Multiple Sclerosis

Multiple sclerosis (popularly known as MS) is a long lasting disease that can impair your brain, spinal cord and the optic nerves in your eyes. In fact, it is a disease of the central nervous system that can cause symptoms throughout the body. It can lead to problems with vision, balance, muscle control and other basic functions of the body. However, no two people may have the same pattern of effects. Some people may have mild symptoms that don’t warrant intense treatment, whereas others may have trouble getting around and doing daily tasks. Symptoms depend on what part of the central nervous system has been attacked.

Multiple sclerosis is considered to be an autoimmune disease (an autoimmune disease is a condition in which your immune system mistakenly attacks normal tissues in the body). Multiple sclerosis occurs when your immune system attacks fatty material called myelin. Myelin wraps around your nerve fibers in the brain, spinal cord, and optic nerve. Without the protection of myelin, your nerve fibers are prone to damage and can be destroyed. Sustained attack on the myelin sheath makes it inflamed and gradually losing its strength, leading to formation of scar tissue (sclerosis).

As the name suggests, the term “multiple sclerosis” refers to multiple areas of scar tissue or lesions that develop along the affected nerve fibers. These lesions are visible on MRI scans. Symptoms of multiple sclerosis stem from these lesions and disruption of electrical impulse throughout the body. If there is damage in these nerve fibers, your brain cannot send signals through your body correctly. The electrical impulses sent by the brain to other parts of the body are disrupted. Moreover, your nerves don’t work as well as they are supposed to. Moving and feeling sensation may be difficult. As a result, you may have symptoms like:

Trouble walking

Feeling tired

Muscle weakness or spasms

Blurred or double vision

Numbness and tingling

Sexual problems

Poor bladder or bowel control

Pain

Depression

Problems focusing or remembering

The above-mentioned symptoms can wax and wane over time. The first signs of multiple sclerosis can be found between the ages of 20 and 40. When the disease is at an advanced stage, people may get attacks called relapses. Ironically, there may be times of recovery following a relapse. For a large number of people, symptoms get worse over a period of time. Needn’t worry, there is a ray of hope. In the recent years, scientists have found a host of treatments that can often help prevent relapses and slacken the progression of the disease.

What causes Multiple Sclerosis?

It is not clearly known as to what triggers MS; though there are many factors that tend to make the disease more likely. One is genetics; people with certain genes may have higher chances of getting it. About 20% of people with MS have that disease in their family. Smoking increases the risk of MS. Post a viral infection (like the Epstein-Barr virus or the human herpesvirus) people are seen to have got infected as it impairs your immune system. The infection may set off the disease or causes relapses. Researches are going on to study the link between viruses and MS. Ironically, most people who are diagnosed with MS have no known risk factors. Some other risk factors for MS are being a woman, vitamin D deficiency, obesity. Virtually anyone can have MS, many of those who have it may have the following characteristics:

Age: The vast majority of people who get MS are affected before the age of 40 Race: MS is two or three times more common in women as in men Genes: If MS runs in your family, get a thorough medical check up in order to see if you have any traces of the condition.

Some medical studies suggest that vitamin D, which you can get from sunlight, may beef up your immune system and protect you from MS.

Types of Multiple Sclerosis:

Relapsing-remitting multiple sclerosis (RRMS)

Secondary-progressive multiple sclerosis (SPMS)

Primary-progressive multiple sclerosis (PPMS)

Benign multiple sclerosis

Malignant multiple sclerosis

Complications of Multiple Sclerosis:

Beyond the direct effects of MS, there can be additional consequences of some health disorders such as:

Urinary tract infections: Bladder problems are very common in people with MS. Nearly 80% of the people with MS have bladder issues that include trouble holding their urine (incontinence). However, some people cannot fully empty their bladder (retention). Failing to empty the bladder may lead to urinary tract infections. Urinary tract infections may lead to discomfort while urinating, needing to urinate frequently and releasing only small amounts of urine. If not treated, an urinary tract infection can lead to kidney infection, which is a medical emergency.

Pneumonia: Some people with MS may have trouble swallowing known as dysphagia. When the muscles involved in swallowing are weak, the foods and liquids may enter the airway instead of the esophagus. If the person cannot cough properly to expel them, there is the risk of food and liquid ending up in the lungs. This can cause aspirational pneumonia, a serious condition that requires hospitalization. Symptoms of aspirational pneumonia may include chest pain, fever, shortness of breath and coughing up foul-smelling phlegm.

Physical trauma from falling: MS symptoms, like balance problems, muscle weakness, fatigue, dizziness, blurred vision, and numbness, raise the risk of falling, which in turn raise the risk of serious injuries such as broken bones and head trauma.

Pressure sores: People with MS tend to sit and lie down for extended period of time, leading to pressure sores or bed sores.



Diagnosis – The real challenge: History of a person’s symptoms forms a major part in arriving at the diagnosis, along with the results of a host of medical tests, which may include:

A neurologic evaluation of physical movement and coordination, vision, balance, and mental functioning

Blood tests to rule out other conditions

Magnetic resonance imaging (MRI) to detect brain lesions typical of MS

Lumbar puncture (spinal tap) to obtain cerebrospinal fluid, which may contain substances more likely to be found in people with MS

Diagnosing MS early is very important, so that remedial treatment can be started early, with the objective of delaying the rapid onset of the disease. It should be noted that MS symptoms can mimic those of a number of other conditions. Symptoms can also be highly volatile, it can come and go from one day or week to the next, as well as change the intensity gradually over time. All of the above make diagnosing MS a real challenge.

Treatment for Multiple Sclerosis:

The main aim of the treatment of multiple sclerosis is to improve and maintain function at home, work and community. Depending on the severity of the condition, at Plexus, we work closely with the patient to chart out a comprehensive MS carewhich comprises of the following:

Stem Cell Therapy:

Stem Cell Therapy using autologous mesenchymal stem cells from the bone marrow of a patient has given a new ray of hope to patients suffering from Multiple Sclerosis. To understand more about the Stem Cells, please refer to our section under “about stem cells”.

Physical Therapy:

Physiotherapists who work on people with MS, mainly concentrate on providing their body with strength to maintain function and movement. This is done using several type of exercises like pelvic exercises, gait training and training in the use of mobility aids like wheelchairs, scooters, crutches etc. They chart of exercise program which will prevent complications related to muscle weakness and muscle contractures due to spasticity.

Occupational Therapy:

Occupational Therapists work closely with people with Multiple Sclerosis, making sure their energy is conserved and their life is made easy at home, work and at other places in the community. They provide training in the use of adaptive tools and devices to simplify tasks. They provide necessary modifications at home and workplace to ensure safety, accessibility and convenience. The ultimate aim is to ensure maximum independence to the individuals with MS and to help them improve quality of their lives. Occupational Therapists along with Speech Language Pathologists use different treatment strategies to improve the cognitive skills of people with MS. They work on improving their ability to think, remember, focus, reason etc. Fatigue Management using Energy conservation and Work Simplification techniques form the crux of occupational therapy intervention in MS. Splinting is recommended and customized depending on the deficits presented by the patient, if spasticity is the concern then anti-spasticity splints are given and if muscle weakness interferes with daily functioning then functional splinting is done.

Speech and Language Therapy:

Individuals with MS have difficulty in controlling the muscles related to speech and swallowing. This is due to the damage in the Central Nervous System. Various exercises of the jaw, lip and tongue are taught to strengthen the oral musculature. The aim of these exercises is to enhance ease and clarity of communication. Various swallowing exercises are taught to improve eating, chewing, drinking etc. This is to help with safe swallowing and enhancing overall health. Articulation Therapy forms a core part of the treatment of SLPs wherein individuals with Multiple Sclerosis are shown how the mouth, teeth and tongue works to produce different sounds and words.

For Questions related to treatment of Multiple Sclerosis, send a message to www.plexusnc.com

Regenerative Rehabilitation Program at Plexus for Multiple Sclerosis

Gait training

Balance re-training

Speech Therapy

Speech Therapy

Speech Therapy

Speech Therapy

Functional strengthening

Coordination exercises

Balance training

Training for fine coordination

Training for tool use

Splinting for weak lumbricals in MS

A Case Study…

Turning Setbacks Into Comebacks

About a year ago, Mr S was forced to quit his job as typing on the keyboard was fast becoming an next to impossible task. The diagnosis revealed that he was suffering from Multiple Sclerosis – a condition where nerve cells in the brain and spinal cord are damaged, resulting in severe muscle weakness, muscle spasms, and difficulty in muscle coordination.

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