Question

Multiple sclerosis - disorder template

Answer 1

Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system that is made up of the brain, spinal cord and optic nerves.

Within the CNS, the immune system causes inflammation that damages myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves, and the specialized cells that make myelin.

• When myelin or nerve fibers are damaged or destroyed in MS, messages within the CNS are altered or stopped completely.
• Damage to areas of the CNS may produce a variety of neurological symptoms that will vary among people with MS in type and severity.
• The damaged areas develop scar tissue which gives the disease its name – multiple areas of scarring or multiple sclerosis.

Epidemiology-

Gender: Female preponderance and Female to male ratio is 2:1

Age: Usually present between 20-40 years of age and rare after 60 years of age.

Pathophysiology-

Genetic: Risk of familial recurrence in MS is 15% with the highest risk in 1st degree relative. Multiple genes interact and it has polygenic inheritance pattern . HLA DR2 Association.

Environmental: Epidemiological evidence aupports the role of an Environment exposure in MS but these factors are still largely unknown. For Example, Sunlight Exposure , Vitamin-D and Exposure to Epstein-Barr Virus.

Common Symptoms of Multiple Sclerosis are-

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or your legs and trunk
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
• Tremor, lack of coordination or unsteady gait

Vision problems are also common, including:

• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Blurry vision

Multiple sclerosis symptoms may also include:

• Slurred speech
• Fatigue
• Dizziness
• Tingling or pain in parts of your body
• Problems with sexual, bowel and bladder function

Common presentations of multiple sclerosis-
• Optic neuritis
• Relapsing/remitting sensory symptoms
• Subacute painless spinal cord lesion
• Acute brainstem syndrome
• Subacute loss of function of upper limb (dorsal column deficit)
• 6th cranial nerve palsy
• Afferent pupillary defect and optic atrophy (previous optic neuritis)
• Lhermitte’s symptom (tingling in spine or limbs on neck flexion)
• Progressive non-compressive paraparesis
• Partial Brown–Séquard syndrome
• Internuclear ophthalmoplegia with ataxia
• Postural (‘rubral’, ‘Holmes’) tremor
• Trigeminal neuralgia under the age of 50
• Recurrent facial palsy

Complications:

• Muscle stiffness or spasms
• Paralysis, typically in the legs
• Problems with bladder, bowel or sexual function
• Mental changes, such as forgetfulness or mood swings
• Depression
• Epilepsy

Diagnosis is done by-

• Blood tests, to help rule out other diseases with symptoms similar to MS. Tests to check for specific biomarkers associated with MS are currently under development and may also aid in diagnosing the disease.
• Spinal tap (lumbar puncture), in which a small sample of cerebrospinal fluid is removed from your spinal canal for laboratory analysis. This sample can show abnormalities in antibodies that are associated with MS. A spinal tap can also help rule out infections and other conditions with similar symptoms.
• MRI, which can reveal areas of MS (lesions) on your brain and spinal cord. You may receive an intravenous injection of a contrast material to highlight lesions that indicate your disease is in an active phase.
• Evoked potential tests, which record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli. In these tests, you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms.

Treatment-

Medications to slow progression

Injectable medications

• interferon beta 1-a (Avonex and Rebif)
• interferon beta-1b (Betaseron and Extavia)
• glatiramer acetate: (Copaxone and Glatopa)
• peginterferon beta-1a) (Plegridy)

Oral medications

• teriflunomide (Aubagio)
• fingolimod (Gilenya)
• dimethyl fumarate (Tecfidera)
• mavenclad (cladribine)
• mayzent (siponimod)

Infused medications

• alemtuzumab (Lemtrada)
• mitoxantrone (Novantrone)
• ocrelizumab (Ocrevus)
• natalizumab (Tysabri)

Medications for Relieving other Symptoms of flare-

Corticosteroids: These reduce inflammation and suppress the immune system. They can treat an acute flare-up of symptoms in certain types of MS. Examples include Solu-Medrol (methylprednisolone) and Deltasone (prednisone)

Behavioral changes: If vision problems occur, a doctor may recommend resting the eyes from time to time or limiting screen time. A person with MS may need to learn to rest when fatigue sets in and to pace themselves so they can complete activities.

Problems with mobility and balance: Physical therapy and walking devices, such as a cane, may help. The drug dalfampridine (Ampyra) may also prove useful.

Tremor: A person may use assistive devices or attach weights to the limbs to reduce shaking. Medications may also help with tremors.

Fatigue: Getting enough rest and avoiding heat can help.

Pain: A doctor may prescribe anticonvulsant or antispasmodic drugs or alcohol injections to relieve trigeminal neuralgia, a sharp pain that affects the face. Pain relief medication, such as gabapentin, may help with body pain.

Bladder and bowel problems: Some medications and dietary changes can help resolve these.

Depression: A doctor may prescribe a selective serotonin reuptake inhibitor (SSRI), as these are less likely to cause fatigue than other antidepressant drugs.

Cognitive changes: Donepezil, a drug for Alzheimer’s, may help some people.

Alternative Therapies-

• heat and massage treatment for pain
• acupuncture for pain and gait
• stress management to boost mood
• exercise to maintain strength and flexibility, reduce stiffness, and boost mood
• a healthful diet with plenty of fresh fruits, vegetables, and fiber
• quitting or avoiding smoking