Multiple Sclerosis Alan Chen 4/1/14

General Information Other names: disseminated sclerosis or encephalomyelitis disseminata Inflammatory disease that affects the insulating covers of nerve cells Causes wide range of symptoms Physical, mental and sometimes psychiatric No known cure or cause Affects women twice as often as men Disease presents itself between ages 20 and 50

Causes Causes are currently not known Could be a combination of environmental, genetic, and viral/bacterial components Genetics Probability of inheritance is higher in relatives of affected person However, not considered a “hereditary” condition Infectious agents Some microbes have been proposed to trigger MS; none confirmed Human herpes, Epstein-Barr, measles, mumps, rubella have all been proposed to potentially contribute to MS

Pathophysiology - Lesions “Multiple sclerosis”  scars that form in the nervous system Affects white matter in optic nerve, brain stem, basal ganglia spinal cord White matter is the “communication” part of the brain Loss of oligodendrocytes  thinning or complete loss of myelin sheath Neurons cannot conduct signals Scar-like plaque builds up around damaged neurons

Pathophysiology – Blood-brain Barrier and Inflammation Blood-brain barrier becomes permeable Mechanism is not completely understood Inflammation caused by T cells entering the BBB and attacking myelin T cells may recognize myelin as foreign Cytokines and antibodies are released by other immune cells during inflammation, preventing transmission of information Enhances loss of myelin Could even cause axon to break down entirely

Signs and Symptoms Most common signs are neurological Usually associated with autonomic, visual, motor, sensory problems Loss of sensitivity, changes in sensation Uhthoff’s phenomenon  higher temperatures worsen symptoms Lhermitte’s sign  electrical sensation running down back when bending your neck

Diagnostic Methods Look for key signs Issues with CNS, neurological signaling problems Administer neurological exam to test for reduced nerve function Neuroimaging  MRI Show areas of demyelination, lesion, plaque Analysis of cerebrospinal fluid Can provide evidence of inflammation Test for inflammation markers, such as IgG Visual and sensor- evoked potentials Look for less activity to stimulation in optic and sensory nerves

Healthy Brain vs. Brain with Multiple Sclerosis

Treatment There is no known cure for MS, however there are some therapeutic measures and drugs that one can take to manage the attacks Intravenous corticosteroids can assist in decreasing the severity attacks Generally, drug therapy has been seen to reduce the severity of attacks, or in some cases can help to reduce the number of attacks and frequency Some potential alternative treatments are yoga, relaxation techniques, medical marijuana, acupuncture Physical Therapy and Occupational Therapy have been seen to help as well