1. An Introduction to Multiple Sclerosis

2. What is MS? Common symptoms. Diagnosis & potential treatments. Case Studies Support for people with MS and carers

3. Multiple Sclerosis An autoimmune condition - nerve fibres 100,000 people affected in the UK Cause unknown No Cure Usually diagnosed from 20-40 yrs Not contagious Not fatal – life expectancy reduced ~ 5-10 years

4. Causes Research suggests a combination of genetic and environmental factors: Genetics Climate/ geography Viruses/ bacteria?

5. Prevalence of MS - Worldwide

6. Diagnosis Clinical examination MRI– visualisation of inflammation Evoked potentials- measure speed of nerve conduction Lumbar puncture

7. MS – What is happening?

9. Central Nervous System The brain and spinal cord are surrounded by the blood brain barrier (BBB) Lets in e.g. oxygen & sugar Keeps out e.g. viruses & bacteria Few immune cells enter the CNS In MS the blood brain barrier breaks down

10. Skin barrier breaks down Immune cells move to the area causing redness and swelling (inflammation) Immune cells identify “foreign material” and destroy it Healing or scar development

11. Myelin Sheath

12. Permanent disability Symptoms Relapses Lost messages

14. What types of MS? Relapsing Remitting Secondary Progressive Primary Progressive Benign

15. 4 types of MS Relapsing Remitting MS Primary Progressive MS Benign MSSecondary Progressive MS

16. MS Management Main types Relapse treatments Symptom treatments – Quality of Life Disease Modifying Drugs

17. Common symptoms What are the common symptoms of MS?

18. Common symptoms Visual problems Sensory problems Fatigue Vertigo Bladder problems Bowel problems Sexual problems Tremor Spasticity/Spasm Pain Depression Cognition Personality changes Loss of mobility Speech Swallowing

19. MS & Fatigue Most common symptom - variable Overwhelming, unrelated to physical activity Cannot be seen by you Affects thought, vision, physical abilities ~~ Heat Physical exertion Infection Disturbed sleep Medication What to do? Understand variety Go at the person’s rate – plan activities etc OT can assess

20. MS & Cognition As many as 65% affected Learning and memory (recent events and remembering to do things ) Attention, concentration and mental speed Problem solving Word finding Things that make it worse are often some of the symptoms of MS.

21. Wider consequences Psychological impact (depression/ cognitive problems) Loss of mobility Home Relationships and family Finances (Incl. insurance) Employment issues Unplanned hospital admissions

22. Case studies

23. Mental Capacity Act 2005 The five key principles in the Act are: Every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. A person must be given all practicable help before anyone treats them as not being able to make their own decisions. Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision. Anything done or any decision made on behalf of a person who lacks capacity must be done in their best interests. Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.

24. Safeguarding & Capacity Safeguarding Mental Capacity Act Capacity Assessment Best Interests DOLS Court of Protection & OPG

25. Good Practice MS effects people differently Be responsive, flexible and ready to adapt to changes. My care needs can & will change – sometimes overnight! Not all changes may be due to MS Remember the MS Nurse It is obvious – but listen to me Let’s discuss contingency plans in regards to any changes in need

26. MS Society Support Education & Information Service Development Professional Network Policy & Campaigns Grants to Individuals Peer Support Branch Networks Research Fundraising Voluntary Opportunities

27. Thank You!