Multiple Sclerosis Presentation PDF

Presentation by Lois Stevens Multiple Sclerosis Senior Lecturer MULTIPLE SCLEROSIS Most common disabling neurological disease amongst young adults. Approx 85,000 people in the UK, though recent mapping has shown this to be more likely nearer 100’000.  2,500,000 worldwide. ...

Presentation by Lois Stevens Multiple Sclerosis Senior Lecturer MULTIPLE SCLEROSIS Most common disabling neurological disease amongst young adults. Approx 85,000 people in the UK, though recent mapping has shown this to be more likely nearer 100’000.  2,500,000 worldwide. Women more likely then men (2:1) Diagnosis usually between 20 and 40 years. Epidemiology Prevalence increases as you move away from the equator. Race Certain ethnic groups have a lower prevalence (i.e. Maoris in New Zealand) Migration Moving as an adult from an area of low risk to an area of high risk you retain the risk from the original area. Moving as a child you obtain the local risk. CAUSES Genetics Infection Lack of sunlight Diet Environment CHANCE Pathology Pathology  Pathology Progressive autoimmune inflammatory disorder affecting CNS myelin Demyelinating plaques appear in the white matter as seen in radiographic images Preponderance of lesions in the peri- ventricular white matter, within the optic nerves and in the long tracts of the spinal cord  Pathology Acute lesion: marked inflammatory reaction, destruction of myelin and degeneration of oligodendrocytes – relative sparing of the cell body and axon Older lesion: infiltration with macrophages, proliferation of astrocytes, laying down of fibrous tissue Ultimately leaves a fibrous scar with no potential for recovery  Pathology Axonal damage in late stages of the disease Probably responsible for the more progressive and chronic forms of the disease Shows on MRI as brain atrophy, degeneration of the ascending and descending tracts and ventricular dilation MRI DIAGNOSIS CLINICAL SIGNS MRI LUMBAR PUNCTURE VISUAL EVOKED POTENTIALS Site of damage Spinal cord. Brain Stem. Optic Nerve Cerebellum. Areas involved with thought and emotion. Non specific area. Clinical signs will reflect the site and severity of lesions.  Cerebellar Signs Ataxic gait – wide base/poorly co-ordinated limb placement Intention tremor – only during volitional movement, not seen at rest Dysmetria – overshooting/undershooting Dysdiadochokinesia Slurred speech - rhythm and flow disrupted Balance difficulties  Impairments Spasticity and spasm Weakness Fatigue Pain Gait impairments https://youtu.be/W8nCWxMbSDU TYPES OF MS TYPES OF MS TYPES OF MS TYPES OF MS TREATMENTS - PHARMALOGICAL Disease modifying drugs Beta Interferon 1a (Avonex, Rebif) Beta Interferon 1B (Betaferon) Glatiramer acetate (Copaxone) Can reduce the relapse rate for people with RRMS by about one third over a two year period. TREATMENTS - PHARMALOGICAL STEROIDS Methylpredinisolone Helps to reduce inflammation  Year 2 Treatments Research Outcome Measures