2. GROUP MEMBERS  Vanessa Wickham  Satrupa Devi Singh  Joshua Griffith  Jennifer Hayner  Carlwyn Collins  Ashley Singh

3. DEFINITION  Multiple Sclerosis (MS)  Multiple Sclerosis (MS) a progressive disease of the CNS characterized by the destruction of the myelin sheath surrounding the nerve fibres of the brain, spinal cord, and optic nerves.  As a result, the transmission of nerve impulses becomes impaired, particularly in pathways involved with vision, sensation, and movement.  Patients become paralyzed and/or blind in severe cases while in milder cases there may be numbness in the limbs.

4.  MS can affect people of all ages.  It’s more common among persons aged from 20-40/50.  Developed more in women than men

5.  The exact cause is still “Unknown”  However, it is said to be caused by damage to the myelin sheath.  This sheath is the protective covering that surrounds nerve cells.  When this nerve covering is damaged, nerve signals slow down or stop.  The nerve damage is caused by inflammation.  Inflammation occurs when the body's own immune cells attack the nervous system.  This can occur along any area of the brain, optic nerve, and spinal cord. AETIOLOGY

6. AETIOLOGY CONT’D  Reasons why our Immune System attack the myelin:  Genetically  Environmental  Infections  Too much salt

7.  These symptoms are less common, but also possible:  Headache  Hearing Loss  Itching  Respiration / Breathing Problems  Seizures  Speech Disorders  Swallowing Problems  Tremor CLINICAL FEATURES

8. CLINICAL FEATURES CONT’D As the MS advances these symptoms may appear:  Alterations in perception and thinking  Fatigue  Heat sensitivity  Muscle spasm  Sexual dysfunction  Vision impairment  Tingling and numbness of the skin and limbs  Difficulty with walking  Weakness and exhaustion  Memory loss  Depression  Urinary and bowel problems

9. PATHOPHYSIOLOGY  Blood-brain Barrier Breakdown  The BBB prevent entrance of T-cells into the nervous system.  The blood–brain barrier is normally not permeable to these types of cells, unless triggered by infection or a virus, which decreases the integrity of the tight junctions.  When the blood–brain barrier regains its integrity, usually after infection or virus has cleared, the T-cells are trapped inside the brain.

10. PATHOPHYSIOLOGY CONT’D  AUTOIMMUNOLOGY  The immune system attacks the nervous system, forming plaques or lesions.  Commonly involves white matter.  Destroys oligodendrocytes- causing demyelination.  Remyelination occurs in early phase but not completely.  Repeated attacks lead to fewer remyelination

11.  INFLAMMATORY  T-cells attacks on myelin triggers inflammatory processes, stimulating other immune cells and soluble factors like cytokines and antibodies.  Leaks form in the BBB cause swelling, activation of macrophages, and more activation of cytokines and other destructive proteins PATHOPHYSIOLOGY CONT’D

12. MEDICAL MANAGEMENT MEDICAL MANAGEMENT  There is no known cure for multiple sclerosis at this time. But, there are treatments that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.  Medicines are often taken long-term. These include:  Medicines to slow the disease  Steroids to decrease the severity of attacks  Medicines to control symptoms such as muscle spasms, urinary problems, fatigue, or mood problems  Medicines are more effective for the relapsing-remitting form than for other forms of MS.

13. MEDICAL MANAGEMENT CONT’D The following may also be helpful for people with MS:  Physical therapy, speech therapy, occupational therapy, and support groups  Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars  A planned exercise program early in the course of the disorder  A healthy lifestyle, with good nutrition and enough rest and relaxation  Avoiding fatigue, stress, temperature extremes, and illness

14.  Changes in what you eat or drink if there are swallowing problems  Making changes around the home to prevent falls  Social workers or other counseling services to help you cope with the disorder and get assistance  Vitamin D or other supplements (talk to your doctor first)  Complementary and alternative approaches, such as acupressure or cannabis, to help with muscle problems. MEDICAL MANAGEMENT CONT’D

15. REFERENCES  (n.d.). Retrieved March 30, 2015, from http://www.slideshare.net: http://www.slideshare.net/irfanziad1/multiple-sclerosis-9926963  Definition of Multiple Sclerosis. (n.d.). Retrieved March 30, 2015, from http://www.medicalnewstoday.com: http://www.medicalnewstoday.com/articles/37556.php  Medline Plus - Multiple Sclerosis. (n.d.). Retrieved March 30, 2015, from http://www.nlm.nih.gov: http://www.nlm.nih.gov/medlineplus/ency/article/000737.htm  Mutiple Sclerosis. (n.d.). Retrieved March 30, 2015, from http://www.britannica.com: http://www.britannica.com/EBchecked/topic/397172/multiple- sclerosis-MS