Name: Aryaman Singh Class: Xii-L Roll No.

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Name : Aryaman Singh

Class : Xii-L

Roll No. :
INDEX

Topic Page no.

Certificate (i)

Acknowledgements (ii)

Aim 1

Introduction 2

Physiology of Disorder 3

Types of Multiple Sclerosis 4

Diagnosis 5

Symptoms 6

Treatment 7

Conclusion 8

Bibliography 9
CERTIFICATE

This is to certify that Aryaman Singh of class XII-L of Delhi


Public School, Sector 45, Gurgaon has satisfactorily
completed his/her project on the topic “Multiple Sclerosis”,
under the guidance of Ms Sangeeta Luthra, in the academic
year 2023-2024.

Signature of internal teacher Signature of External Examiner

(i)
ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to Mrs.


Sangeeta Luthra and Mrs. Sarita Singh, my biology
teachers, for their guidance and support in
completing this project. I also thank my parents
and friends for their encouragement and
assistance. Lastly, I appreciate the cooperation of
the laboratory staff who provided the necessary
resources for this research.

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AIM
To study Multiple Sclerosis, its physiology, symptoms, diagnosis and
possible treatments.

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INTRODUCTION
Multiple sclerosis (MS) is a chronic autoimmune disease that affects
the central nervous system, including the brain and spinal cord. In MS,
the immune system mistakenly attacks the protective covering of
nerve fibers, known as myelin. This damage disrupts the normal flow
of electrical impulses along the nerves, leading to a wide range of
neurological symptoms. These can include problems with vision,
muscle strength, coordination, and balance, as well as cognitive
functions.
Multiple sclerosis (MS) most commonly occurs in individuals between
the ages of 20 and 40, although it can be diagnosed at any age. The
disease is more frequently diagnosed in young adults, and the
average age of onset is around 30.

Certain groups are more vulnerable to developing MS:


Gender: Women are significantly more likely than men to develop
MS. The female-to-male ratio is approximately 2 to 3 to 1.
Genetics: A family history of MS can increase the risk of
developing the disease. Although MS is not directly inherited,
having a close relative with MS does slightly elevate one's risk.
Geographic and Environmental Factors: MS is more common
in individuals who live farther from the equator, suggesting that
environmental factors such as vitamin D deficiency may play a
role in the disease's development.
Immune System Factors: As an autoimmune condition, MS is
influenced by genetic and immune system factors, which means
individuals with other autoimmune disorders may be at a higher
risk.
People with MS may experience varied level of disability affecting
their life to varied extent, reflecting the diverse nature of the disease.

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cut paste

Level of Impact on
disability
Symptoms
Daily Life

Minor issues with vision,


occasional numbness, or mild Most people can
coordination problems Most manage daily
Mild people can manage daily activities with little to
activities with little to no no assistance.
assistance.

Noticeable issues with mobility, Daily activities and


such as difficulty walking or employment may be
balance problems. Potential for affected, but many
Moderate increased fatigue, muscle individuals can still
weakness, or cognitive lead active lives with
challenges. appropriate support.

Individuals often need


Significant impairment in mobility, help with most daily
such as difficulty walking without activities and may
assistance or reliance on a require assistive
Severe wheelchair. Major challenges devices and personal
with daily activities, including care support.
self-care and personal hygiene. Employment may be
limited or not possible

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INTRODUCTION
MS is classified as an autoimmune disorder. In autoimmune diseases,
the immune system mistakenly attacks the body's own tissues. In MS,
the immune system targets and damages the myelin sheath, a
protective covering that surrounds nerve fibers in the central nervous
system (CNS), which includes the brain and spinal cord. This immune
attack leads to inflammation and the breakdown of myelin
(demyelination). Without myelin, nerve signals are disrupted or
blocked, leading to the neurological symptoms associated with MS.

MS attacks axons in the central nervous system protected by myelin,


which are commonly called white matter and also damages the nerve
cell bodies, which are found in the brain's gray matter. As the disease
progresses, the outermost layer of the brain, called the cerebral
cortex, shrinks in a process known as cortical atrophy.

The term multiple sclerosis refers to the distinctive areas of scar tissue
(sclerosis—also called plaques or lesions) that result from the attack
on myelin by the immune system. These plaques are visible using
magnetic resonance imaging (MRI). Plaques can be as small as a
pinhead or as large as a golf ball.

The symptoms of MS depend on the severity of the inflammatory


reaction as well as the location and extent of the plaques, which
primarily appear in the brain stem, cerebellum (involved with balance
and coordination of movement, among other functions), spinal cord,
optic nerves, and the white matter around the brain ventricles (fluid-
filled cavities).

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CAUSES
The cause of MS is unknown. Many things may contribute to someone
getting MS, including viruses, autoimmune disorders, environmental
factors, and genetic factors. But all of the possible causes share a
common feature. The body's immune system attacks its own nervous
tissue.Its important to highlight, While MS is not directly inherited,
genetic factors do play a role in susceptibility. Individuals with a
family history of MS are at a higher risk of developing the disease.

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PHYSIOLOGY
The pathophysiology of multiple sclerosis primarily affects the CNS
and involves various areas such as the cortical gray matter,
periventricular and, optic nerves, spinal cord, cerebellum, and
meninges.

The 2 fundamental processes that constitute general pathological


processes observed in multiple sclerosis patients include:
Focal inflammation results in macroscopic plaques and injury to
the blood-brain barrier.
Neurodegeneration involves microscopic damage to various
components of the CNS, such as axons, neurons, and synapses.

Together, these 2 primary processes result in macroscopic and


microscopic injury. Lesions, called plaques, occur in waves throughout
the disease course and result from focal inflammation. The chief
components of plaque pathology include myelin loss, edema, and
axonal injury. As the inflammatory process subsides over time, it leads
to the formation of an astrocytic scar (see Image. Perivascular
Plaques in Multiple Sclerosis as seen in MRI).

Innate immune cells such as monocytes and macrophages stimulate


T-cell migration across the blood-brain barrier, resulting in blood-
brain barrier injury and systemic immune cell infiltration. This CNS
injury triggers cytotoxic activities in microglia, leading to the release
of nitric oxide and other superoxide radicals which further increases
the inflammation. Inflamed areas with blood-brain barrier breakdown
are visible on MRI as gadolinium-enhancing lesions.

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PHYSIOLOGY
The pathological events ultimately lead to demyelination,
neuroaxonal degeneration, loss of synapses, dying-back (damage
starts at the end of a nerve fiber and progresses backward toward
the cell body) oligodendrogliopathy, tissue injury, and astrogliosis
(astrocytes become excessively active in response to disease).

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TYPES OF MS
MS is currently divided into 4 different types as defined by the
International Advisory Committee on Clinical Trials of MS in 1996. They
are:
Clinically isolated syndrome (CIS)- refers to a single episode of
neurological symptoms that lasts at least 24 hours and is
suggestive of multiple sclerosis (MS). It is often the first sign of
MS but doesn't yet meet the criteria for an MS diagnosis.
Relapsing-remitting MS (RRMS)- It involves periods of new or
worsening symptoms (relapses) followed by periods of
improvement or stability (remissions).
Secondary progressive MS (SPMS)- the disease can transition
to a stage where it steadily worsens with or without occasional
relapses.
Primary Progressive MS (PPMS)- This form of MS is
characterized by a gradual accumulation of disability from the
onset, without distinct relapses or remissions. Over time, the
pattern shifts to continuous progression with fewer or no relapses.

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DIAGNOSIS
Diagnosing MS is complicated because no single test can positively
diagnose it. Diagnosing multiple sclerosis (MS) involves a
comprehensive approach that includes evaluating the patient’s
medical history and symptoms, performing a neurological
examination to assess motor and sensory functions, and using
magnetic resonance imaging (MRI) to identify characteristic lesions in
the brain and spinal cord.

A lumbar puncture may be conducted to analyze cerebrospinal fluid


for biomarkers associated with MS. Evoked potentials tests are used
to measure the speed and efficiency of nerve signal transmission are
used to support the diagnosis.

Blood tests help, exclude other conditions that could mimic MS. The
diagnosis is confirmed by applying the McDonald Criteria, which
integrates clinical findings, MRI results, and evidence of lesions in
multiple areas of the central nervous system.

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DIAGNOSIS
NEUROLOGICAL EXAMINATION- Your neurologist will ask you lots of
questions about your health problems and symptoms, now and in the
past. They'll also give you a physical examination. This will check for
changes or weaknesses in eye movements, leg or hand coordination,
balance, speech or reflexes.
MAGNETIC RESONANCE IMAGING (MRI)- An MRI scanner uses a
strong magnetic field to create a detailed image of inside brain and
spinal cord. It's very accurate and can pinpoint the exact location
and size of any inflammation, damage or scarring (lesions). MRI scans
confirm a diagnosis in over 90 per cent of people with MS.
EVOKED POTENTIAL TESTS- They measure the time it takes for the
brain to receive messages or signals from eyes, ears and skin. To
measure these signals, small electrodes are put on head. These check
how brain reacts to sounds we hear in headphones or patterns we
see on a screen. To measure signals between brain and skin,
electrodes will be put on arm or leg. Signals to and from brain will be
slower if MS has damaged the myelin covering around some of your
nerves.

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DIAGNOSIS
LUMBAR PUNCTURE/SPINAL TAP- This test is performed under local
anesthesia, then a needle is put in lower back. It goes into the space
around spinal cord and collects a small sample of the fluid there.
People with MS nearly always have antibodies in this fluid. Antibodies
are a sign that immune system has been active in brain and spinal
cord. People who don't have MS don't normally have antibodies in this
fluid.
BLOOD TESTS- Neurologists might also want to rule out conditions
that are similar to MS by running some other tests. These could
include blood tests to check for particular antibodies.

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Multiple sclerosis signs and symptoms may differ greatly from person
to person and over the course of the disease depending on the
location of affected nerve fibers.

Common symptoms include:


Numbness or weakness in one or more limbs that typically
occurs on one side of your body at a time
Tingling
Electric-shock sensations that occur with certain neck
movements, especially bending the neck forward (Lhermitte sign)
Lack of coordination
Unsteady gait or inability to walk
Partial or complete loss of vision, usually in one eye at a time,
SYMPTOMS
often with pain during eye movement
Prolonged double vision
Blurry vision
Vertigo
Problems with sexual, bowel and bladder function
Fatigue
Slurred speech
Cognitive problems
Mood Disturbance

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TREATMENT
There is no cure for multiple sclerosis. Treatment typically focuses on
speeding recovery from attacks, reducing clinical relapses, slowing
the progression of the disease, and managing MS symptoms. These
medications aim to reduce the frequency and severity of MS relapses.

DISEASE MODIFYING THERAPIES (DMT)-


Interferons: These drugs, like Avonex, Betaseron, and Rebif,
help reduce inflammation and immune system activity.
Glatiramer Acetate (Copaxone): This medication helps to
protect the nerves and reduce inflammation.
Natalizumab (Tysabri): This drug helps prevent immune cells
from entering the brain and spinal cord.
Fingolimod (Gilenya): This oral medication helps keep
immune cells in the lymph nodes, preventing them from
attacking the nervous system.
Dimethyl Fumarate (Tecfidera): Another oral medication
that helps reduce inflammation and protect nerves from
damage.
Ocrelizumab (Ocrevus): This drug targets specific immune
cells involved in MS.
Siponimod (Mayzent): This oral drug helps reduce the
number of relapses and slow disease progression.
ACUTE RELAPSE TREATMENTS
During a relapse (when symptoms suddenly worsen), doctors may
use treatments to help reduce inflammation and speed recovery.
Corticosteroids: Medications like prednisone or
methylprednisolone are often used to reduce inflammation
quickly during a relapse.

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TREATMENT
SYMPTOM MANAGEMENT
MS can cause a range of symptoms, and managing them is
crucial for improving quality of life.
Muscle Relaxants: Medications like baclofen or tizanidine
help reduce muscle spasms and stiffness.
Pain Relievers: Over-the-counter or prescription pain
medications help manage chronic pain.
Bladder and Bowel Medications: Drugs can help manage
urinary and bowel issues, common in MS.
Fatigue Management: Medications like amantadine or
modafinil can help combat MS-related fatigue.
Physical Therapy: Exercises and physical therapy can help
improve movement, balance, and strength.
Occupational Therapy: This therapy helps people adapt
their daily activities and home environment to cope with
physical changes.
Speech Therapy: If MS affects speech or swallowing,
speech therapy can help improve these functions.

LIFESTYLE AND SUPPORTIVE THERAPIES


Healthy Lifestyle: Eating a balanced diet, staying hydrated,
and regular exercise can help manage symptoms and
improve overall well-being.
Counseling and Support Groups: Emotional support
through counseling or MS support groups can help people
cope with the psychological impact of the disease.

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CONCLUSION
In conclusion, managing multiple sclerosis (MS) requires a
comprehensive approach that integrates various treatments and
therapies tailored to individual needs. From disease-modifying
therapies that aim to slow disease progression and reduce relapse
frequency to targeted treatments for managing symptoms and
enhancing quality of life, the goal is to provide holistic care.
Advances in medication, supportive therapies, and lifestyle
management continue to improve outcomes for those living with MS.
By combining medical interventions with physical, occupational, and
emotional support, patients can better navigate the challenges of
MS, achieving a more manageable and fulfilling life. Continued
research and individualized care remain crucial as we strive for more
effective treatments and ultimately, a cure for this complex condition.

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BIBLIOGRAPHY

www.mayoclinic.com

www.clevelandclinic.com

www.mssociety.org.uk

www.nationalinstituteofneurologicaldisorder.com

www.medicalnewstoday.com

www.johnhopkinsmedicine.com

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284444/

https://www.physio-pedia.com/Multiple_Sclerosis_(MS)_Case_Study

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