OT6 - Multiple Sclerosis

7/30/2019 OT6 - Multiple Sclerosis

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In multiple sclerosis , damage to the myelin in the central nervous system (CNS), and to the nerve

fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cordand other parts of the body. This disruption of nerve signals produces the primary symptoms of MS,which vary depending on where the damage has occurred.

Over the course of the disease, some symptoms will come and go, while others may be more lasting.

Symptoms

Most Common SymptomsSome symptoms of MS are much more common than others.

FatigueFatigue is one of the most common symptoms of MS, occurring in about 80% of people. Fatigue can

significantly interfere with a person's ability to function at home and at work, and may be the most

prominent symptom in a person who otherwise has minimal activity limitations.

NumbnessNumbness of the face, body, or extremities (arms and legs) is one of the most common symptoms of MS,

and is often the first symptom experienced by those eventually diagnosed as having MS.

Walking (Gait), Balance, & Coordination ProblemsProblems with gait (difficulty in walking) are among the most common mobility limitations in MS. Gait

problems are related to several factors.

Bladder DysfunctionBladder dysfunction, which occurs in at least 80% of people with MS, usually can be managed quite

successfully

Bowel DysfunctionConstipation is a particular concern among people living with MS, as is loss of control of the bowels.

Diarrhea and other problems of the stomach and bowels also can occur.

Vision ProblemsA vision problem is the first symptom of MS for many people. The sudden onset of double vision, poor

contrast, eye pain, or heavy blurring is frankly terrifying-and the knowledge that vision may be

compromised can make people with MS anxious about the future.

Dizziness and VertigoDizziness is a common symptom of MS. People with MS may feel off balance or lightheaded. Much less

often, they have the sensation that they or their surroundings are spinning, a condition known as vertigo.

Sexual DysfunctionSexual problems are often experienced by people with MS, but they are very common in the genera

population as well. Sexual arousal begins in the central nervous system, as the brain sends message

the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathwa

sexual responseincluding arousal and orgasmcan be directly affected. Sexual problems also ste

from MS symptoms such as fatigue or spasticity, as well as from psychological factors relating to se

esteem and mood changes.

PainPain syndromes are common in MS. In one study, 55% of people with MS had "clinically significant pat some time. Almost half were troubled by chronic pain.

Cognitive DysfunctionCognition refers to a range of high-level brain functions, including the ability to learn and remembe

information: organize, plan, and problem-solve; focus, maintain, and shift attention as necessary;

understand and use language; accurately perceive the environment, and perform calculations. Cogn

changes are common in people with MSapproximately 50% of people with MS will develop probl

with cognition.

Emotional ChangesEmotional changes are very common in MSas a reaction to the stresses of living with a chronic,

unpredictable illness and because of neurologic and immune changes caused by the disease. Bouts severe depression (which is different from the healthy grieving that needs to occur in the face of lo

and changes caused by MS), mood swings, irritability, and episodes of uncontrollable laughing and

(called pseudobulbar affect) pose significant challenges for people with MS and their family membe

DepressionDepression is common during the course of multiple sclerosis. In fact, studies have suggested that c

depression, the severest form of depression, is more frequent among people with MS than it is in t

general population or in persons with other chronic, disabling conditions.

SpasticitySpasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained m

contractions or sudden movements). It is one of the more common symptoms of MS. Spasticity may

mild as the feeling of tightness of muscles or may be so severe as to produce painful, uncontrollable

spasms of extremities, usually of the legs. Spasticity may also produce feelings of pain or tightness

around joints, and can cause low back pain. Although spasticity can occur in any limb, it is much mo

common in the legs.


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Less Common Symptoms

These symptoms also occur in MS, but much less frequently.

Speech DisordersSpeech and voice problems occur in approximately 25-40 percent of people with MS, particularly during

relapses or periods of extreme fatigue. The problems are of two typesdysarthria refers to changes in

the production of speech, including slurring, unclear articulation of words, and difficulty controlling

loudness; dysphonia is the term used for changes in voice quality, including hoarseness, breathiness,

nasality, poor control of pitch.

Swallowing ProblemsSwallowing problemsreferred to as dysphagiaresult from damage to the nerves controlling the many

small muscles in the mouth and throat. When dysphagia occurs, food and liquids can pass into the airway

and lungs, causing the person to cough and choke. Because particles that remain in the lungs can cause

aspiration pneumoniaa serious complication of MSprompt evaluation and treatment by a

speech/language pathologist are essential.

HeadacheAlthough headache is not a common symptom of MS, some reports suggest that people with MS have an

increased incidence of certain types of headache.

Hearing LossHearing loss is an uncommon symptom of MS. About 6% of people who have MS complain of impaired

hearing. In very rare cases, hearing loss has been reported as the first symptom of the disease. Deafness

due to MS is exceedingly rare, and most acute episodes of hearing deficit caused by MS tend to improve.

SeizuresSeizures, which are the result of abnormal electrical discharges in an injured or scarred area of the brain,

are fairly uncommon among people with MS. Their incidence has been estimated at 2% to 5%, compared

to the estimated 3% incidence of seizures in the general population.

TremorMany people with MS experience some degree of tremor, or uncontrollable shaking. It can occur in

various parts of the body.

Respiration / Breathing ProblemsRespiration problems occur in people whose chest muscles have been severely weakened by damage to

the nerves that control those muscles. Aspiration pneumonia (resulting from the food particles and/or

liquids passing into the lungs) can also make breathing more difficult. Breathing problems, which can

contribute to MS-related fatigue and interfere with speech and voice production, should be evaluat

treated by nurses or rehabilitation professionals with expertise in respiratory problems.

ItchingPruritis (itching) may occur as a symptom of MS. It is one of the family of abnormal sensationssu

"pins and needles" and burning, stabbing, or tearing painswhich may be experienced by people w

These sensations are known as dysesthesias, and they are neurologic in origin.

Incidence and Prevalence of MS

The following observations have been drawn from existing epidemiological studies:

1. Although more people are being diagnosed with MS today than in the past, the reasonsthis are not clear. Likely contributors, however, include greater awareness of the diseas

better access to medical care, and improved diagnostic capabilities. There is no definitievidence that the rate of MS is generally on the increase.

2. Most people are diagnosed between the ages of 20 and 50, although MS can occur in yochildren and significantly older adults.

3. Worldwide, MS occurs with much greater frequency above 40 latitude than closer to tequator. However, prevalence rates may differ significantly even within a geographic awhere latitude and climate are fairly consistent. These differences demonstrate that

geographical factors are not the only ones involved.

4. MS is more common among Caucasians (particularly those of northern European ancesthan other ethnic groups, but people of African, Asian, and Hispanic ancestry also devedisease. In spite of the latitude at which they live, MS is almost unheard of in some

populations, such as Inuit, Yakutes, Hutterites, Hungarian Romani, Norwegian Lapps,Australian Aborigines and New Zealand Maorisindicating that ethnicity andgeography interact in some complex way to impact prevalence figures in different parts

world.5. Scientists have long searched for an infectious agent that might trigger MS. While man

different viruses have been suggestedincluding rabies, herpes simplex virus, measlecorona virus, canine distemper virus, HTLV-1, Epstein-Barr virus and othersnone h

been confirmed. To date, the most promising candidate appears to be the Epstein-Barr

Chlamydia pneumoniae, a bacterial agent, has also been suggested but never proven.Although no trigger has yet been confirmed, most MS experts believe that some infectiagent is involved in initiating the disease process.

6. Migration from one geographic area to another seems to alter a persons risk of developMS. Studies indicate that immigrants and their descendents tend to take on the risk leve

either higher or lowerof the area to which they move. The change in risk, however, not appear immediately. Those who move in early childhood tend to take on the new rithemselves. For those who move later in life, the change in risk level may not appear unext generation. While underlining the complex relationship between environmental angenetic factors in determining who develops MS, these studies have also provided supp


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the opinion that MS is caused by early exposure to some environmental trigger in genetically

susceptible individuals.7. MS is at least two to three times more common in women than in men, suggesting that

hormones may also play a significant role in determining susceptibility to MS. And somerecent studies have suggested that the female to male ratio may be as high as three or four toone.

8. Genetic factors are thought to play a significant role in determining who develops MS. Theaverage person in the United States has about one chance in 750 of developing MS. For first-

degree relatives of a person with MS, such as children, siblings or non-identical twins, therisk rises to approximately one in 40with the risk being potentially higher in families that

have several family members with the disease. The identical twin of someone with MS, whoshares all the same genes, has a one in four chance of developing the disease. If genes weresolely responsible for determining who gets MS, an identical twin of someone with MS

would have a 100% chance of developing the disease; the fact that the risk is only one in fourdemonstrates that other factors, including geography, ethnicity, and the elusive infectioustrigger, are likely involved as well.

9. Certain outbreaks or clusters of MS have been identified, but the cause and significance ofthese outbreaks are not known.

While the cause (etiology) of MS is still not known, scientists believe that a combination of severalfactors may be involved. Studies are ongoing in the areas of immunology (the science of the bodys

immune system), epidemiology (that looks at patterns of disease in the population), and genetics in aneffort to answer this important question. Understanding what causes MS will be an important steptoward finding more effective ways to treat it andultimatelycure it, or even prevent it fromoccurring in the first place.

The major scientific theories about the causes of MS include the following:

Immunologic

It is now generally accepted that MS involves an immune-mediated processan abnormal response of

the bodys immune system that is directed against the myelin (the fatty sheath that surrounds andinsulates the nerve fibers) in the central nervous system (CNSthe brain, spinal cord and opticnerves). The exact antigen, or target that the immune cells are sensitized to attack, remains unknown --which is why MS is considered by most experts to be immune-mediated rather than autoimmune. Inrecent years, however, researchers have been able to identify which immune cells are mounting the

attack, some of the factors that cause them to attack, and some of the sites, or receptors, on theattacking cells that appear to be attracted to the myelin to begin the destructive process. Ongoingefforts to learn more about the immune-mediated process in MSwhat sets it in motion, how it works,and how to slow or stop itare bringing us closer to understanding the cause of MS.

Environmental

MS is known to occur more frequently in areas that are farther from the equator. Epidemiologisscientists who study disease patternsare looking at many factors, including variations in geog

demographics (age, gender, and ethnic background), genetics, infectious causes, and migrationpatterns, in an effort to understand why. Studies of migration patterns have shown that people ban area of the world with a high risk of MS who then move to an area with a lower risk before tof 15, acquire the risk of their new area. Such data suggest that exposure to some environmenta

that occurs before puberty may predispose a person to develop MS later on.

Some scientists think the reason may have something to do with vitamin D (.pdf), which the humbody produces naturally when the skin is exposed to sunlight. People who live closer to the equ

are exposed to greater amounts of sunlight year-round. As a result, they tend to have higher levenaturally-produced vitamin D, which is thought to have a beneficial impact on immune functionmay help protect against autoimmune diseases like MS. The possible relationship between MS sunlight exposure is currently being looked at in a Society-funded epidemiological study in Aus

Other scientists study MS clusterswhich are defined as higher-than-expected numbers of caseMS that have occurred over a specific time period and/or in a certain area. These clusters are ofinterest because they may provide clues to environmental (such as environmental and industriadiet, or trace metal exposures) factors that might cause or trigger the disease. So far, cluster stud

have not produced clear evidence for the existence of any triggering factor or factors in MS.

Infectious

Since initial exposure to numerous viruses, bacteria and other microbes occurs during childhoodsince viruses are well recognized as causes of demyelination and inflammation, it is possible th

virus or other infectious agent is the triggering factor in MS. More than a dozen viruses and bacincluding measles, canine distemper, human herpes virus-6, Epstein-Barr, and Chlamydia pneuhave been or are being investigated to determine if they are involved in the development of MSnone have been definitively proven to trigger MS.

Genetic

While MS is not hereditary in a strict sense, having a first-degree relative such as a parent or sib

with MS increases an individual's risk of developing the disease several-fold above the risk for general population. Studies have shown that there is a higher prevalence of certain genes in

populations with higher rates of MS. Common genetic factors have also been found in some famwhere there is more than one person with MS. Some researchers theorize that MS develops bec

person is born with a genetic predisposition to react to some environmental agent that, upon exptriggers an autoimmune response. Sophisticated new techniques for identifying genes may helpanswer questions about the role of genes in the development of MS.

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OT6 - Multiple Sclerosis