1. MULTIPLE SCLEROSIS THE INS AND OUTS

2. OVERVIEW - An autoimmune disease that attacks the myelin on the nerves within the CNS. The classic symptoms may include fatigue, weakness, blurred vision, numbness, and balance and coordination problems. Relapse-remitting vs progressive  Diagnosis:  MRI Imaging – 90% of MS patients  lumbar puncture/spinal tap – Immunoglobulin G  somatosensory evoked potential testing

3. SYMPTOMS  Spasticity is most common in the calf, thigh, back and groin muscles.  Fatigue can increase the severity and intensity of other symptoms, including motor weakness.  Ataxia, nystagmus, dysarthria, slurred speech, intention tremors and vertigo  Decreased proprioception, balance and coordination  Pain, mood disorders, depression  Bladder, bowel and sexual dysfunction

4. TRIGGERS FOR A FLARE-UP  Stress  Fatigue  Infection  Heat and/or Fever  Increase in temperature blocks the conduction of demyelinated nerves.  Cool temperature – increase in comfort and less fatigue  Study with 8 patients

5. PREVENTION TO FLARE-UPS  Sleep  Eating a good diet  Exercise  Education  Up to 75% of MS patients are affected by balance problems during the course of their disease, increasing the danger of falling and causing serious injury.

6. PHYSICAL THERAPY INTERVENTION  PT has a positive impact on fatigue in patients with MS.  Outcome measures: Modified Fatigue Impact Scale (MFIS) and Ambulation Index (AI  Limitation: They did not state what interventions were provided during rehab.  Ai-Chi aquatic therapy may improved balance, functional mobility, UE & LE muscle strength, and fatigue in patients with MS.  Breathing techniques and progressive resistance training in water to relax and strengthen the body  Single education day on physical functioning, activity and quality of life are beneficial.  adapting exercises and sports (ie: golf & cycling)  Attended 3/6 group exercise classes

7. PHYSICAL THERAPY INTERVENTION  Home based exercise program improves walking in people with cerebellar ataxia  Sitting balance: standard chair, 6-inch dense foam, exercise ball (standard or peanut shaped) or balance disc  Stabilizing in static position progressing to dynamic arm and leg movements.  In-person demonstrations and education to perform at home  Improved Timed Up and Go, Dynamic Gait Index, and walking speed  No change in Functional Reach or static postural sway

8. PHARMACOLOGIC TREATMENT - No cure for Multiple Sclerosis Managing Relapse and/or progression  IV Corticosteroids  Long term side effects – hypertension, diabetes, osteoporosis, cataracts, and ulcers  Immunotherapy – may reduce frequency of relapses up to 30%  Anticonvulsants  Antidepressants  Narcotics  Muscle Relaxants  Medical Marijuana

9. ANESTHESIA AND SURGERY Stress from surgery is unlikely to exacerbate symptoms, however complications such as infection and fever can exacerbate symptoms. No significant evidence proving that anesthesia exacerbates MS symptoms. Recommend: General > Regional anesthesia Epidural & peripheral nerve blocks > Spinal anesthesia Spinal anesthesia (unknown) - lack of protective nerve sheath around the spinal cord may increase the risk of neurotoxic effects from local anesthetics.

10. SUPPORT GROUPS NATIONALMSSOCIETY.ORG

14. REFERENCES http://www.everydayhealth.com/health-report/living-better-with-ms-guide/triggers- that-can-cause-ms-flares.aspx http://www.aana.com/newsandjournal/Documents/p217-224.pdf http://web.a.ebscohost.com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?s id=fa02bb3e-8eff-4631-9ef7- 3f3e598094ab%40sessionmgr4001&vid=1&hid=4206 http://web.a.ebscohost.com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?s id=82d54f1a-0606-42cc-ac46- 2754bd3ebefe%40sessionmgr4004&vid=0&hid=4206 http://web.a.ebscohost.com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?s id=fb1a9f64-2ba1-4da4-83fe- 9835c4272c3b%40sessionmgr4001&vid=0&hid=4206