Multiple Sclerosis (MS) PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 10: Altered Neuronal Transmission Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lec...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 10: Altered Neuronal Transmission Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lecture Series Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins  Multiple Sclerosis (MS) Clinical Treatment manifestations Diagnostic Pathophysiology criteria  Multiple Sclerosis (MS) Pathophysiology Demyelinating disorder: damage to myelin nerve sheet Occur in CNS (MS) or in the peripheral NS Multiple sclerosis: CNS Chronic inflammatory disease and is a progressive disease: permanent disability after 20 years of onset Characterized by central nervous system demyelination: destruction of previously normal myelin of axons in CNS Scarring, formation of plaque, loss of axons Leading cause of neurological disability in early adulthood 3x more female than male, highest in whites Etiology: genetic, environmental factors, autoimmunity, regional variation (higher in temperate regions far above equator)  Process of Demyelination McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015 McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015  Multiple Sclerosis (MS) ClinicalManifestations Related to impaired and slowed nerve conduction Clinical course variation 1. Clinically isolated syndrome: initial presentation of symptoms 2. Relapsing-remitting: periods of acute neurologic symptoms (flare-ups, exacerbations, relapses) alternating with periods of symptom relief or return of neurologic function (remissions) 3. Primary progressive: slow, chronic deterioration of neurologic function not associated with exacerbations or remissions 4. Secondary progressive initially presenting with RR characteristics of exacerbations and remissions followed by a pattern of slow, chronic deterioration as seen in primary progressive 5. Progressive-relapsing: steady progression of a decline in neurologic function associated with exacerbations and possible remissions  Multiple Sclerosis (MS) ClinicalManifestations Common effects: Cognitive loss Bladder and bowel dysfunction Altered mobility Spasticity, paresthesia, slurred speech, fatigue, pain Common: Impaired vision due to optic neuritis or impaired extraocular eye movement Loss of visual fields, unilateral vision loss, altered color perception, nystagmus (irregular eye movements), pain Rare effect: pseudobulbar effect (uncontrolled laughing, crying) >> indicating cerebral involvement, altered emotional responsiveness  Multiple Sclerosis (MS)Diagnostic Criteria Based on clinical manifestations: presence of signs and symptoms History Physical examination Neurologic Imaging MRI: to detect plaques, lesions Evoked potentials (EP) Testing electrical activity in special sensory nerve pathways Visual EP (checkerboards), brainstem auditory EP (click sound), sensory EV (arm, leg) Diagnosis: combined subjective, objective, and diagnostic testing Based on the number of flare ups or clinical attacks, number of objective lesions  Multiple Sclerosis (MS) Treatment No cure for MS Pharmacologic Disease modifying drugs Target symptoms Delays progression of the disease Immunomodulators Immunosuppressants Non-pharmacologic Balanced rest and activity Assistive devices