MS Flashcards
Multiple sclerosis (MS) is an autoimmune disorder characterized by
inflammation,selective demyelination and gliosis[1] causing both acute and chronic symptoms and resulting into significant disability and impaired quality of life. MS affects An inflammatory response occurs when the body’s immune cells attack the CNS (often referred to as an exacerbation or relapse) which leads to an increase in pressure thereby disrupting nerve conductivity.
Demyelination is a process, where myelin is damaged, due to the autoimmune response,leading to decreased nerve conduction velocity and early fatigue of the nerve. Gliosis occurs when demyelinated areas become fibrotic,causing proliferation of neuroglial tissue and scarring in the CNS. [1]
The course that MS can take will be different from one person to another as well as unpredictable.The disease can be divided into four clinical subytpes,which describes how the disease will progress as well as the corresponding characteristics that become evident for each subtype:
Relapsing-remitting MS (RRMS) is the most commone subtype, affecting 85% of people with MS and is characterized by short attacks to the CNS followed by complete or partial return to normal functioning[1].
Secondary-progressive MS (SPMS) is a subgroup that begins as a relapsing-remitting course accompanied by a steady decline in function and is often developed by patient.
Primary-Progressive MS (PPMS) is a progression of the disease where a steady decline in function experienced from the onset of the disease.
Progressive-Relapsing MS (PRMS) is similar to PPMS but has the additional characteristic of acute attacks.
MS Prevalence?
Females are 2 to 3 times more likely to have MS than males, which may indicate hormones play a role in acquiring the disease
. MS rarely occurs in children as well as adults over the age of 50 and will most commonly present between the ages of 20-40 years.
The risk of being diagnosed with MS is increased in a person, who has a sibling with MS by 3%, a fraternal twin by 5% and an identical twin by 25%.[1]
Characteristics/Clinical Presentation (MS)
Symptoms usually appear suddenly and rapidly over a period of minutes or hours,but in more rare cases the symptoms may be insidious and take several weeks to months to develop
Early symptoms:-
Numbness and weakness in one or several limbs progressing from parathesias,
Visual disturbances such as double vision and
Fatigue are typically the early symptoms that will present with MS
MS other symptoms?
Pain: Headache, chronic neuropathic pain, paroxysmal limb pain.
Cognitive symptoms: Short-term memory deficits, diminished executive function, diminished attention/concentration.
Affective Symptoms: Depression, anxiety.
Motor symptoms: spasticity, spasms, ataxia, impaired balance and gait.
Speech and swallowing: dysarthria, dysphonia, dysphagia.
Bladder/Bowel symptoms: spastic or flaccid bladder, constipation, diarrhea and incontinence.
Sexual Symptoms: impotence, decreased libido, decreased ability to achieve orgasm.
An increase in symptoms can occur with an increase in body temperature because many MS patients have a sensitivity to heat[10]. Multiple sclerosis can also cause lumbar radiculopathy.
Associated Co-morbidities (MS)
Autoimmune • Inflammatory bowel disease • Thyroid disease • Uveitis • Arthritis • Systemic lupus erythematosus
Physical • Hypertension • Hyperlipidemia • Heart disease • Cancer • Chronic lung disease • Osteopenia/Osteoporosis
Behavioral • Anxiety • Depression • Sleep disorders • Alcohol use • Obesity
Vestibular System: (MS)
Vision disturbances are a common first symptom with MS that come on suddenly in one or both eyes[15]. Symptoms may present as blurred or double vision, pain, and trouble seeing contrast in one or both eyes[15]. Vision impairments are due to inflammation and fatigue to the eye muscles and are temporary in most cases. Hearing loss is another affect of MS but less common to occur[15]. Problems with hearing usually occur due to damage to the brainstem and most commonly resolve on their own[15].
Pulmonary System (MS)
:respiratory muscles due to nerve damage can create speech as well as breathing difficulties. This complication usually occurs early on in the disease process and worsens as MS progresses[15]. Swallowing difficulties can also arise because the muscles responsible for swallowing become weak due to nerve damage. Problems with swallowing can lead to food or liquid to get into the lungs and cause an infection[15].
MS (autonomic)
MS can affect the bladder when damage to the nerves that control bladder and sphincter function occurs[2]. The bladder can become “spastic” in which it is unable to empty urine properly or a “flaccid” bladder in which it is unable to hold urine[2]. Bowel problems are another complication that can occur in MS patients and will present as a loss of bowel control as well as constipation. Sexual impairments is a common occurrence in people with MS, which occurs when the nerves sending information to the sexual organs are damaged[2]. This damage can lead to problems in arousal and orgasm. Sexual impairments can also be caused by other MS symptoms, such as fatigue, spasticity and mood[2].
