MULTIPLE SCLEROSIS WHAT IS MULTIPLE SCLEROSIS (MS)? MS is an inflammatory demyelinating condition of the central nervous system. Myelin is a fatty material that covers the nerves and serves to transmit nerve impulses rapidly. Speed and efficiency of the transmission are important for smooth, rapid, and coordinated movements. The loss of myelin prevents the nerves from conducting impulses back and forth from the brain, which causes the symptoms of MS. The areas where the myelin is lost is called plaques or lesions. These lesions appear in various areas of the brain and spinal cord and may appear at different times. WHO GETS MS? *MS is not a contagious disease nor is it inherited or genetically transmitted, but there seems to be some genetic susceptibility to the disease. *MS appears to be more prevalent the further one lives from the equator. *MS appears 50% more frequently in women than in men. *The mean age of onset of MS is 29-33 years. (early MRI diagnoses have lowered this age by 15 years) WHAT CAUSES MS? The cause of MS is not yet known. Researchers do know that the immune system attacks its own myelin, which suggests an auto-immune disease, but they do not know why this happens. One theory is that a virus may cause the auto-immune process to begin. WHAT ARE THE SYMPTOMS OF MS? Symptoms of MS depend on the location of the lesions within the central nervous system. MS is a variable disease in that there is no set pattern, severity, or duration of symptoms. The systems that are commonly affected are: * vision * coordination * strength * sensation * speech and swallowing * bladder control * sexuality *cognitive function WHAT ARE THE TYPES OF MS? Relapsing-Remitting MS: This form of MS is characterized by unpredictable relapses during which new symptoms appear or existing symptoms become more severe. This can last for varying periods and there can be partial or total remission. FREQUENCY- 25% Benign MS: This form of MS does not worsen with time and there is not permanent disability. This type is only identified when there is minimal disability 10-15 years post-onset. The initial diagnosis would have been relapsing-remitting. FREQUENCY- 20% Secondary Progressive MS: This form is first diagnosed as relapsing-remitting, but then becomes progressively disabling with superimposed relapses. FREQUENCY- 40% Primary Progressive MS: This form is characterized by a lack of distinct attacks. Onset of this type is slow with steadily worsening symptoms. The accumulation of deficits may level off or continue to worsen. FREQUENCY- 15% Conventional Treatments Various medications have been effective in slowing the progression of MS and reducing the frequency of relapses, which may reduce cumulative disability of the person with MS. The purpose of medication is to modify the response of the immune system, which is thought to attack mylen. Betaseron is the most common treatment that has been proven effective for people with relapsing-remitting MS, who are able to walk. Betaseron is made from recumbent DNA and is taken by injection. Disadvantages of this medicine are that it is expensive, injections are rarely covered by insurance ( but there are foundations that help ), effects may be reduced by "blocking antibodies" after 1-2 years, and there are no direct effects on symptoms such as fatigue and muscle spasms. Other medications include Prednisone, steroids, Chemotherapeutic agents, and immune suppressors. Alternative Treatments Many alternative treatments have been used because there are few medical treatments available. These treatments need to be proven effective for the individual and not a result of a placebo effect or spontaneous remission. When a person with MS is considering alternative treatment, they should be encouraged to compare the benefits of the treatment to the amount of time, money, and energy available to do it. Types of treatments and symptoms they may help: Acupuncture - pain; Hypnosis - anxiety attacks; Acupressure - muscle spasticity, pain, fatigue; Chiropractor - relief of limb contractures, muscle pain; Massage - relaxes muscles, increases blood flow, improves joint mobility; Visualization/meditation - positive effect on immune system, decreases stress; Tai Chi - balance of energy, increases muscle tone, flexibility, improves coordination, increases self-esteem; and Bee Stings - have been shown to improve immune system, research is being done. Health Care Team Varies according to the needs of the person with MS. Resources can be found with the assistance of the National Multiple Sclerosis Society. Typical team members and role: patient with MS, PT - design individualized exercise plan, primary care MD - general health concerns, Neurologist - manage medical treatment, Psychological counselor - coping and cognitive problems, OT - ADL's, SLP - motor speech disorders, urologist - bladder problems, and Social Worker - identify available resources. Social Aspects/Support Family and friends have an important part in providing emotional support and assisting the person with MS with managing diet, exercise, sleep, and stress. Withdraw of family and friends is common due to confusion and feelings of helplessness. To avoid isolation the person with MS can communicate with their family and friends to help them understand and help effectively. References Cook, S.D. (1996). Handbook of multiple sclerosis. New York: Marcel Dekker, Inc. Kraft, G.H. and Catanzaro, M. (1996). Living with multiple sclerosis; A wellness approach. New York: Demos Vermande.
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