Kneiser 1

Multiple Sclerosis Pathophysiology 216C11 Professor Steggall Bessie Kneiser November 28, 2011

Kneiser 2

Abstract

Multiple Sclerosis is a chronic immune mediated disease that affects the central nervous system.
The bodies immune system attacks normal tissue and/or organs. The attack starts with inflammation against myelin and the cells that make the myelin. Myelin is the insulation that surrounds axons and speeds up nerve impulses. There are multiple symptoms that characterize MS. Double vision, fatigue, numbness and weakness are common traits. Pain in various extremities is common. The actual cause of MS is unknown. There is no cure. There are medications used to help treat the symptoms of MS, such as corticosteriods and interferons. It is diagnosed after an MRI of two different parts of the CNS show lesions that occurred at two separate times. The doctor must rule out any other possible explanation before diagnosing the patient. MS is very stressful for the patient and family. Planning ahead is the best option for families to help them cope with the disease. There are approximately one in seven-hundred and fifty people that have the diagnosis at any given time. MS is more common in temperate areas and unusual in tropical areas. It is extremely rare in
Africans.
MS is known as a disease of the white matter because the lesions generally appear in the white matter. The location of the lesions dictates the type of deficits that will occur. Scientists believe there are many causes that haven’t been discovered yet. One hypothesis is environmental factors or events such as a virus, bacteria, chemical or lack of sun exposure acts with the genetic predisposition to cause the immune dysfunction. There have not been any significant discoveries as of yet that will aid in the cure of MS.

Kneiser 3
Bessie Kneiser
Professor Steggall
Patho final paper
November 28th, 2011

Multiple Sclerosis Multiple Sclerosis (MS) is a chronic immune mediated disease that effects the central nervous system (Kalb Questions 7). It is most commonly diagnosed in young adults (7). Worldwide, MS is thought to affect more than two million people (7). The current estimated prevalence of MS in the United States is 350,000 to 400,000 individuals, which means approximately one in 750 people have the diagnosis at any given time (7). There are around 10,000 new cases diagnosed in the United States every year (7). MS is a chronic illness that is not always disabling but can change one's life forever (7). MS is more prevalent in temperate areas of the world (Kalb Questions 7). It is more common in individuals from Great Britain, Scandinavia, and northern Germany (8). It is relatively unusual in tropical areas (8). It is more common in the northern part of the U.S. It is extremely rare among Africans (8). MS appears mostly in people who are genetically predisposed (8). MS is considered an autoimmune disease (Kalb Questions 8). The body's immune system attacks normal tissue and/or organs (8). This attack starts with inflammation against the myelin and the cells that make the myelin (8). This process is called demyelination (9).
Leaks in the blood-brain barrier where immune cells infiltrate is what is known as the demyelination. Myelin is insulation that surrounds axons (or cell bodies in the CNS) and speeds up nerve impulses (9). In some cases of MS the axon can also be completely destroyed. Myelin is about fourty percent water, the dry portion is about seventy percent lipids and thirty percent proteins. Schwann cells supply the myelin for the peripheral neurons, and oligodendrocytes myelinate the central nervous axons. The oligodendrocytes that originally form the myelin sheath can not completely rebuild a destroyed myelin sheath. The new myelin sheaths are thinner and are not as effective as the original. When demyelination occurs it causes lesions along the myelin sheath that interfere with impulses (9). The severity of the slower impulses depends on the amount of myelin destroyed and how long it has been Kneiser 4 destroyed for. The location of the lesions in the central nervous system are what dictate the types of deficits that result. Multiple Sclerosis is known as a disease of the white matter because the lesions generally appear in the white matter and only occasionaly will appear in the gray matter. It is characterized by perivenular infiltration of lymphocytes and macrophages in the parenchyma of the brain, brain stem, optic nerves and spinal cord. After the breakdown of the blood-brain barrier accurs there are several problems that will appear such as swelling, activation of macrophages and more activation of cytokines and other proteins that are destructive. Multiple different symptoms characterize MS (Kalb Questions 13). MS can result in double vision or loss of vision (13). Fatigue, numbness, and weakness are a few very common traits in MS (13). Patients may lose control of their bowels and bladder, causing them to become incontinent (13). They will experience pain in various parts of the body (13). They will have sexual changes or more likely, lack of interest (13). Emotionally they will become depressed (13). Speech and swallowing difficulties can occur (13). Their intellect will become impaired (13). The type and number of symptoms vary from patient to patient, as does the severity of the disease (13). The actual cause of MS is unknown. The reason for the axon damage is also unknown (Kalb Questions 10). Scientists believe that there are many causes yet to be discovered (10).
One hypothesis is that MS results from environmental factors or event such as a virus, bacteria, chemical or lack of sun exposure acts with a genetic predisposition to cause the immune dysfunction (ninds).
The disease tends to appear during early adulthood when careers and family growth are at their peak (10). There is currently no cure available for MS (10). Many patients with MS are able to lead active and productive lives. For them the symptoms are episodic, they come and go (Kalb Questions 13). The symptoms are more of an annoyance or hindrance on their lives than a disabling one (13). Patients whose MS is severe and debilitating have a variety of management options available (50). These options may help to keep neurological impairments from compromising their daily activities (50). Many of the options available help improve the quality of life they live. One of the most important steps is to find a group of healthcare professionals that can accommodate the patients needs (50). The body's action and reactions to outside stimuli require quick processing (Kalb Kneiser 5
Questions 12). The body sends a report to the brain and then responds to the instructions received from the brain (12). The process depends on a coordinated transmission of nerve impulses from one nerve to the next (12). The myelin that surrounds the nerve helps speed up this transmission (12). In MS, the inflammation causes damage to the myelin (12). Most of the damage is known as silent scars (12). However, the damage that is not, interferes with sensation and function (12). This damage is irreversible (13). Currently there is are no specific blood tests, imaging techniques, tests of immune function, or genetic tests available to determine if a person has or will develop MS (13). Diagnosis is purely clinical (13). It is made on the basis of a person's medical history, assessment of symptoms, and the existence of signs detected by the physician (13). A misconception is that any acute attack on the myelination means an acute MS exacerbation, however MS must be distinguished from other neuroinflammatory disorders such as acute disseminated encephalomylelitis. Common signs that a physician detects are altered eye movements, abnormal pupil response, changes in speech patterns, impaired coordination, and weakness in the limbs (14). Cerebrospinal fluid is analyzed to detect thelevel of certain immune system proteins and the presence of oligoclonal bands (13). To make a definite diagnosis of MS, the physician must find plaque or lesions in two different parts of the CNS using an MRI machine and determine that the lesions occurred at two different times (14). They must be positive that there are no other explanations for the lesions (14). In other words, MS can only be diagnosed after all other possible explanations have been ruled out (14). There are four different types of MS (Kalbs Questions 17). Relapsing is when the acute attacks last for days to weeks and there is a full recovery (17). Primary progressive is a progression of disability from onset without any remissions or minor improvements (17).
Secondary progressive is when relapsing is the initial type occurring then later it becomes progressive (17). Progressive relapsing has a clear progression in disability level from the onset, but may have some recovery following acute episodes (17). There are several different medications offered to treat MS (Kalb Questions 52). During an exacerbation, corticosteroids are used intravenously (52). Most patients feel better when using them because they have a mood elevating effect (52).They are only used short-term because of the side effects. Interferons are a group of immune system proteins that modify the body’s immune response (53). They work by inhibiting the entry of inflammatory cells into the CNS (53). These meds are used on a regular basis (53).The medications used to treat MS are extremely expensive (54). This is because the technology used to develop and Kneiser 6 produce them is highly specialized (54). Research is ongoing to find a way to repair the myelin that is being damaged, however as of yet is unsuccessful. Physical and occupation therapy are also used to improve a patient’s overall function.
Physical therapy is used to improve movement and function of the body. The goal of physical therapy is to meet the mobility challenges and physical demands of a patient's family, work, and social life such as walking, getting into and out of the car, going up stairs, and standing (Kalb Questions 107). Occupational therapy assists individuals to manage both the variety of symptoms and the variations of symptom progression. The focus of occupational therapy is on energy conservation and the maintenance of every day skills for productive, independent living, such as dressing, bathing, grooming, eating, writing, and driving (133). Approximately twenty-five to forty percent of people with MS have speech and voice disorders (Kalb Questions 170). The disorders are caused by weakness, slowness, and uncoordination of the muscles in the tongue, lips, vocal cords, and diaphragm (171). Many experience dysarthria, which results in slurred or unclear articulation of words (171). Speech therapy is required to help treat the cognitive communication symptoms, as well as, the process of swallowing (171). Stress is another big factor in MS patients (Kalb Questions 273). Many believe that stress is one of the precipitating factors in the onset of MS and its progression (274). Most patients report significant emotional distress (274). They may go through a grieving process every time a new disability appears (274). Adjusting to MS is as complex as it is slow (275). MS is an unpredictable disease (Living). From day to day a patient will not know what to expect (Living). They won't know when and if an exacerbation will occur or how severe it will be (Living). They don't even know how they will feel from morning to afternoon (Living). Professional counseling and support groups can be very helpful in dealing with the anxiety and distress that accompany MS (Living). A family's effort to cope with the intrusion of MS into their lives is challenged not only by the complexities of the disease, but also the complexities of the families themselves (Kalb Guide 4). MS can be expensive and cause financial consequences for the entire family (2). Family members experience loss and grief with each new symptom and each change in functional mobility (3). Individual family members may feel increasing resentment toward the MS (3). The first important step to coping is to give MS no more space in the household than necessary (7). Families need to find a balance between interests and abilities of their disabled and non-disabled family members (7). Second families need to accept that they Kneiser 7 should hope for the best, but also plan for the worst that might occur (8). Many resist planning ahead because "the worst" seems too frightening (8). This type of thinking will cause family members to be totally unprepared (8). The best solution is to become educated about the potential impact MS has on the family (8). Also to take the proper steps to protect the families financial, social, and emotional well being (9). This well help each person feel less vulnerable in the face of this unpredictable disease (9).

Kneiser 8 Works Cited

Kalb, Rosalind. Multiple Sclerosis A Guide for Families. Third. New York, NY: Demos Medical

Publishing, LLC, 2006. 1-232. Print.

Kalb, Rosalind. Multiple Sclerosis The Questions You Have The Answers You Need. Third. New NY: Demos Medical Publishing, LLC, 2004. 1-601. Print.

“ Living With MS.” National Multiple Sclerosis Society. National MS Society, 11/2/2010.

0].

“ Multiple Sclerosis Hope In Research.” National Institute Of Neurological Disorders and Stroke.

National Institutes of Health, 7/1/2010.

O'Connor, Paul. Multiple Sclerosis The Facts You Need. Buffalo, NY : Firefly Books, 1998. 1-137.

Print.

[->0] - http://www.nationalmssociety.org/