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Multiple Sclerosis Student Version

This document provides an overview of Multiple Sclerosis (MS), including its etiology, epidemiology, diagnosis, risk factors, signs and symptoms, clinical problems, disease progression patterns, interventions, outcome measures, and supporting guidelines. MS is a chronic inflammatory demyelinating condition involving the immune system attacking the central nervous system. It most commonly affects people ages 20-40 and has a slightly higher prevalence in women. Diagnosis involves clinical evaluation and MRI scanning to detect lesions. Management focuses on lifestyle changes, disease-modifying therapies, and symptom management.

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46 views16 pages

Multiple Sclerosis Student Version

This document provides an overview of Multiple Sclerosis (MS), including its etiology, epidemiology, diagnosis, risk factors, signs and symptoms, clinical problems, disease progression patterns, interventions, outcome measures, and supporting guidelines. MS is a chronic inflammatory demyelinating condition involving the immune system attacking the central nervous system. It most commonly affects people ages 20-40 and has a slightly higher prevalence in women. Diagnosis involves clinical evaluation and MRI scanning to detect lesions. Management focuses on lifestyle changes, disease-modifying therapies, and symptom management.

Uploaded by

Geneva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Introduction to Neurology: PT0405

Multiple Sclerosis

April 2018
Aetiology
• A chronic (usually progressive) inflammatory demyelinating condition
involving the immune system.
• When MS is active, activated T-cells (lymphocytes) cross the blood-
brain barrier and attack myelin and oligodendrocytes causing
demyelination and inflammatory response.
• Axonal conduction/nerve transmission becomes distorted.
• Inflammation dies down in the plaque and healing mechanisms follow,
forming a scar – gliosis.
• Further episodes of acute inflammatory process can damage axons
(usually later in the disease).
Epidemiology and Incidence
• Most common disabling neurological disorder among young people.
• Most commonly diagnosed between the ages of 20 and 40; slightly
more common in women.
• Between three and seven people per 100,000 population are
diagnosed with MS each year.
• About 100 to 120 people per 100,000 population have MS.
• It is estimated that in England and Wales about 1800 to 3400 people
are newly diagnosed with MS each year and that 52,000 to 62,000
people have MS.
(NICE guidelines, 2003)
Diagnosis
• Clinical history and examination (McDonald Criteria)
• MRI scanning (MRI scans confirm a diagnosis in over 90 per cent of
people with MS.)
• Evoked potentials
• Lumbar puncture
Risk factors
• Minor gender bias ( female: male)
• Minor familial trait
• Geographical distribution
• Possible viral ‘trigger’ –link with Epstein Barr virus
• Low levels of Vitamin D
• Lifestyle factors
Global prevalence of MS (per
100,000 population)
Patterns of Disease Progression
Signs and Symptoms
• Depends on site and extent of lesion(s)
• Cerebral hemisphere- memory, processing, emotions, selective
movement, altered sensation.
• Spinal cord- weakness, spasticity, tingling, numbness, L’hermitte’s
sign, altered bladder and sexual function.
• Optic nerves- Impaired vision and eye pain
• Medulla and pons- Dysarthria, double vision, vertigo, nystagmus,
oscillopsia
• Cerebellar white matter- Dysarthria, nystagmus, oscillopsia, intention
tremor, ataxia
Primary Clinical Problems
• Weakness
• Spasticity/spasms
• Sensory loss/alteration
• Pain
• Ataxia/tremor
• Swallowing difficulty
• Speech problems
• Visual problems
• Fatigue
• Cognitive deficits
• Depression
• Emotionalism
• Bladder, bowel dysfunction
• Sexual dysfunction
Secondary Clinical Problems
• Contractures
• Muscle atrophy
• Osteoporosis
• Urinary tract infections
• Skin breakdown
• Reduced Cardio Vascular fitness
Tertiary Problems
• Income
• Status
• Social isolation
• Depression
• Anxiety
• Relationships
Multiple Sclerosis -NICE guidelines
Interventions
• Lifestyle changes
• Disease modifying therapies Interferons
• Symptom management ( pharmaceutical)
• Symptom management ( physical )
• Symptom management ( other MDT members )
• Encourage person centred care and facilitate self management and
agency
Outcome Measures
• MS clinical study measures : https://
www.nationalmssociety.org/For-Professionals/Researchers/Resources
-for-Researchers/Clinical-Study-Measures

Overarching:
• Functional Systems Score (FSS) and Expanded Disability Status Scale
(EDSS)
• Multiple Sclerosis Functional Composite (MSFC)
Specific
• 9 hole peg test
• Timed 25 foot walk; Ambulation Index
Supporting guidelines
• NICE pathways and guidelines (October 2014) https://
www.nice.org.uk/guidance/cg186

• Quality Standards (Jan 2016)


https://www.nice.org.uk/guidance/qs108

• Physiotherapy (2008)
https://
www.mssociety.org.uk/sites/default/files/Documents/Professionals/Ph
ysios/Translating_NICE_and_NSF_a%20guide%20for%20physios.pdf
References
• Marieb, E.N. & Hoehn, K. (2010). “Human anatomy & physiology”. 8th edn. San Francisco: Pearson
Benjamin Cummings
• Stokes, M. (2004). "Physical Management in Neurological Rehabilitation. 2nd edition". Elsevier
Mosby.

• MS Society (2016) MS in the UK: https://


www.mssociety.org.uk/sites/default/files/MS%20in%20the%20UK%20January%202016_0.pdf

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