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Multiple Sclerosis

Brooke Hildt and Jim Hutchins

Overview

Multiple sclerosis (MS) is an autoimmune disease where the body’s own immune system attacks oligodendrocytes and myelin sheath in the central nervous system.

Disease Process

The body’s immune system attacks the myelin sheath surrounding nerve fibers. As the myelin is damaged and the body attempts to repair it, scarring can occur, leading to plaques that may be visible during an MRI.

Types of Multiple Sclerosis

Stages of Multiple Sclerosis

  1. Relapsing remitting: most common, flare ups followed by periods of remission
  2. Secondary progressive: begins as relapsing remitting, after a time period of relapses, disease starts to steadily progress
  3. Primary progressive: slowly worsening symptoms with no periods of remission, uncommon
  4. Progressive relapsing: rare form characterized by steadily worsening disease with occasional relapses

Signs & Symptoms

  • Fatigue
  • Cognitive impairment
  • Muscle weakness
  • Muscle spasms
  • Neuropathic pain
  • Vision problems (e.g., blurred vision, double vision, optic neuritis)
  • Bladder control issues (e.g., urgency, frequency, incontinence)
  • Dizziness

Diagnosis

Diagnosis of Multiple Sclerosis typically includes a CT or MRI scan to look for areas of scarring or demyelinating lesions, and a lumbar puncture to collect cerebrospinal fluid (CSF) for analysis of white blood cells, neurofilaments, and oligoclonal bands. A visual field and visual acuity test may also be performed to check for visual changes commonly associated with the disease.

Treatment

There is no cure for Multiple Sclerosis, but there are treatments that can reduce the number and severity of relapses and delay the long-term progression of the disease. Corticosteroids have been found to help suppress the immune system and reduce inflammation. Beta interferon drugs additionally have the ability of suppressing the immune system. Monoclonal antibodies are used to target proteins involved in autoimmune attack. Stem cell therapies are a growing area of study with a goal of regenerating nerve tissue.

Risk Factors & Disease Prevalence

About 900,000 people in the United States are affected by Multiple Sclerosis. MS is three times more common in women, however, the disease is more severe in men. Diagnosis usually occurs in individuals age 20-30. Environmental factors such as low levels of vitamin D, UV radiation, contracting the Epstein-Barr virus, obesity, and tobacco smoking influence disease prevalence. Exposure to these insults during adolescence seems to be the most relevant to the disease.

Case Study

32-year-old female presenting to the emergency room with sudden onset of blurry vision in her right eye and numbness on the right side of her face. 6-month history of delirium unilateral visual impairment and facial numbness. No reported muscle weakness, gait disturbance, fever, or urinary incontinence.
Her vital signs are unremarkable. Visual acuity reveals 20/20 vision in left eye & 20/100 vision in right eye. Muscle strength 5/5 in all extremities. Lesions present upon MRI. CSF values reveal high lymphocytes. Patient findings consistent with Multiple Sclerosis.

 

https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284444/
https://www.khanacademy.org/test-prep/nclex-rn/rn-nervous-system-diseases/rn-multiple-sclerosis/a/what-is-multiple-sclerosis

License

Advanced Neuroscience Copyright © by Jim Hutchins; Kobe Christensen; and Cody Zundel. All Rights Reserved.