As of 2008 multiple sclerosisis (MS) affected between 2-2.5 million people in the US. MS is an inflammatory disease that effects the myelin of the nerves of the brain and spinal cord. Myelin is the insulating sheath around nerves that allows nerves to communicate with each other. This attack on the nerves causes lesions (plaques or scarring) to form.
The symptoms are caused by 2 main destructive processes.
Lesions (Plaques or neural scarring)
One process that occurs is a loss of the cells responsible for creating the myelin layer around nerve cells. In the early phases of the disease, the body can “remyelinate” or replace the cells that are lost. Over time, the body loses this ability and scars will form in place of the myelin. These scars don’t allow the electrical signal to travel down the nerve.
This involves T-cells which is part of our immune response that usually attacks foreign material. In MS, it is believed that the a break down occurs with the blood-brain barrier (a semi permiable layer that protects the brain) and T-cells are allowed to enter the brain. These T – cells identify the myelin in the brain as foreign and begin to attack. This attack causes an inflammatory process which sends more destructive chemicals causing the myelin and underlying nerve to break down completely.
Types of MS
There are 4 subtypes of MS:
With this type of MS, patient will experience unpredictable attacks (exacerbations), followed by a period where symptoms may resolve completely.
Secondary progressive develops over time when symptoms from relapses do not completely resolve and periods between relapses shorten.
With this type of MS, their is no sign of remission after the initial attack. Pt. develops symptoms that worsen over time
This is the least common subtype which is characterized by progressive decline combined with clear “attacks” or relapses.
Because the attack can occur anywhere in the brain or spinal cord, symptoms can vary greatly between individuals. The following is a list of the most commonly seen symptoms with a wide range of severity.
Visual Disturbances (optic neuritis, nystagmus, and double vision)
Loss of sensation
Change in sensation (Numbness, tingling, pins and needles)
Increase in deep tendon reflexes
Impaired coordination and balance
Problems with speech and swallowing
Depression and other mood related impairments
There is currently no cure for Multiple Sclerosis. However, an acute exacerbation is a medical emergency and immediate medical attention is extremely important to stop the inflammatory process. This may include IVIG, plasmaphoresis, and/or steroid medication depending on the severity of the inflammatory process. Ongoing treatment will typically include medication, and physical therapy to manage the symptoms.
Medication can be used to decrease spasticity, treat depression, and improved balance and walking IVIG: This is a form of plasma protien replacement therapy used to stop the inflammatory process during an acute exacerbation. It is administered intravenously. Plasmaphoresis: This procedure involved removing plasma from the blood and thus removing the “bad antibodies” that are attacking the healthy immune system. Can help to stop the inflammatory process for an acute exacerbation
A physical therapist will do an evaluation looking at muscle quality (looking for spasticity, tightness, and/or weakness), static and dynamic balance, and gait (walking). The therapist will determine the functional deficits (difficulty walking, standing, transfering…etc) and any underlying impairments (decrease strength, decrease balance, spasticity…etc). Once all of the data is collected, the patient and the therapist will discuss the individual’s goals and develop a plan to address the “problem areas”. This may include strengthening, stretching, bracing (if it is determined that nerve damage is to severe to regain strength in a muscle or group of muscles), energy conservation strategies, and education on environmental factors contributing to an acute exacerbation. As stated earlier, there is currently no “cure” for Multiple Sclerosis. However, making certain lifestyle modifications today may decrease the frequency and severity of acute exacerbations thus decreasing the number and severity of neural scarring (lesions). This will improve an individuals quality of life and may delay the onset of more severe mobiltiy problems that occur in the later stages of the disease.