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[1]

Multiple Sclerosis
By: Celine Jensen

[10]

Introduction

Multiple Sclerosis is a chronic progressive

disease of the central nervous system. 2

Multiple = many locations within the CNS

Sclerosis = patches of scar tissue called

plaques or lesions which form over
damaged nerves causing a interruption to
the transmission of nerve impulses. 14

Multiple sclerosis is thought to be a

immune-mediated disease, which attacks
the myelin and axons causing inflammation
and damage. When the myelin is destroyed
as a result of demyelination , the
transmission of nerve impulses becomes
slowed, distorted or halted which causes
a communication breakdown between the
brain and the body.2,4,8

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Etiology of MS
The

exact cause is. A MYSTERY .

Research suggests that a combination of genetic and

environmental factors may be involved in the development
of this disease. Most research suggests that an abnormal
response of immune system damages the myelin however
research doesnt know why this occurs. 9,3
Possible risk factors:

Genetic factors- Increased chance of MS if you have a

relative with this disease

Person's environment- Lack of sunlight and vitamin D can

lead to weaken immune system

Infections- A virus or bacteria may trigger demyelination

and inflammation in MS 2,14,15

TYPES OF MS
The classification of the disease are based on
periods of relapses and remissions. 2

What is an relapse?

Can be called exacerbations, attacks

or flare ups

It is also defined as the appearance of

new or the worsening of old symptoms
that last longer then 24 hours. These
attacks can range from mild to severe
symptoms that impact the daily
functioning of an individual. 2

What is a remission?
Remissions: when the disease doesnt
progress and the individual returns to how
they were before the relapse. 8
During these remissions the CNS can
partially heal itself when the inflammation
lessens but eventually the rate of
demyelination occurs to rapid for the central
nervous system to repair the axons. 4,16

Four Common Types of MS

According to the National Multiple Sclerosis Society classifications:

RRMS: Relapsing-Remitting Multiple Sclerosis :
It is the most common initial diagnosis 85 percent are diagnosed
Relapses occur then improve partially or completely (remissions)
then the symptoms return.
SPMS: Secondary-Progressive Multiple Sclerosis:
Approximately half of the people with relapsing-remitting MS will shift
to a progressive form of the disease within 10-20 years.
It is marked when the symptoms steadily get worse with fewer
remissions.
PPMS: Primary-Progressive Multiple Sclerosis:
Occurs in 10-15 percent of MS population
From the onset , an individual experiences a continuous worsening of
MS symptoms without any relapses or remissions.
PRMS: Progressive-Relapsing MS:
Relatively Rare occurs in 5percent of diagnosis
It follows a steady progression of symptoms just like primary
12,14,15,17
progressive
MS but experiences relapses that steadily worsen from
the onset of the disease.

[13]

+ Signs and Symptoms

There
Two

are over 50 symptoms linked with MS.

important symptoms to acknowledge is fatigue and overheating.

vision problems
spasticity of limbs
speech delays
gait difficulties
numbness and tingling
motor weakness
bowel/bladder problem
abnormal sensations
dizziness
[6]

pain
cognitive impairments( decreased attention and
memory, slow processing, problem solving changes)
emotional changes( depression ,fatigue).

2,8,11,12

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The day in the life:

http://www.youtube.com/watch?v=-BGBSsKBrbI

[7]

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Incidence & Prevalence of MS

Multiple sclerosis is the most common disease affecting the central

nervous system in young adults throughout Canada. 12,8

The MS Society of Canada says the rate of MS in this countrycould

be as high as 340 per 100,000 people.12

Alberta has one of the highest rates of MS in the world:1 in 300

Albertans and over 11,000 Albertans are currently living with MS 2

Estimates indicate that 1,000 Canadians are diagnosed with MS

each year2

MS is typically diagnosed between the ages of 15 and 40.

More than three times as many woman as men are affected by MS. 2

Between 55,000 to 75,000 Canadians have MS2

More prevalent in temperate areas of the world and rare in tropical

areas2

Caucasians have a higher incidence of MS than those of African

heritage 2

+ Prognosis

Multiple sclerosis has no cure but it is not considered a fatal

disease because majority of individuals have normal life span
expectancy. 2

The prognosis is very unpredictable because individuals will

progress differently based on what nerves have been damaged.
The textbook states that as the disease progresses, the periods
of relapses become more frequent and longer while the
remissions diminish. 8 Some people have a severe progressive
form and other people have slow progression of their symptoms
and are able to function independently for years after they are
diagnosed. 3

The most favorable course of MS has the following

characteristics:

female gender

diagnosed before 35

relapsing-remitting pattern

longer periods of remission between relapses

initial symptoms are sensory symptoms ( sensation or vision ) rather than motor

Distinguishing Features

1)Individuals with MS will have two or more attacks within the white matter of
the CNS that indicate damage is occurring and these symptoms last for 24
hours and occur a month apart.5
2) MS is extremely unpredictable compared to other diseases, you can see
two individuals with completely different functioning capabilities that were
given the same diagnosis. 5
3) Many conditions mimic the symptoms of MS however MS has a greater
variety of possible symptoms.
4) MS is distinguished by the demyelination of myelin and damage to the
axons as the primary symptom of disease and ALS demyelination is a
secondary symptom. 8
5) An individual with MS can experience many relapses and remissions of
symptoms. 12
6) Individuals with MS can live a productive life and have full life expectancy.

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Treatment:
There isnt a cure to MS, so the focus is on managing symptoms, slowing progression
of the disease , helping recovery from attacks and maximizing the individuals quality
of life.
1.Treatment of acute attacks
High-dose corticosteroids
Medications

14,15

Disease-modifying drugs (DMDS)

2,12,14,15

2.Rehabilitation and managing symptoms

OT, PT, speech pathologist, psychologist help, support groups, family counseling
Maximizing independence, enhancing participation and functioning, minimizing
complications and injuries, modifying environment/ activities . 14,15
3.Psychosocial supportProviding patient education and increase understanding about the disease
Provides coping strategies and helping individuals adjust to new changes
Provides support with emotional and cognitive problems
Involves family support

15

PTA ROLE

Areas where a PTA can focus: An PTA may be involved in assisting with
exercises to improve gross motor skills, fine motor skills, mobility, and
muscle flexibility.

1)Stretching and Exercise programs

2)Pain Management
3)Helping with Assistive equipment
4)Balance and Coordination
5)Ambulation/ Mobility

8,14

OTA ROLE
Areas where an OTA can focus: The OTA will help
increasing the individuals functional abilities with daily
living, leisure activities and making necessary
modifications to live the most independent and
productive life possible.

1)Mentally stimulation activities

2)ADLS
3)Home and work modification
4)Energy conservation
5)Patient Education

Myth or Fact:

1.

You shouldnt exercise if you have

MS

2.

You will need a wheelchair if you

have MS

3.

MS symptoms are very unpredictable

4.

MS is not curable

5.

MS is a death sentence
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Conclusion

Multiple sclerosis is a very unpredictable and complex

disease that can be very debilitating however, many
individuals are able to manage symptoms and live a
productive active life. MS is caused by degeneration and
inflammation of the myelin surrounding nerves therefore
causing a disruption in nerve signals from the brain.
Symptoms can vary from person to person depending on
what area of the CNS is impacted. Currently there is no
cure, but research is trying to find out the cause and ways
to prevent the progression of this disease. MS impacts
everyone differently and nobody should face this disease
alone, there are always places to go for support and
resources .A personalized and flexible treatment plan is
important to help improve quality of life for someone with
this disease and achieve maximize independence despite
challenges.

CLASS DISCUSSION

How would having this symptom impact your daily routine?