1. Multiple Sclerosis (MS)
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Course: Biology 1407
Instructor: Dr. Nesterovitch
Semester: Spring 2010
Houston Community College

2. Multiple Sclerosis: An Overview
In this presentation, you will be given an overview of the disease, Multiple Sclerosis.
The following topics will be covered:
MS: What Is It?
Possible Causes of MS
Symptoms of MS
Disease Courses of MS
Methods of Diagnosis
MS Research

3. MS: What Is It? An autoimmune disease (self attacks self)
Attacks the Myelin Sheath that protects and insulates the axon portion of neuron cells

4. MS: What Is It? Axons are demyelinated and damaged
Scar tissue (sclerosis) develops in the damaged areas
Electrochemical signals normally travelling along the axons are hampered or blocked

5. MS: What Is It?

6. MS: What Is It? Attacks the Central Nervous System (CNS) only
Brain
Spinal chord
Optic nerves
Not evident in the Peripheral Nervous System.

7. Possible Causes of MS Immunologic:
MS is believed to be an autoimmune response
T-Cells attack the Myelin
Exact markers or targets on Myelin are unknown
Researchers have begun to identify the receptors on the T-Cells
Could possibly lead to immunotherapy that targets specific receptor

8. Possible Causes of MS Immunologic:
Weakness in Blood-Brain Barrier might play a role
Allowing uncontrolled T-Cell release into the CNS

9. Possible Causes of MS Environmental
MS Clusters (groups and/or time periods where higher rates of MS occurred)
MS Clusters, and their associated environments, are under study but have not yielded conclusive evidence
Hemispheric proximity
MS is known to occur in higher rates farther from the equator.
Possible link to Vitamin D/Sunlight exposure levels

10. Possible Causes of MS

11. Possible Causes of MS Genetics Not statistically a hereditary disease
Yet a higher rate of disease contraction in direct family members (parents, siblings, children) of a diagnosed patient
1-3% in families compared to 0.1% in general population

12. Possible Causes of MS Genetics
Increased frequency of specific Human Leukocyte Antigen (HLA) alleles found in MS patients compared to population
HLA: genetically determined proteins that influence immune systems and are found on Chromosome 6

13. Possible Causes of MS Infectious
No causal link established between viruses and the onset of MS
Studies are being conducted, however, on certain viruses (observed to have some effect on Myelin on their own) that may be part of a combination of triggers that causes a patient to have MS
Epstein-Barr Virus has been observed to have a closer relationship to MS in some patients, but no direct cause has been established.

14. Possible Causes of MS Summary of Possible Causes:
To date, the exact cause of MS has not been established. It is thought that MS might arise from a combination of triggers, such as both environmental and viral. Scientists continue to work to establish causal factors while also focusing on treatments focusing on the known element: the immune response (attacking the self).

15. Symptoms of MS (more common)
Numbness or weakness in limbs
On one side of body or on whole of lower body
Partial or complete loss of vision
Usually in one eye at a time
Pain often accompanies eye movement
Double vision or blurring of vision
Tingling or pain in parts of body

16. Symptoms of MS (more common)
Electric shock sensation with certain head movements
Lack of coordination or unsteady gait
Fatigue
Dizziness and vertigo
Bladder or bowel dysfunction

17. Symptoms of MS (more common)
Decrease in cognitive function performance
Sexual dysfunction
Emotional changes and depression
Spasticity

18. Symptoms of MS (less common)
Speech disorders
Swallowing problems
Headache
Hearing loss
Seizures and tremors
Respiration/breathing problems
Itching

19. Symptoms of MS
Signs and symptoms of MS vary widely among patients, depending on the location of the affected nerve fibers in the CNS
Some symptoms will come and go, while other symptoms are more lasting
Increases in body temperature tend to trigger or worsen symptoms in MS patients

20. Symptoms Summary

21. Courses of MS Relapsing-remitting (RR) MS Primary-progressive (PP) MS
MS symptoms are first observed as a series of symptomatic attacks followed by a remission period.
After a period of stability, the symptoms later return
Primary-progressive (PP) MS
After initial attacks, the patient experiences clinical decline with no apparent remission phases

22. Courses of MS Secondary-progressive (SP) MS
Begins with a RR MS course and then follows with a PP MS course
Progressive-relapsing (PR) MS
Begins with a progressive path interspersed with higher acute attacks
This course is rare in the patient population

23. Courses of MS
Approximately 20% of diagnosed patients have a benign form of the disease
After the initial acute attacks, the symptoms never return, and the patients have fully functional lives
A small percentage experience swift decline leading to significant disability or death soon after onset.
Overall, however, MS is rarely fatal, and patients have a fairly normal life expectancy

24. Methods of Diagnosis
Note: One method alone is not a final determination of a MS diagnosis, but instead a combination of methods is used to rule out the possibility of other diseases

25. Methods of Diagnosis Medical history
Investigating family history, places and dates of travel, birthplace, etc.

26. Methods of Diagnosis Neurologic exam
Testing functions of speech, vision, balance, and other motor skills and sensory functions
Evaluating mental and emotional changes

27. Methods of Diagnosis Magnetic Resonance Imaging (MRI)
Searching for locations, growth patterns, and timeline of scarring and lesions

28. Methods of Diagnosis Visual Evoked Potential (VEP)
Used to find impaired electrochemical response times along the optic nerve pathways
Slowed or impaired responses signify demyelination along the nerve fibers

29. Methods of Diagnosis Cerebrospinal Fluid analysis Measuring levels of:
Immune response antibodies
Proteins called oligoclonal bands
Breakdown proteins from damaged Myelin

30. Current MS Treatments There is no cure for MS
Due to risks and side effects, many MS patients do not use currently offered medications
Steroids, such as prednisone, are used by some patients to reduce severity and duration of attacks
Not recommended for long term use due to possible side effects of weight gain, acne, seizures, and psychosis

31. Current MS Treatments
Three forms of beta interferon are currently FDA-approved and have been observed to:
Reduce the number of exacerbations of attacks
Reduce the time and severity of attacks
May slow the progression of physical disability
Possibly decreases myelin destruction
Side effects of beta interferon: fever, chills, sweating, muscle aches, fatigue, depression, injection-site skin reactions

32. MS Research
An organization called the Myelin Repair Foundation sums up the areas of current MS research.
After reading each research area in the following slides, refer to the corresponding number in the chart following the listed research areas.

33. MS Research
“Understanding how oligodendrocytes are normally generated from neural stem cells and how multiple sclerosis perturbs this process.”

34. MS Research
“Understanding the underlying mechanism of myelination and how it is perturbed in multiple sclerosis.”

35. MS Research
“Understanding how nodes of Ranvier and paranodes are normally formed and how they are perturbed in multiple sclerosis.”
“Understanding the immune response in multiple sclerosis and how inflammation affects myelin repair. “

36. MS Research
“Understanding how the Blood-Brain Barrier is affected in multiple sclerosis and its role in the disease.”
“Development of better animal models for study of multiple sclerosis and remyelination.”

37. MS Research

38. MS Research Research goals:
Promote myelin repair at targeted locations
Gain control of the immune response that is currently damaging myelin
Prevent inflammation during myelin repair
Fortify the Blood-Brain Barrier

39. Conclusions
Multiple Sclerosis is a disease that is rarely fatal yet causes years of pain and discomfort for most patients.
The cause of MS in a patient is unknown.
A combination of triggers is a possibility.
The current treatments for MS focus on symptom management.
Research scientists are aggressively pursuing several pathways to possible cures and treatments for the disease.

40. References/Bibliography
National Multiple Sclerosis Society
Multiple Sclerosis: Hope Through Research. National Institute of Neurological Disorders and Stroke
The Merck Manuals: Online Medical Library

41. References/Bibliography
Multiple Sclerosis and Epstein-Barr Virus. Lynn I. Levin, PhD, MPH; Kassandra L. Munger, MSc; Mark V. Rubertone, MD, MPH; Charles A. Peck, MD; Evelyne T. Lennette, PhD; Donna Spiegelman, DSc; Alberto Ascherio, MD, DrPH. Journal of the American Medical Association ; 289:  
The Mayo Clinic
The Myelin Repair Foundation