Multiple Sclerosis

Multiple Sclerosis Pathophysiology
MS is an immune-mediated, progressive demyelinating  MS is an autoimmune disease where the body

disease of the CNS. Demyelination refers to the destruction of attacks the myelin sheaths – those sheets of fatty
myelin—the fatty and protein material that surrounds certain tissue around the nerve cells which help the body
nerve fibers in the brain and spinal cord; it results in impaired move.
transmission of nerve impulses  So the memory trick for MS – Myelin Sheath
destruction Muscle spasms and stiffness
Etiology  Myelin sheath are called muscle sheets since they
are the protective coverings around the nerve ceklss
 The exact cause of MS is unknown but is both linked
around the CNS – the brain and spinal cord which
to both genetic and environmental factors
helps the body move by sending electrical impulses,
Genetic factors from the brain to the rest of the body
 Risk factors include being a woman and having genes Clinical Manifestations
that encode specific type of immune molecule called
 May vary depending on location of plaques
HLA-DR2 which is used to identify and bind to foreign
 MS typically affects individuals between ages of 20-
molecules
40
Environmental factors  Symptoms related to bouts can typically worsen over
weeks and can linger for months without treatment
 Infections and vitamin D deficiency  One common trio of MS symptoms is called Charoct’s
neurologic triad it include dysarthria (which is
Types of Multiple Sclerosis
unclear speech) nystagmus (involuntary eye
1. Relapsing Remitting Multiple Sclerosis (RRMS) movement) and an intention tremor
 Bouts of autoimmune attacks happening months, or
Dysathria is due to plaques in the brain stem that affect nerve
even years after apart and causing increase in the
that controls muscles of mouth and throat; this can interfere
level of disability
with conscious movements like eating and talking and can lead
 With each attack more and more of the CNS get
to things like a new stutter, as well as unconscious movements
irreversibly damaged
 In relapsing MS type there’s typically no increase in Nystagmus is due to plaques around the nerves controlling
disability between bouts, so the line stays flat during eye movement  plaques around the optic nerve causes loss
that time of vision in one or both of the eyes because of damage to the
2. Secondary Progressive Multiple Sclerosis (SPMS) optic nerve, which called optic neuritis
 Initially similar to RRMS but overtime the immune
attack becomes constant which causes a steady  If there is damage to the nerves controlling eye
progression of disability. movement, then eye movement can be painful and
3. Primary Progressive multiple sclerosis (PPMS) there can be double vision, if the eyes can no longer
 One constant attack of myelin which causes a steady moving in coordinated way
progression of disability over a person’s lifetime
Intention Tremors can be caused by plaques along the motor
4. Relapsing Multiple Sclerosis (RPMS)
pathways in the spinal cord which can affect outbound signals
 Which also a one constant attack but this time there
like skeletal muscle control; motor symptoms can include
are bouts superimposed during which the diability
muscle weakness, muscle spasms, tremors and ataxia (loss of
increases even faster
balance and coordination)
Plaques in sensory pathways from skin can affect inbound

signals like sensations from the skin which causes symptoms
like numbness, pins-and –needles, and paresthesias which
(tingling feeling but may also be painful itching or bursning  Physical Therapy and cognitive rehabilitation therp
sensation) can be helpful with sensory, motor and cognitive
symptoms
 Lhermites’s Sign – when an electric shock runs down  Vitamin D
the back and radiates to the limbs when a person
bends their neck forward
Plaques in autonomic nervous system which can lead to

bowel and bladder symptoms like constipation and urinary
incontinence, as well as sexual symptoms like sexual
dysfunction
Higher order of activities of the brain causing poor

concentration and critical thinking as well as depression and
anxiety.
Assessment and Diagnostics
MS is typically suspected when there are multiple neurologic

symptoms separated in space, which is atribulate to damage in
different locations in the nervous system as well as time,
meaning separate bouts or flare-ups as well as remission.
MRI – shows multiple CNS lesions, called white matter

plaques, since these regions tend to have lots of myelin.
Cerbrospinal Fluid – where there might be high level of

antibodies, which indicates an autoimmune process.
Visual Evoked potential – can be helpful as well, which

measures the nervous system’s response to visual stimuli
Treatment
 There is no cure of MS but there are medications

which are particularly effective for relapsing-remitting
type because they lessen the severity of the relapses
and make them happen less frequently;
corticosteroids, cyclophosphamide – which is a cell
inhibitor and intravenous immunoglobulin can be used
to help blunt autoimmune process
 Plasmaheresis can be effective as well, which is
when the plasma is filtered to remove disease-
causing autoantibodies
 Chronic treatment for MS includes
immunosuppressants like recombinant beta-Interferon
which decreases the level of inflammatory cytokines
in the brain and increases the function of T regulatory
cells
 Other immunosuppresnats actually blocks T -cells
from getting into the brain by interfering with their cell
through the blood brain barrier

Multiple Sclerosis

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Multiple Sclerosis

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Multiple Sclerosis Pathophysiology

MS is an immune-mediated, progressive demyelinating  MS is an autoimmune disease where the body

Plaques in sensory pathways from skin can affect inbound

Plaques in autonomic nervous system which can lead to

Higher order of activities of the brain causing poor

Assessment and Diagnostics

MS is typically suspected when there are multiple neurologic

MRI – shows multiple CNS lesions, called white matter

Cerbrospinal Fluid – where there might be high level of

Visual Evoked potential – can be helpful as well, which

 There is no cure of MS but there are medications

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