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Multiple Sclerosis. Brett Glover Paramedic ’08 5/26/08. What is MS?. MS is a chronic, often disabling disease that attacks the CNS. MS is thought to be an autoimmune disease. T- cells attack myelin that protects nerve fibers. T-cells also secrete chemicals that damage nerve fibers
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Multiple Sclerosis Brett Glover Paramedic ’08 5/26/08
What is MS? • MS is a chronic, often disabling disease that attacks the CNS. • MS is thought to be an autoimmune disease. • T- cells attack myelin that protects nerve fibers. • T-cells also secrete chemicals that damage nerve fibers • Damaged myelin forms scars. • Damaged myelin sheath or nerve fibers cause nerve impulses to be interrupted or distorted.
Four types of MS • Relapsing-Remitting MS • Primary-Progressive MS • Secondary-Progressive MS • Progressive-Relapsing MS
Relapsing-Remitting MS • ~ 85% of people who have MS are initially diagnosed with R-R MS. • Clearly defined attacks or worsening neurologic function (relapses) followed by periods of remission.
Primary-Progressive MS • ~ 10% of people with MS are diagnosed with P-R MS. • Characterized by slowly worsening neurologic function from the beginning of disease process. • No periods of relapses or remissions.
Secondary-Progressive MS • Following an initial period of R-R MS, many people develop S-P MS. • Diseases worsens more steadily. • May have occasional flare-ups or minor remission periods.
Progressive-Relapsing MS • ~ 5% of people with MS are diagnosed with Progressive-Relapsing MS. • Steadily worsening disease from the beginning. • Includes clear attacks of worsening neurologic function. • Disease progresses with out remissions.
What Causes MS? • Still unknown, but scientists believe that a combination of several factors may be involved. • Immunologic • Environmental • Infectious • Genetic
Immunologic • It is known that T-cells attack the myelin sheath and nerve fibers • It is unknown what triggers this response
Environmental • Known to occur more often in areas far from the equator. • Scientists believe that MS may be associated with Vitamin D. • Vitamin D is thought to be beneficial to immune function and may help protect against autoimmune diseases. • Produced naturally when you are exposed to sunlight. • People who live closer to the equator are exposed to more sunlight causing them to have a higher level of vitamin D.
Infectious • Exposure to viruses, bacteria or other microbes in childhood may increase your chances of getting MS. • Viruses are well know to cause damage and inflammation to the myelin. • Over a dozen viruses and bacterias are being investigated. • Measles and chlamydia.
Genetic • MS is not hereditary, but having an immediate family member with MS increases the risk. • Some researchers believe that people are born with a genetic predisposition to react to other environmental factors that possibly cause MS.
Who Gets MS? • 2.5 million world wide • 400,000 in the United States • Caucasians are more likely to be diagnosed • At least 2/3 more likely to occur in women than men • Most people are diagnosed between age 20 and 50 • Risk is 1/750 in general population vs. 1/40 in anyone who has an immediate family member with MS
Signs and Symptoms • Fatigue • Most common symptom • Numbness of the face, body or extremities • Balance and coordination problems • Difficulty in walking • Bladder dysfunction • Found in ~ 80% of MS Pt • Bowel dysfunction • Vision problems • Generally the first symptom of MS
Signs and Symptoms • Dizziness and Vertigo • Sexual Dysfunction • Pain • ~55% complain of significant pain • Cognitive Function • Ability to learn, plan, organize and problem solve • Emotional changes • Spasticity • Feelings of stiffness and involuntary muscle spasms
Treatments • There is no cure • Modifying the disease course • Avonex, Betaseron, Copaxone, Novantrone, Rebif, Tysabri • Managing Symptoms • Physical therapy, occupational therapy, speech therapy, cognitive rehab, vocational rehab • Emotional support • Stress management skills, dealing with mood swings and depression
Old Theories • Owning a dog or small pet • Canine distemper • Allergies • Exposure to heavy metals • Mercury, manganese, lead • Aspartame
Bibliography • Bledsoe, Bryan. Porter, Robert. Cherry, Richard. Paramedic Care: Principles and Practice. Vol. 5. Upper Saddle River, NJ. 2006. • National Multiple Sclerosis Society. www.nationalmssociety.org. 22 May 2008 • WebMd. www.webmd.com/multiple-sclerosis/default.htm. 24 May 2008