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OVERVIEW

- An autoimmune disease that attacks the myelin on the nerves within the CNS. The classic symptoms may include fatigue, weakness, blurred vision, numbness, and balance and coordination problems.

Relapse-remitting vs progressive

Diagnosis: MRI Imaging – 90% of MS patients lumbar puncture/spinal tap – Immunoglobulin Gsomatosensory evoked potential testing

SYMPTOMS

Spasticity is most common in the calf, thigh, back and groin muscles.

Fatigue can increase the severity and intensity of other symptoms, including motor weakness.

Ataxia, nystagmus, dysarthria, slurred speech, intention tremors and vertigo

Decreased proprioception, balance and coordination

Pain, mood disorders, depression

Bladder, bowel and sexual dysfunction

TRIGGERS FOR A FLARE-UP

Stress

Fatigue

Infection

Heat and/or FeverIncrease in temperature blocks the conduction of

demyelinated nerves.Cool temperature – increase in comfort and less fatigue

Study with 8 patients

PREVENTION TO FLARE-UPS

Sleep

Eating a good diet

Exercise

EducationUp to 75% of MS patients are affected by balance

problems during the course of their disease, increasing the danger of falling and causing serious injury.

PHYSICAL THERAPY INTERVENTION

PT has a positive impact on fatigue in patients with MS. Outcome measures: Modified Fatigue Impact Scale (MFIS) and

Ambulation Index (AILimitation: They did not state what interventions were provided

during rehab.

Ai-Chi aquatic therapy may improved balance, functional mobility, UE & LE muscle strength, and fatigue in patients with MS.Breathing techniques and progressive resistance training in water to relax and strengthen the body

Single education day on physical functioning, activity and

quality of life are beneficial. adapting exercises and sports (ie: golf & cycling)Attended 3/6 group exercise classes

PHYSICAL THERAPY INTERVENTION

Home based exercise program improves walking in people with cerebellar ataxiaSitting balance: standard chair, 6-inch dense foam, exercise ball

(standard or peanut shaped) or balance discStabilizing in static position progressing to dynamic arm and leg

movements.In-person demonstrations and education to perform at homeImproved Timed Up and Go, Dynamic Gait Index, and walking

speedNo change in Functional Reach or static postural sway

PHARMACOLOGIC TREATMENT

- No cure for Multiple Sclerosis

Managing Relapse and/or progression

IV CorticosteroidsLong term side effects – hypertension, diabetes, osteoporosis,

cataracts, and ulcers

Immunotherapy – may reduce frequency of relapses up to 30%

Anticonvulsants

Antidepressants

Narcotics

Muscle Relaxants

Medical Marijuana

ANESTHESIA AND SURGERY

Stress from surgery is unlikely to exacerbate symptoms, however complications such as infection and fever can exacerbate symptoms.

No significant evidence proving that anesthesia exacerbates MS symptoms.

Recommend: General > Regional anesthesia

Epidural & peripheral nerve blocks > Spinal anesthesia

Spinal anesthesia (unknown) - lack of protective nerve sheath

around the spinal cord may increase the risk of neurotoxic

effects from local anesthetics.

SUPPORT

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REFERENCES

http://www.everydayhealth.com/health-report/living-better-with-ms-guide/triggers-that-can-cause-ms-flares.aspx

http://www.aana.com/newsandjournal/Documents/p217-224.pdf

http://web.a.ebscohost.com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?sid=fa02bb3e-8eff-4631-9ef7-3f3e598094ab%40sessionmgr4001&vid=1&hid=4206

http://web.a.ebscohost.com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?sid=82d54f1a-0606-42cc-ac46-2754bd3ebefe%40sessionmgr4004&vid=0&hid=4206

http://web.a.ebscohost.com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?sid=fb1a9f64-2ba1-4da4-83fe-9835c4272c3b%40sessionmgr4001&vid=0&hid=4206