REACH supports patients to live well with MS

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Going beyond medicines & medication

"This material is copyright of Biogen Idec. All rights reserved. Any reproduction of part or all of this material in any form is prohibited”
 A look at the Nervous System

A single neuron has DENDRITES

that branch out to make contact
with many other neurons.

CELL NUCLEUS

THE NERVE CELL BODY

is the heart of the nerve
containing the cell nucleus.

DI
RE
CT
AXONS are nerve fibres, which

IO
O

N
OLIGODENDROCYTE F can be up to a metre long.
forms a layered wrapping NE Axonterminals are where the nerve
RV
Multiple around the nerves or across. EP
UL
SE
divides to form connections with other
nerves controlling muscles and glands.
Sclerosis The gap between myelin
sheaths allows the nerve
signals to jump across
the nerve - it is called
the NODE OF RANVIER. Myelin Sheath
insulates the nerve fibre
or axon. it is formed by
oligodendrocytes. Nerve Fibres or Axons
carry the body`s electrical
DIR

impulses away from the cell

EC

body to glands and muscles

TIO
N
O

N
F

DAMAGED MYELIN SHEATH ER

V EP
UL
SE
Neurons are the body's most specialised cells. At the
heart of the nervous system, neurons act like electrical
wiring. They receive signals and carry that signal from
one part of the body to another via the central nervous
system. In MS, the myelin sheath is 'attacked' by the
body's immune system and the damage causes poor
conduction of the nerve impulses. A MACROPHAGE is one of the cells of the immune system
that attacks and remove the damaged sections of myelin,
causing poor or non existent electrical conduction.

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 What is Multiple Sclerosis (MS)?
Multiple Sclerosis is a chronic disease where the covering of some nerves in the brain
and spinal cord (central nervous system), called myelin, becomes damaged

Genetic Predisposition
How MS interrupts nerve signals

Normal nerve cell Central nervous system

(brain and spinal cord)
What causes MS?

Axon Infectious Agents Environmental Factors

Myelin

Nerve cell affected by MS

Abnormal Immunologic Response

Damage
to myelin

MS
Ø MS affects up to 25,00,000 people worldwide.

Ø Your physical and mental functions are normally controlled through signals transmitted from the central nervous system (the brain and spinal
cord) to other parts of your body.

Ø In MS, these signals can become interrupted, causing a wide range of symptoms.

Ø MS is usually first diagnosed between the ages of 20 and 40 years.

Ø It occurs in twice as many women as it does in men.

Despite a great deal of research, we still do not know what triggers MS

Ref.: Compston A, Coles A. Multiple sclerosis. Lancet 2002;359:1221–31

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 SYMPTOMS OF MS?
Doctors suspect MS in people who suddenly develop blurred or double vision, movement problems
and/or abnormal sensations, such as tingling over their body

Problems with balance Weakness or deteriorating

Visual disturbances Extreme fatigue Mood changes
& co-ordination muscle strength

Muscle stiffness Bladder and bowel

Tingling and numbness Memory loss
or spasms problems

Ø The symptoms of MS vary greatly from person to person. There are no 'typical set of symptoms' for MS.

Ø An individual’s symptoms depend upon which nerve fibres are affected.

Ø If the nerve fibres that carry sensory signals are affected, the individual will experience abnormal sensations and various other sensorysymptoms.

Ø If the nerve fibres carrying signals to the muscles are affected, the person will suffer movement symptoms.

Ref.: Compston A, Coles A. Multiple sclerosis. Lancet 2002;359:1221–31

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 How is MS diagnosed?

MS presents differently in each person. It may mimic many other nervous system disorders.
MS is typically diagnosed by observing symptoms over a period of time, combined with the results of medical tests

Review of person’s medical history Eye examination to determine

and perform a neurological examination whether the person’s optic nerve
(to check the person’s nervous system) is inflamed or unusually pale

Evoked potentials measure the time

it takes for the brain to receive
and interpret messages from the
Magnetic resonance imaging (MRI) a scan body. If myelin damage has
of the brain and spinal cord which in MS occurred, messages will take
reveals areas of inflammation & scarring longer to get through

Lumbar puncture or spinal tap is a test where a needle is inserted into

the lower part of the back to get a sample of the fluid that surrounds
the brain and spinal cord (cerebrospinal fluid) is removed.
Ref.: Compston A, Coles A. Multiple sclerosis. Lancet 2002;359:1221–31

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 WHAT IF I HAVE MS?
Is everyone's MS the same?
Ø Both the symptoms and course of MS can vary considerably from person to person.

Ø By assessing the pattern and frequency of your MS related symptoms, clinicians will be able to determine the type of MS you have and its likely course.

Ø Relapsing remitting MS accounts for 80% of new diagnoses in people who are first diagnosed with MS.

Relapsing Remitting MS (RRMS) Secondary Progressive MS (SPMS) Primary Progressive MS (PRMS) Progressive Relapsing MS (RRMS)

High High RRMS SPMS High High

Disability
Disability

Disability

Disability
Low Time in years Low Time in years Low Time in years Low Time in years

Recovery after a relapse may not After MS has started off with a pattern of Progression of neurological disability occurs The periods between relapses are
always be complete. relapse and remission, there comes a time gradually from onset without occurrence of characterised by continuing disease
when gradual progression of the disease relapses progression.
becomes noticeable, occurring between the
periods of relapse.

What is an MS relapse?
Ø A relapse is usually defined as a new symptom or deterioration of an existing symptom that lasts for more than 24 hours.

Ø Relapses are also often called exacerbations, flare ups or 'attacks’.

What is remission?
Ø Remission defines the period during which a person’s MS is stable and there are no new symptoms.

Ø It is important to remember that, even during remission, individuals may have on-going symptoms related to previous MS relapses or problems.

Ref.: Compston A, Coles A. Multiple sclerosis. Lancet 2002;359:1221–31

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 How do I start dealing with MS?

Healthy changes to your lifestyle can give you more strength,

Discuss the benefits of starting therapy with your doctor
energy and confidence in managing your MS.

Learn about your condition Live healthy lifestyle

The more you understand MS, the better informed you will be to make important Cut back or eliminate junk food and add more fruits and vegetables to your diet.
treatment decision, and manage possible flare-ups as they occur.

Please refer to your doctor to make determinations of suitability of treatment for your Exercise may improve your problems with fatigue, as well as increase your overall
type of MS. energy level. Consult your doctor regarding exercises suitable for you.

Research shows that MS therapy may help in reducing the number of flare-ups, slowing Quit smoking Smoking strains your lungs, making fatigue worse and compounding the
down physical disability, and reducing brain lesions. effects of MS

Remember there’s more to life than dealing with MS. Many people with MS can continue to live a full and active life.

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 Living well with MS

Your Body Monitor Bladder and Bowel Function

ü Develop an exercise program that best suits ü Drink plenty of water
your capability and need ü Try to urinate regularly (i.e. every 2-3 hours)
ü Set up regular routine for exercises ü Wear loose clothes that are easy to unfasten
ü Always rest after exercise ü Speak to your doctor, if you have inability to hold
urine or difficulty emptying the bladder

Eat Healthy Do things to reduce anxiety

ü Eat well and eat healthy ü Learn more about your disease
ü Include variety of foods rich in fibre ü Find support group to meet and talk to others
ü Seek advice form qualified dietician ü Plan ahead
ü Avoid isolating yourself from others
ü Set aside regular time to relax
ü Talk with counsellor about coping stratergies

Minimize Fatigue Maintain your self esteem

ü Do regular exercise ü Continue to value yourself and what you have to offer
ü Prioritise activities and learn to pace yourself ü Set goals and take small steps to achieve them
ü Plan your activities in advance ü Praise yourself when you achieve your goals
ü Be energy efficient ü Plan things in advance and have something to look
ü Delegate whenever possible forward to
ü Participate in regular activities
ü Try to remain positive

Look at your situation as a fresh beginning and focus on good things in your life

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 Relationships Pregnancy and MS
ü Acknowledge your partners feelings and anxiety ü MS is generally less active during pregnancy
about your condition ü Relapses tend to occur less frequently
ü Work together with your partner to overcome ü MS does not hinder a woman’s chance of becoming
difficulties pregnant and carrying a child to full term.
ü Peoples relationships often change due to poor ü However, an increase in symptoms is noted during
communication or misunderstandings the postpartum (after delivery) period.
ü Try to be open and honest with your partner ü Pregnant women with MS must have a close
ü Share your feelings to family and friends monitoring of the disease and of fetal well-being
throughout the pregnancy, in delivery and post
partum.
ü Consult your doctor if you are planning to start a
Children's family
ü Listen and acknowledge your children's questions
ü Don’t hide the truth about your condition
ü Let them know that at times you may get angry or
frustated Depression and MS
ü Depression is common in MS patients
ü Recognize the signs of depression
ü There are numerous treatment options available
ü Consult your doctor if you are planning to start a
family

Employment
ü With MS you can continue your work for many
years after diagnosis
ü Take short breaks if you get tired
ü Arrange your desk for easy access to things around
you
ü Ensure your chair is at good height to maintain good Don’t be afraid to share your feelings and concerns
posture with people who can help you
ü Do things that are achievable and fun

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