MULTIPLE SCLEROSIS

DEFINITION
Multiple sclerosis (MS) is a disease of the central nervous
system largely affecting young adults, predominately white
populations; the cause of which is unknown.
Major causative theories currently focus on an infectious
1s Characterized by demyelinating lesions known as
plaques that are scattered throughout the white matter in
the central nervous system.
The myelin sheath is ultimately replaced by the fibrous
scarring produced by glial cells (gliosis).
The presence of scattered bright spots on an MRI of the
CNS is highly diagnostic of MS.
CLINICAL FEATURES
Symptoms
Weakness in one or more Iimbs
Optic neuritis
Persistent paresthesiae are extremely common, occurring
in 84% of patients.
The initial complaint is of fatigue or of weakness only on
exertion.
Abnormal sensations begin in one foot and soon spread to
involve lower limbs, the buttocks and perineum and a
variable area on the trunk.
The sensations described are of paraesthesiae or tingling
Chronic respiratory weakness is common.
In established disease exaggerated tendon reflexes and
extensor plantar reflexes are usually present.
In the lower limbs increased extensor tone may be
exaggerated as extensor spasms.
As the disease progresses flexor tone begins to take over.
Emotional changes keep happening irrelevantly and
frequently.
The hand muscles often arelsymmetrically wasted.
Learning and short-term memory may be impaired early in
the diSease.
There may be other symptoms like epilepsy, multiple
personality disorder, dysarthria, loss of coordination
and bladder control.
PATHOPHYSIOLOGY & COURSE :-
The disease progresses very variably, from sow and
benign, to rapidly progressive. In between there may
exacerbations and remissions.
PROGNOSIS
Life expectancy is normal for more than three-fourths of
MS patients from the onset.
MANAGEMENT
Short-term Goals-Physiotherapy
Improve sensory awareness
Educate the patient with sensory loss and skin care
Diminish spasticity and tonal influences on movement
lmprove muscle strength
Improve gait pattern
Occupational Therapy
Improve functional mobility and independence in activities
of daily living:
Teach problem solving skills
Teach compensatory training
Teach energy conservation
Provide appropriate mobility aids and adaptive equipment.
Promote understanding of the disease, its symptoms and
management
Emphasize realistic expectations while maintaining hope.
Focus on remaining abilities.
Daycare patient about support groups, like the MS society.