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Multiply Sclerosis (MS)

Multiply Sclerosis (MS). Introduction. What is MS? Symptoms Causes of the disorder Diagnostic: Audiometric/Vestibular Treatment and prognosis. What is MS?. A disease of unknown cause that affects the nervous system. Name “Multiple Sclerosis” refers to two features of the disease:

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Multiply Sclerosis (MS)

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  1. Multiply Sclerosis (MS)

  2. Introduction • What is MS? • Symptoms • Causes of the disorder • Diagnostic: Audiometric/Vestibular • Treatment and prognosis

  3. What is MS? • A disease of unknown cause that affects the nervous system. • Name “Multiple Sclerosis” refers to two features of the disease: 1. Multiple: • - 2. Sclerosis: • - The appearance of _______________________________ of scared tissue in the affected areas in CNS

  4. What is MS? cont. • Scattered plaques cause demyelination throughout the CNS system, which disrupt the transmission of messages from the brain. • Video clip: • Health and Sciences: Multiple Sclerosis 4:16

  5. Symptoms of MS 1. _____________________ 2. ____________or ___________ double vision 3. slurred or slow speech 4. Easily fatigued 5. ________________________ changes 6. Weakness or paralysis of limbs 7. Poor coordination 8. Shaking limb 9. Dragging Feet 10. Poor Balance – _____________________________ 11. Poor bladder of bowel control

  6. Attacks of MS • When demyelination happens: • A flare-up (exacerbation) of a person’s symptoms is a sign that inflammation or demyelization is occurring. • - • After an attack debris is cleared away and remylination (repair) begins. • Symptoms may_______________________________________________________________________________________________________________.

  7. Causes of MS • Unknown attack of the immune system • Theories: • Congenital defects in the nervous system structure • Direct effect of a virus or bacterial infection on the nervous system myelin • Environmental toxin or even a dietary imbalance • _______________________________________ • Health and Sciences: Multiple Sclerosis Clip – 6:17 to 8:10

  8. Diagnostic: Audiometric/Vestibular • Audiometric: 1. Immittance testing • Normal: • Tympanometry • Ipsilateral reflexes. • Abnormal: • Ipsilateral reflex decay may be absent • Contralateral reflex may be absent • reflex decay may be absent or not testable if crossover fibers of the brainstem are involved. 2. Speech - Poorer then PTA - Abnormal CAP testing ___________ ___________ ____________________ _____________________________

  9. Diagnostic cont. • Audiometric cont.: 3. Auditory Brainstem Response • Abnormal • How? • Could ABR be Normal if Pt has MS?

  10. Diagnostic cont. • Vestibular: • _________________________ • involuntary jerky eye movement • recorded during Vestibular test battery and points to central disorder • Nystagmus during fixation and eyes closed • _________________________________________________ • Vertical nystagmus • _________________________________ • Saccade – slow velocity and prolonged latencies • _________________________________________________ • Colorics – unilateral weakness and directional preponderance - Clip 3:56 NCME Multiple Sclerosis Update

  11. Diagnostic cont. • Vestibular cont.: • Platform Posturography • Poor performance in sensory organization tests (SOT) • Prolonged latencies from the lower body results in the motor control test (MCT).

  12. Diagnostic cont. • Light reflex: • Light reflex: Less dramatic response to bright light then when the light is shone in unaffected eye (Not Really vestibular test, but easy thing you can try during testing if you suspect MS)

  13. Prognosis • Prognosis: • Different for everyone: 10:25 NCME Multiple Sclerosis Update • 4 Clinical Profiles: • ______________________ – 20% • Abrupt onset • No permanent disability • Relapsing – _______________________ – 20-30% • Abrupt onset • Periods of partial or total remission • Inactive for months or years • Relapsing – _______________________ – 40% • Abrupt onset • Remissions initially • Progressive disability later in course of disease • ______________________ – progressive – 10-20% • Slow/Progressive onset of symptoms and disability

  14. Treatment • Three Types of Treatment: • Management of Acute Attack • Treatment of the underlying disease • Management of symptoms

  15. Management of Acute Attack • A flare-up (exacerbation) of a person’s symptoms is a sign that inflammation or demyelization is occurring. • Therefore _____________________ are used to reduced swelling • High-dose intravenous (IV) Methyloprednisolone • Adrenocorticophic Hormone (ACTH) • Glucocorticosteriods (GCS) • Also it is recommended to “stay active, with reasonable rest”

  16. Treatment of the underlying disease Beta Interferons: • Naturally occurring proteins that are produced when the body reacts to a foreign substance or agent such as a virus – regulators of the immune system • 1b (Betaseron), 1a (Avonex), 1a (Rebif) • Found reduction in the number and severity of attacks and • Decreases number of lesions in MRI • Slows progression on disease Mimics myelin basic protein: • Glatiramer Acetate (Copaxone) • Similar to Beta Interferons Immunosuppressive Treatment: • Azathioprine (Imuran) and Mitoxantrone (Novantrone)

  17. Management of Symptoms • Numbness • IV steroids • Amytriptyline (Elavil) – depression medication • Fatigue • Modify day schedule – naps/brief rests • Amantadine (Symmetrel) • Modafinial (Provigil) – for narcolepsy • high dosage of enteric-coated aspirin (ECASE) (Entrophen) – long-term high dose • Spasticity • Baclofen (Lioresal) • Tizanidine (Zanaflex) – good for night spasms

  18. Management of Symptoms • Bladder control • Frequency and urgency can be controlled with: • Propantheline Bromide (Probanthine) • Tolterodine tartrate (Detrol) • Oxybutynin Cloride (Ditropan) • Difficulty walking • Physical Therapy • Tremors • Propranolol (Inderal) - Beta blockers

  19. References • Burks, JS, Johnson, KP (2000) Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation. New York, NY: Demos Medical Publishing, LLC. • Holland, NJ, Murray, TJ, Reingold, SC (2002). Multiple Sclerosis; A guide for the Newly Diagnosed. New York, NY: Demos Medical Publishing. • Lechtenberg, R (1995). Multiple Sclerosis Fact Book. Philidelphia, PA: F.A. Davis Company. • Multiple Sclerosis, by: Humanities and Sciences, INC. Published by: PAD/WPF production, Texlertown, PA. • Multiple Sclerosis Update, by: Stuart Cook MD (1990) Published by: Network for Continuing Medical Education, Secaucus, NJ • Photos for Posturography: http://resourcesonbalance.com/neurocom/about/index.aspx • Rudick, RA, Goodkin, DE (1992). Treatment of Multiple Sclerosis; Trail design, results, and future perspectives. Germany: Springer-Verlag Londen Limited.

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