Medical Aspects of DisabilityMultiple SclerosisSlide 3Slide 4Slide 5Slide 6CNS and Myelin SheathMS MRI ImagesSlide 9Slide 10Slide 11Slide 12Slide 13Slide 14Functional Disability of MSTreatment and Prognosis of MSVocational Implications of MSSlide 18Slide 19Slide 20Additional Resources and Information from the WebMedical Aspects of DisabilityMultiple SclerosisMultiple SclerosisMS is characterized by exacerbations and remissions of a multitude of signs and symptoms indicative of damage to several areas of the brain and spinal cordMS is a nonhereditary chronic disease of the CNS, with onset mostly in young adult lifeIn most cases, symptoms begin between the ages of 20 and 40, although onset before age 10 and after age 60 have been reportedThere seems to be a genetic predisposition to the disease that is modified by some environmental influenceMultiple SclerosisMS is rare in some parts of the world and more common in others – it increases in frequency with latitude in both northern and southern directionsWorldwide, MS occurs with much greater frequency in higher latitudes (above 40 latitude) away from the equator, than in lower latitudes, closer to the equator.In the U.S., MS occurs more frequently in the northern states than in southern states. Nationwide, there are an estimated 400,000 people with MS.Multiple SclerosisAn individual who is born in an area with a higher risk of developing MS and moves to an area of lower risk, acquires a risk similar to that of the new home if the move occurs prior to adolescence.MS is more common among Caucasians (particularly those of northern European ancestry) than other ethnic groups, and is almost unheard of in some populations, such as Inuit.MS is 2-3 times as common in women than in men.Multiple SclerosisCertain outbreaks or “clusters” of MS have been identified, but the cause and significance of these outbreaks is not known.In certain populations, a genetic marker, or trait, has been found to occur more frequently in people with MS than in those who do not have the disease. Thus far, no specific gene has been identified that definitely confers susceptibility to MS. Large-scale research is ongoing to identify the multiple genes that appear to make people susceptible to MS.Multiple SclerosisThe exact cause of MS is unknown, but the most widely held theory is that MS occurs in people who have a genetically determined increased immune response to viral infections and that some part of the immune response “attacks” the myelin sheath covering the different components of the CNSThe resulting pathological picture is that of scattered areas of demyelination (plaques) in the brain and spinal cordThese plaques can often be seen with an MRI scanCNS and Myelin SheathMS MRI ImagesMultiple SclerosisThere are four major areas of research focus:Immunology: new mechanisms are being tested for their ability to influence immune function, particularly the function of T cells, which clearly play a role in MSGenetics: Although MS is not directly inherited, it seems that a person must carry a genetic predisposition if he or she is to develop MS. Investigators are screening the genetic makeup of families in which more than one member has MS. This may someday help identify the genes inherited by people who are susceptible to MS.Multiple SclerosisVirology: MS is believed to be triggered by something in the environment. Although many scientists now suspect that no single virus causes MS, the key may lie in the way a person genetically predisposed to MS handles viral infections.The Biology of the Glial Cells: Myelin is manufactured by the glial cells of the CNS. Understanding how these cells function, how they form myelin, and how they might form new myelin after disease (which is the best hope for recovery of function) is an important and growing area of MS research.Multiple SclerosisThe clinical course of MS is chronic, lasting for decadesThe onset of exacerbations is acute, and remission can occur within daysThe first exacerbation is almost always followed by complete recovery, and subsequent attacks are gradually less completely resolvedWith each subsequent attack, there may be a recurrence of old symptoms and some additional onesMultiple SclerosisThe signs and symptoms vary in nature and severity, depending on the area of injury in the CNS and the chronicity of the illnessThe most common are fatigue, muscle weakness and spasticity, impaired sensation and coordination, unexplained pain, visual disturbances, gait abnormalities, bowel and bladder dysfunction, mental status changes, dizziness and vertigo, and emotional problemsA typical characteristic of MS is that all of the symptoms tend to vary in both nature and severity with timeMultiple SclerosisMS tends to take one of four clinical courses, each of which might be mild, moderate, or severeRelapsing-Remitting MS (RRMS): a relapsing-remitting course characterized by partial or total recovery after exacerbationsThis is the most common form of MS70-75% of people with MS initially begin with a relapsing-remitting courseSecondary-Progressive MS (SPMS): a relapsing-remitting course, which later becomes steadily progressiveAttacks and partial recoveries may continue to occurOf the 70-75% who start with RRMS, more than 50% will develop SPMS within 10 years and 90% within 25 yearsMultiple SclerosisPrimary-Progressive MS (PPMS): a progressive course from onsetThe symptoms generally do not remit15% of people with MS are diagnosed with PPMS, although the diagnosis usually needs to be made after the fact when the person has been living with MS for a period of time with progressive disability but not acute attacksProgressive-Relapsing MS (PRMS): a progressive course from the onset, which is also characterized by obvious acute exacerbationsIt is quite rare – 6-10% of people with MS appear to have PRMS at diagnosisFunctional Disability of MSAll aspects of function can be affected by disability, including ambulation, transfers, ADLs, vision, hearing, and mental statusGait difficulties are the most common and can include spasticity, ataxia, loss of position sense, and weaknessArm and hand function can be similarly affected, and there is often an intention tremor, which further makes self-care activities difficult or impossibleBladder functions are affectedDeteriorating vision, hearing, and speech, along with
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