Multiple sclerosis

MS is an immune mediated progressive demyelinating disease of the CNS

Destruction of myelin the fatty and protien materila that surrounds certain nerve fiber in the brain and spinal cords 

impaird transmissin of nerve impulses

Age 15-50 and it affect women more often than men.

T and B lymphocytes cross teh blood brain barrier they are supposed to check the NCS for antigens and leave.  But T cells remain.  The immune system attacks causing randomly scatterd plaques of sclerotic tissues 

Cause is unknow: environmental exposure at a young age and immunologic causes are implicated.  

Europe, New Zealand, Southern australia, teh norther USA and southern Canada.

By the presence of specific cluster (haplotype) of human leukocyte andtines on the cell walls

• Onset in early adult life,
• Female 
• caucasion living in temperte limates 
• Trigeminal neuralgia 
• Fatigue, stress, and heat 

• optic nerves
• chiasm 
• and tracts 
• the cerebrum
• the brain stem 
• cerevellum 
• spinal cord 
• The Axons

Acute episodes with almost a complete recovery

Steady dgenerative progression without exacerbation

Initally RR followed by steady deterioration later in disease process 

Progressive but with periodic acute exacerbations

80-85% with each relapse recovery is complete with residual deficits 

• varied and multiple reflecting location of he lesion (plaque) 
• faigue
• depression
• weakness
• numbness 
• difficultiy in coordination
• loss of balance 
• PAIN
• visual disturbances 
• blurring visoin
• diplopia (double vision)
• Scotoma (patchy blindness
• total blindness

Fatigue

• Heat
• Depression
• anemia
• deconditioning
• medications

Social isolation

• paresthesias
• dysesthesias
• propioception loss

• opiods 
• anti-seisure 
• antidepressants 

• osteoporosis 
• estrogen loss
• immobility
• corticosteriod therapy

Muscle hypertonicity 

muscle hypertonicity of the extremites and loss of teh abdominal relexes from involvment of teh main motor pathways (pyramidal tracts) of the spinal cord. 

Cognitive and psychosocial problems 

RARE

impaird coordination of movements

Ataxia

• Charot Triad 
• intention tremors 
• nystagums 
• scalling 
• clipped speech
• ataxia
• shuffling gait
• increased deeptendon reflexes
• spastic paralysis 
• impaired bowl and bladder function 
• impotance
• cognitive loss in advanced stage 
• pallor of optic discs blindness
• Increaased immunoglobulin G (IgG) levels in the CSF
• MRI indicates demyelinatin and presence of MS

not dramatically diffrent from those with out MS.

Presence of multiple plaques in the CNS Observed in MRI.

oligoclonal banding (several bands of imunoglobulin G bonded together) which indicates an immune system abnormality.

NO CURE EXISTES!!!

• indicated to relieve the patient symptoms 
• provide continuing support 

• Delay progression 
• manage chronic symptoms 
• treat acute exacerbations

• those for modification and those for symptom managment
• such as immunomdulatin therapies, immunosuppressive agents.

• reduce the frequency of relapse 
• the duration of relapse 
• and number and size of plauques 
• all mes require injection

SQ

IM q wk

• flulike symptoms 
• potential liver damage
• fetal abnormalites
• depressin

• Reduces rate of relape in RR 
• decreases the number of plaques
• increases the time between relapses
• admin SQ Q D
• Side effects are minimal and manageble
• may take 6 months for evidence of immune response to appear

• the key in treating acute relapse in the RR
• shorten duration of relapse 
• exerts anti-inflammatory effect vy acting on T cells
• 1 gram is adim IV Q D doe 3 days followed by  a oral taper of predenisone. 
• Side effects include 
• mood swings
• weight gain
• electrolye imbalance 

• Admin via IV every 3 months
• reduce frequency of clincia relapses in PT with SP or worseing RR
• Montior for side effects of cardiac toxicity

• Baclofen 
• GABA agonis - tx of spasticity
• Benzodiazepines (valium)
• Tizanidine (Zanaflex)
• Dantrolene (Dantrium)
• Symmeterel 
• Cylert
• Prozac 
• Inderal 
• Neurontin
• Klonopin

• History of onset and progression of motor and sensory loss
• factor that intensify symptoms
• neurologic status 
• Glasgow Coma scale

• The major goals may include 
• promotion of physical movility 
• avoidance of of injury
• achievement of bladder and bowel continece 
• promotion of speech
• swallowing mechanisms 
• improvement of cognitive function
• develpompent of coping skills 
• improved home maintence management 
• adaptation to sexual dysfunction

• Relaxation and coordination exercises promee muscle efficency.
• Progressive resistive exercies to strengthen weak muscles.

• Walking to improve gait
• if muscle groups are iffeversibley affecte other muscle can be trained to compenste. 
• teach use of assistive device.

• Severe adductor spasm of the hips wieh flexor spasm of the hips and kness
• Warm packs can be applied 
• no hot baths due to risk for injury secondary to sensorly loss
• increaed temp can incre symptoms
• Daily exercises for streaching to min contractures
• Swimming and bicycleing are useful 
• weight bearing can relive spasticity in th elegs
• PT should not be hurried may increase spasticity

• work to just short of fatigue 
• strenous exersice not advised due to increased body temp
• take short rest periods,preferably lying down 
• Extreme fatigue may contribute to exacerbation.

• effects such as 
• pressure ulcers
• expiratory muscle weakness 
• accumulaton of brochial secretions 
• conduct coughing and deep breathing 

• teach to walk with feet apart to widen the base of support and increase stability
• if positon sense is lost have PT watch feer while walking
• gait training with assistive devices
• if gait is ineffective may use wheelchair or motro scooter
• weighted braclets for movement control

inability to store urine

inability to empty bladder 

• voiding schedule 1.5-2 hrs and increase time
• drink measured amount of fliud Q2hr and void 30 min later
• use timer 
• take meds to TX bladder spasticity
• intermittent self cath to maintain bladder control
• bowel problems include fecal impaction constipation and incontince

• speech therapy
• take small bites 
• chew well 
• use straw with liquied 
• eat food of more solid consistancy

• if cranial nerve affecting vision may use an eye patch
• for diplopia
• Prism glasses 
• talking books

• Improve physical mobilit
• is free of injury
• attains or maintaind control of bladder and bowel patterns
• participate 
• in stratiges to imporve speech and swallowing
• compenstes for alter thought process
• demonstrates effective coping stratagies
• adheres to plan for home maintenace managment
• adapt to changes in sexual function