CLAUDIA’S NOTES ON

MULTIPLESCLEROSIS

CLAUDIA CHANDLER, THE CHICAGO SCHOOL, 2014

• Multiple Sclerosis (MS) is a chronic, oftendisabling disease that attacks the centralnervous system (CNS), which is made up ofthe brain, spinal cord, and optic nerves.• Symptoms may be mild, such as numbnessin the limbs, or severe, such as paralysis orloss of vision.• The progress, severity, and specific symptomsof MS are unpredictable and vary from oneperson to another. Today, new treatments andadvances in research are giving new hope topeople affected by the disease.

• Multiple Sclerosis (MS) is a chronic, oftendisabling disease that attacks the centralnervous system (CNS), which is made up ofthe brain, spinal cord, and optic nerves.• Symptoms may be mild, such as numbnessin the limbs, or severe, such as paralysis orloss of vision.• The progress, severity, and specific symptomsof MS are unpredictable and vary from oneperson to another. Today, new treatments andadvances in research are giving new hope topeople affected by the disease.

The Invisible Side ofMultiple Sclerosis (MS)Understanding and Treating Psychosocial Barriers

What is Multiple Sclerosis? (MS)

>Predominant age: 20-40

MULTIPLE SCLEROSIS AFFECT:0.1%Worldwide incidence

Higher incidence in Northern European descent and in temperate climate, but the latitude gradient is decreasing

The ratio is increasing

now

people in US have MS

400, 000 1–3% risk of MS among 1st-degree relatives

worse prognosis

Highly variable and unpredictable

Blood-brain barrier breakdown

The BBB prevent entrance of T cells into the nervous system. The blood–brain barrier is normally not permeable to these types of cells, unless triggered by infection or a virus, which decreases the integrity of the tight junctions. When the blood–brain barrier regains its integrity, usually after infection or virus has cleared, the T cells are trapped inside the brain.

Autoimmunology The immune system attacks the nervous system, forming plaques or lesions.Commonly involves white matter.Destroys oligodendrocytes- causing demyelinationRemyelination occurs in early phase but not completely.Repeated attacks lead to fewer remyelination.

Inflammation T-cells attacks on myelin triggers inflammatory processes, stimulating other immune cells and soluble factors like cytokines and antibodies. Leaks form in the BBB cause swelling, activation of macrophages, and more activation of cytokines and other destructive proteins

Pathophysiology

The most common initial symptoms •changes in sensation in the arms, legs or face (33%)•Optic neuritis (20%)•weakness (13%)•double vision- internuclear opthalmoplegia (7%)•unsteadiness when walking (5%)•and balance problems (3%)

Lhermitte's sign  (25-40%) is an electrical sensation that runs down the back and into the limbs and is produced by bending the neck forwards. The sign

suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla.

Uhthoff's phenomenon is the worsening of neurologic symptoms in multiple sclerosis and other neurological,

demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot

tubs.

DisconnectMedical vs. Psychosocial

DisconnectMedical vs. Psychosocial

Overwhelmed with diagnosis- Overloaded by amount ofinformation they are given- Depression due to isolation andmounting losses- Fear and uncertainty about thefuture- Loss of roles: parent, spouse,worker, active member of society- Concern about financial issues- Difficulty with activities of daily

““

“The quality of life inpatients with MS is not solely

determined by physicaldisability, but rather by the

level of social support, living area,depression, level of education,

employment, fatigue and religiosity…we suggest that these should be

evaluated in every patient with MSas they may be modified by

targeted interventions.”

(Yamout et al, 2013)

“The quality of life inpatients with MS is not solely

determined by physicaldisability, but rather by the

level of social support, living area,depression, level of education,

employment, fatigue and religiosity…we suggest that these should be

evaluated in every patient with MSas they may be modified by

targeted interventions.”

(Yamout et al, 2013)

Bring on the Healthcare Extenders!

(The treatment team)

Awesome!