances of getting MS. Exposure to viruses, bacteria or other microbes in childhood may increase your chances of getting MS. Viruses are well know to cause damage and inflammation to the myelin. Viruses are well know to cause damage and inflammation to the myelin. Over a dozen viruses and bacterias are being investigated. Over a dozen viruses and bacterias are being investigated. Measles and chlamydia. Measles and chlamydia.

12. Genetic MS is not hereditary, but having an immediate family member with MS increases the risk. MS is not hereditary, but having an immediate family member with MS increases the risk. Some researchers believe that people are born with a genetic predisposition to react to other environmental factors that possibly cause MS. Some researchers believe that people are born with a genetic predisposition to react to other environmental factors that possibly cause MS.

13. Who Gets MS? 2.5 million world wide 2.5 million world wide 400,000 in the United States 400,000 in the United States Caucasians are more likely to be diagnosed Caucasians are more likely to be diagnosed At least 2/3 more likely to occur in women than men At least 2/3 more likely to occur in women than men Most people are diagnosed between age 20 and 50 Most people are diagnosed between age 20 and 50 Risk is 1/750 in general population vs. 1/40 in anyone who has an immediate family member with MS Risk is 1/750 in general population vs. 1/40 in anyone who has an immediate family member with MS

14. Signs and Symptoms Fatigue Fatigue Most common symptom Most common symptom Numbness of the face, body or extremities Numbness of the face, body or extremities Balance and coordination problems Balance and coordination problems Difficulty in walking Difficulty in walking Bladder dysfunction Bladder dysfunction Found in ~ 80% of MS Pt Found in ~ 80% of MS Pt Bowel dysfunction Bowel dysfunction Vision problems Vision problems Generally the first symptom of MS Generally the first symptom of MS

15. Signs and Symptoms Dizziness and Vertigo Dizziness and Vertigo Sexual Dysfunction Sexual Dysfunction Pain Pain ~55% complain of significant pain ~55% complain of significant pain Cognitive Function Cognitive Function Ability to learn, plan, organize and problem solve Ability to learn, plan, organize and problem solve Emotional changes Emotional changes Spasticity Spasticity Feelings of stiffness and involuntary muscle spasms Feelings of stiffness and involuntary muscle spasms

16. Treatments There is no cure There is no cure Modifying the disease course Modifying the disease course Avonex, Betaseron, Copaxone, Novantrone, Rebif, Tysabri Avonex, Betaseron, Copaxone, Novantrone, Rebif, Tysabri Managing Symptoms Managing Symptoms Physical therapy, occupational therapy, speech therapy, cognitive rehab, vocational rehab Physical therapy, occupational therapy, speech therapy, cognitive rehab, vocational rehab Emotional support Emotional support Stress management skills, dealing with mood swings and depression Stress management skills, dealing with mood swings and depression

17. Old Theories Owning a dog or small pet Owning a dog or small pet Canine distemper Canine distemper Allergies Allergies Exposure to heavy metals Exposure to heavy metals Mercury, manganese, lead Mercury, manganese, lead Aspartame Aspartame

18. Bibliography Bledsoe, Bryan. Porter, Robert. Cherry, Richard. Paramedic Care: Principles and Practice. Vol. 5. Upper Saddle River, NJ. 2006. Bledsoe, Bryan. Porter, Robert. Cherry, Richard. Paramedic Care: Principles and Practice. Vol. 5. Upper Saddle River, NJ. 2006. National Multiple Sclerosis Society. www.nationalmssociety.org. 22 May 2008 National Multiple Sclerosis Society. www.nationalmssociety.org. 22 May 2008 www.nationalmssociety.org WebMd. www.webmd.com/multiple- sclerosis/default.htm. 24 May 2008 WebMd. www.webmd.com/multiple- sclerosis/default.htm. 24 May 2008www.webmd.com/multiple- sclerosis/default.htmwww.webmd.com/multiple- sclerosis/default.htm