Multiple Sclerosis

Disease Process

Multiple Sclerosis (MS) is an autoimmune disorder that affect the central nervous system. Loss of myelin (the nerve covering) causes scar tissue to form. This scar tissue is called sclerosis (also plaques or lesions). This decrease in myelin decreases the ability to transmit impulses which decreases function in whatever that nerve controls.

There are four types of Multiple Sclerosis:

1. Relapsing – Remitting (85% of patients with MS):
   • Clearly defined flare-ups (called exacerbations) followed by periods of partial or complete recovery.
2. Primary – Progressive (10% of patients with MS):
   • Slow but continuous worsening of the disease, with occasional changes (faster or slower) in the rate of progression.
3. Secondary – Progressive (50% of Relapsing – Remitting develop into this type within 10 years of initial diagnosis):
   • An initial period of Relapsing – Remitting type followed by a steady worsening of the disease.
4. Progressive – Relapsing (5% of patients with MS):
   • Steady worsening of the disease, occasional clear, acute relapses with or without recovery.

Causes

The actual cause of MS is unknown. Currently it is thought that an abnormal immune response attacks the body’s own myelin. There are several factors that seem to play a role including genetics, gender, and environmental triggers such as viruses, trauma or absorption of heavy metals.

Symptoms

Symptoms of MS are unpredictable and vary from person to person. The following are some of the more common symptoms seen in a person with MS.

• Bowel or bladder dysfunction.
• Changes in cognitive function (decreased memory, attention and problem solving).
• Dizziness and vertigo (sensation of spinning).
• Depression or other emotional changes.
• Difficulty walking (decreased balance and coordination).
• Numbness
• Pain
• Sexual Dysfunction
• Spasticity
• Vision Problems
• Weakness or Fatigue

Diagnosis

A diagnosis of MS is made by your health care provider. They will probably do one or more of the following:

• Take a medical history.
• Perform a physical examination.
• Complete nervous system tests checking you reflexes, sensation, balance and coordination.
• Do an MRI (looking for plaques).
• Do a spinal tap.

1. The must be signs of the disease in different parts of the nervous system.
2. The patient must have experienced at least 2 separate exacerbations (flare-ups).

Current Treatment

There is no cure for MS. Treatment focuses on:

• Modifying the disease course through the use of medications such as Avonex, Betaseron, Copaxone, Rebif or Novantrone.
• Treating exacerbations with the use of corticosteroids and physical therapy.
• Managing the symptoms.
• Improving function and safety; usually accomplished by visiting a physical, occupational or speech therapist (or a combination of all three).

How Can Physical Therapy Help

The goal of physical therapy is to maintain the patient’s functional status (level) as much as possible. During therapy and exercise, caution needs to be taken in the amount of activity done. People with MS fatigue quickly and can tired for a much longer time. They also tend to react poorly to heat and will fatigue even quicker.

• Provide an exercise program to stretch and strengthen muscles.
• Activities to help improve balance and coordination.
• Assistance with transfers and walking.
• Evaluation for and fitting of any necessary braces or other assistive equipment.

Patient Resources

National Multiple Sclerosis Society
All about Multiple Sclerosis
Multiple Sclerosis Foundation
Medline Plus
National Institute of Neurological Disorders and Stroke
Multiple Sclerosis Association of America
MS Brochure (.PDF) All About Multiple Sclerosis

Disease Process
Causes
Symptoms
Diagnosis
Treatment
Physical Therapy
Patient Resources

Facts

You have a 1 in 750 chance of developing MS. If you have a parent with MS, that increases to a 1 in 40 chance.

MS is usually diagnosed between the ages of 20 and 50.

2-3 times more women than men have MS.

Approximately 400,000 Americans have MS.