Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

Chronic progressive neurological condition that affects the central nervous system (brain and spinal cord).
Autoimmune disease (body’s immune system attacks it’s own tissues)

Question 2

What happens in MS?

Answer 2

MS- attacks protective coating (myelin) that surrounds nerve fibres in the central nervous system

Question 3

What symptoms occur in MS?

Answer 3

 Muscle weakness
 Visual problems
 Fatigue
 Difficulty with coordination/balance

Question 4

What is the treatment for MS?

Answer 4

o Medications to reduce inflammation
o Slow progression
o OT and PT therapy to improve mobility and balance
o Lifestyle changes to stress and exercise

Question 5

Aetiology of MS

Answer 5

o Genetic - genetic predisposition, HLADR2, exposed to particular virus, develops a immune response to virus
o Environmental - linked to low vitamin D
o More common in women 20-40 years old
o Exposure to Epstein virus and human herpes virus can lead to onset of MS

Question 6

What are the mechanisms of MS?

Answer 6

• Oligodendrocytes - release of types of molecules - interleukin, TNF act on the area and, express some cell adhesion areas
• When people are exposed to a particular antigen (viral agent)
  o Normal process = macrophages engulf the antigen and then express the cell on its cell membrane - phagocytosis (engulfs the virus) and when it expresses the cells on the cell membrane, the Helper T cells

Question 7

What are the types of MS?

Answer 7

• Relapsing remitting (90% of MS types)
• Secondary progressive
• Primary progressive
• Progressive relapsing

Question 8

What is relapsing remitting MS?

Answer 8

Flare up as a result of increased deteriation of symptoms, person returns to somewhat improved level of functioning - it’s a progressive decline in function

Question 9

What is secondary progressive MS?

Answer 9

Starts same as relapsing remitting then the Demyelination progresses to a constant state

Question 10

What is primary progressive MS?

Answer 10

Demyelination occurs at constant state

Question 11

What is progressive relapsing?

Answer 11

Continuous myelination with increasing ‘bouts’ (massive flare ups and then slight improvement)

Question 12

What are the signs and symptoms of MS?

Answer 12

• Fatigue
• Dizziness
• Depression
• Pain
• Vision problems
• Bladder problems
• Cognitive problems
• Muscle weakness
• Difficulty with coordination/balance

Question 13

What is the medical treatment of MS?

Answer 13

• Regular exercise.
• Keeping healthy sleep patterns.
• Energy-saving techniques.
• Avoiding medicine that can worsen fatigue (including some painkillers
• Acute relapse management
• Disease modifying treatments

Question 14

What are the complications of MS?

Answer 14

• Muscle stiffness or spasms
• Severe weakness or paralysis, typically in the legs
• Problems with bladder, bowel, or sexual function
• Cognitive problems, like forgetfulness or word finding difficulties.
• Mood problems, such as depression, anxiety, or mood swings
• Seizures, though very rare

Question 15

What is the impact on OP for MS?

Answer 15

Gradual loss of independence in ADLs, and IADLs, and meaningful occupation due to progressing conditions and symptoms
- Balance
- Mobility
- Visual issues
- Coordination

Question 16

How many types of fatigue are there in MS? Name each of the types of fatigue that might be experienced by a person who has MS.

Answer 16

2 types
Primary fatigue – fatigue caused by nerve damage
Secondary fatigue – fatigue caused by factors related to MS

Question 17

What is diplopia?

Answer 17

MS can also have an effect on parts of your brain that control how your eyes move. This can cause symptoms of double vision or wobbly vision

Question 18

What is ataxia and how does MS cause ataxia? (Extension learning: What is a Rombergs Sign?)

Answer 18

Ataxia is a lack of coordination of muscle movements which can appear as clumsiness, unsteady gait, impaired eye and limb movements, speech problems and sometimes dizziness

Question 19

Why is a person with MS intolerant to heat, and what are the functional implications of heat intolerance and mood changes?

Answer 19

being overheated slows down the messages passing along nerves, which have already been damaged by the loss of myelin and this gives rise to increased symptoms. In some cases, there’s a lesion in a part of the brain that controls temperature regulation in the body.

Question 20

What is the difference between a cognitive impairment and a flat affect?

Answer 20

1. A person with a flat affect is note to show diminished or lack of normal emotion, This could include facial expressions, monotonous voice, or reports that they are apathetic or ‘don’t care’
2. A cognitive impairment involves deterioration in the ability to process, learn, and remember information. This can be evident in difficulty in carrying out tasks that require thinking, planning, and memory.

Question 21

What is myelin and its role in MS?

Answer 21

Myelin is the sheath that surround nerves in the body. Myelin allows conductivity along the nerves and damage to it can interrupt motor or sensory message between the body and the brain. In MS breakdown of the myelin occurs ‘demyelination’ and this causes inflammation. As the inflammation builds up scar form resulting in ‘scleroses’. This results in long term nervous damage and a deterioration in motor and sensory function.

Question 22

At what age is the onset of MS most prevalent?

Answer 22

20-50 years

Question 23

What is the difference between MS related neuromuscular fatigue and lassitude?

Answer 23

Lassitude is an overwhelming tiredness that comes on for no obvious reason whilst neuromuscular fatigue is caused by inefficient nerve conduction. To stop or ‘short circuit’ the fatigue and periods of rest or inactivity need to be taken. Strategies to do so include staggering social or work commitments

Question 24

what are the early symptoms of MS?

Answer 24

• Blurry vision
• Increased fatigue
• Decreased attention
• Pins and needles
• Difficulty in bladder control
• Impaired balance