7/30/2019 OT6 - Multiple Sclerosis2

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MULTIPLE SCLEROSIS

- most commonly diagnosed neurological disease that can cause disability in young adults

- 400,000 people in the US have MS

- causes severe disability in some people, but many continue to lead active, productive lives and ar e not severely

disabled

- therapists have a skewed perspective because it is the relatively severely disabled people who are typically referred

for therapy

- tremendous window of opportunity has passed fo r interventions such as upgrading ambulation skills, fatigue

management, and employment modifications

-therapists should work to alert physicians and o ther referral sources to the need f or early intervention with persons

with MS

-cause of MS remains unknown

-present theory: environmental trigger initiates the autoimmune response in people with genetic susceptibility

-multiple in MS refers to both time and location

-sclerosis refers to the hardened and sc lerotic plaques that are the scar tissue resulting from autoimmune attacks on

the CNS (axons and myelin covering)

Axonal Transection

-considered as significant as demyelination in MS damage

-temporarily, demyelinated axons may remyelinate and provide conduction of nerve impulses

-transected axons are permanently destroyed and lose all potential for conduction

-demyelination and axonal damafe occur in the presence of inflammation, which may explain the rapid improvement

often seen in the treatment of relapses with c orticosteroid anti-inflammatory agents

Diagnosing MS

-between the ages 15-50

-children are increasingly diagnosed

-peak age of onset is 20-30 years

-women are two to three times as likely to get MS as m en

-diagnosis of MS is based on findings of the history, neurological examination, and o verall clinical picture

-additional tests: analysis of CSF, MRI

-signs of MS include weakness, hyperreflexia, positive Babinski sign, dysmetria, nystagmus, and impaired vibra

position sensation

-Expanded Disability Status Scale (EDSS) and the MS Functional Composite (MSFC), impairment rating instrum

both clinical and research settings

The Course of MS

-categorized into four types

Relapsing-remitting (RRMS)-produces clearly defined relapses of acute w orsening of neurological function followed by partial o r complete

improvement and then stable periods of remission between attacks

-the most common course of MS at the time of diagnosis, RRMS often becomes SPMS with time

Secondary progressive (SPMS)-start with a RR course of up to 10-15 years following diagnosis

-typically made when there is continued neurological deterioration

Primary progressive (PPMS)-have continuously declining neurological function from onset

Progressive-relapsing (PRMS)-differs from RRMS because disease progression continues through the period between relapses

Benign and Malignant MS

Benign MS-are fully functional 15 years after the disease onset

Malignant MS-rapid progression leading to significant disability or death in a short period