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Multiple Sclerosis: Walter Royal, III, MD

MS is a chronic inflammatory disease of the brain and spinal cord that affects over 500,000 individuals in the US. It is more common in females and in populations farther from the equator. While the exact cause is unknown, genetics and environmental factors likely play a role. Symptoms can vary between individuals but commonly involve vision, sensation, movement, and cognition issues. MRI and neurological exams are used to diagnose MS by detecting lesions in the central nervous system. Current treatments aim to reduce attacks and slow progression through immune-modulating drugs, rehabilitation, and management of symptoms.

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73 views30 pages

Multiple Sclerosis: Walter Royal, III, MD

MS is a chronic inflammatory disease of the brain and spinal cord that affects over 500,000 individuals in the US. It is more common in females and in populations farther from the equator. While the exact cause is unknown, genetics and environmental factors likely play a role. Symptoms can vary between individuals but commonly involve vision, sensation, movement, and cognition issues. MRI and neurological exams are used to diagnose MS by detecting lesions in the central nervous system. Current treatments aim to reduce attacks and slow progression through immune-modulating drugs, rehabilitation, and management of symptoms.

Uploaded by

plasmacartwheel
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Multiple Sclerosis

Walter Royal, III, MD


Associate Professor, Department of Neurology
University of Maryland School of Medicine
Director, Maryland Center for Multiple Sclerosis
Treatment and Research
What is Multiple Sclerosis?
• Multiple Sclerosis (MS) is an chronic
inflammatory demyelinating disease of the
brain and spinal cord.
The Human Nervous System
• Areas affected by MS
– Brain
– Spinal cord
– Optic nerves

(http://web.lemoyne.edu/~hevern/psy340/lectures/psy340.04.2.ns.structure.html)
MS is an Immune-Mediated Disease

BBB=blood-brain barrier; APC=antigen-presenting cell.


Adapted from Miller et al. Continuum: Multiple Sclerosis (Part A). 1999;5:7.
How Common is MS and Who Gets It?

• 8,000 – 10,000 new cases are diagnosed annually


• Affects nearly 500,000 individuals in the U.S.
• Occurs most frequently between ages 25 - 35
• Female: male ratio = 2:1
• More frequent in populations native to areas
further away from the equator
Risk of Developing MS and Region
of Origin
What Causes MS?
• Genetics
• Environmental factors
Genetic and the Immune System
Family Studies
Up to 19% of patients have an affected relative

• Monozygotic (identical) twins 25 – 30%


• Dizygotic (non-identical) 3 – 4.5%
twins
1.9%
• Child of parent with MS
0.9%
• Sibling of person with MS
Groups for Which MS Genetic Traits
Have Been Identified:
• Japanese
• African American
• Mexican
• Arabian
• Sardinian (Italy)
• Swedish
• Norwegian
• French Canadian
• Multi-ethnic Caucasian
• Finnish
• Etc.
Not Everyone with a Genetic Risk
Will Develop MS – Why?
• Risk is modified by Environmental
factors
– Sunlight
– Diet (e.g., vitamin D)
– Other lifetime experiences (infections?)
Initial Presentation of MS
Incidence (%)
Optic nerve inflammation 14–29
Poor balance (ataxia) 2–18
Dizziness (vertigo) 2–9
Weakness 10–40
Double visions (diplopia) 8–18
Bladder, bowel dysfunction 0–14
Pain 21–40
Sensory loss 13–39
Other Common Symptoms of MS

•Fatigue
•Spasticity
•Sexual dysfunction
•Cognitive impairment
–Generally occurs later in the disease
Multiple Sclerosis Clinical Subtypes
Relapsing-remitting Secondary-progressive
Disability

Disability
Time Time
Primary-progressive Progressive-relapsing

Disability
Disability

Time Time

Lublin FD et al. Neurology. 1996;46:907-911.


How Is MS Diagnosed?
• At least two episodes of symptoms
– Occur at different points in time
– Result from involvement of different areas of
the central nervous system
• Absence of other treatable causes for the
symptoms
• Results of neurological testing
Examples of MS Onset
• Case 1: 26 year old woman
– Decreased vision in the right eye in 9/05
– Left leg numbness in 1/06
– Right face numbness, right arm and leg weakness in 4/06
– Left leg weakness in 8/06
• Case 2: 45 year old man
– Left arm weakness in 2/93
– Numbness below the waist in 4/07
Other Potential Causes of
MS-like Symptoms
• Lyme disease
• Lupus
• Migraine
• Non-recurrent inflammatory process
• Encephalitis
• Stroke
• Tumor of the brain or spinal cord
How Is MS Diagnosed?
• Neurological examination
• Magnetic resonance imaging (MRI) Scan
• Blood tests
• Lumbar Puncture (spinal tap): occasionally
performed
• Other testing: infrequently performed
Assessment of the Appearance of
MS Lesions Over time

Time lapse = 1 year


Brain Atrophy (Shrinkage)
in Untreated MS

Images acquired over the course of 7 years


from a single person with untreated MS
Brain Atrophy (Shrinkage)
in Untreated MS
How is MS Treated and Managed?

• Drug therapy
– Treat new attacks (exacerbations)
– Prevent the occurrence of future attacks
– Slow or prevent disease progression
– Treat the chronic symptoms of the disease
• Physical therapy
• Psychosocial support
Treatment of New MS Exacerbations

• Drug therapy
– Corticosteroids
– Intravenous immunoglobulin
– Plasma exchange
• Physical therapy
Prevention of Future Attacks and
Disease Progression
• Immune modulating drugs
– Beta-Interferon
– Glatiramer acetate
– Humanized monoclonal antibodies
• Immunosuppressant drugs
– Anti-cancer agents
• Combination therapies
Symptom Management – Examples

• Pain control
• Management of impaired bladder and bowel
function
• Anti-spasmodic drugs
• Treatment of fatigue
• Splinting for contractures
• Counseling
MS Therapies: What Lies Ahead?

• Neural protection
• Regenerative therapies
• Cell replacement (stem cells)
• Dietary approaches (vitamin D)
Multiple Sclerosis Research at the
University of Maryland
• Drug therapies
– Injectable drugs with increased efficacy
– New oral agents
• Cell replacement therapies
– Stem cell research
• MS “vaccine”
• Novel rehabilitation techniques
– Robotics
• Dietary approaches
– Studies of the role of vitamin D in MS
Summary
• MS is a common inflammatory disease of the CNS
that affects females more frequently than males.
• The cause of MS appears to be a combination of
genetic and environmental factors.
• The symptoms of MS can be quite variable.
• MRI is a sensitive test for making the diagnosis of
MS.
• Treatments are available for reducing the number
of MS attacks and for slowing MS disease
progression.

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