Multiple SclerosisAlan Chen

4/1/14

General Information

• Other names: disseminated sclerosis or encephalomyelitis disseminata

• Inflammatory disease that affects the insulating covers of nerve cells

• Causes wide range of symptoms • Physical, mental and sometimes

psychiatric

• No known cure or cause

• Affects women twice as often as men

• Disease presents itself between ages 20 and 50

Causes

• Causes are currently not known

• Could be a combination of environmental, genetic, and viral/bacterial components

• Genetics• Probability of inheritance is higher

in relatives of affected person • However, not considered a

“hereditary” condition

• Infectious agents • Some microbes have been

proposed to trigger MS; none confirmed

• Human herpes, Epstein-Barr, measles, mumps, rubella have all been proposed to potentially contribute to MS

Pathophysiology - Lesions • “Multiple sclerosis” scars that

form in the nervous system

• Affects white matter in optic nerve, brain stem, basal ganglia spinal cord • White matter is the

“communication” part of the brain

• Loss of oligodendrocytes thinning or complete loss of myelin sheath • Neurons cannot conduct signals• Scar-like plaque builds up around

damaged neurons

Pathophysiology – Blood-brain Barrier and

Inflammation• Blood-brain barrier becomes

permeable• Mechanism is not completely

understood

• Inflammation caused by T cells entering the BBB and attacking myelin • T cells may recognize myelin

as foreign

• Cytokines and antibodies are released by other immune cells during inflammation, preventing transmission of information • Enhances loss of myelin • Could even cause axon to

break down entirely

Signs and Symptoms

• Most common signs are neurological • Usually associated with

autonomic, visual, motor, sensory problems

• Loss of sensitivity, changes in sensation

• Uhthoff’s phenomenon higher temperatures worsen symptoms

• Lhermitte’s sign electrical sensation running down back when bending your neck

Diagnostic Methods

• Look for key signs• Issues with CNS, neurological signaling problems • Administer neurological exam to test for reduced nerve

function

• Neuroimaging MRI• Show areas of demyelination, lesion, plaque

• Analysis of cerebrospinal fluid• Can provide evidence of inflammation• Test for inflammation markers, such as IgG

• Visual and sensor- evoked potentials• Look for less activity to stimulation in optic and sensory

nerves

Healthy Brain vs. Brain with Multiple Sclerosis

Treatment

• There is no known cure for MS, however there are some therapeutic measures and drugs that one can take to manage the attacks • Intravenous corticosteroids can

assist in decreasing the severity attacks

• Generally, drug therapy has been seen to reduce the severity of attacks, or in some cases can help to reduce the number of attacks and frequency

• Some potential alternative treatments are yoga, relaxation techniques, medical marijuana, acupuncture

• Physical Therapy and Occupational Therapy have been seen to help as well