Multiple Sclerosis (MS)

Question 1

What is Multiple Sclerosis (MS)?

Answer 1

A progressive long-term neurological disorder of theCNS where the myelin sheath is damaged due to an autoimmune response.
- Reduce or lose nerve conduction.

Question 2

What are some symptoms of multiple sclerosis (MS)?

Answer 2

• Bladder & bowel dysfunction.
• Blurred vision/vision problems.
• Cognitive dysfunction.
• Depression.
• Dizziness.
• Fatigue.
• Muscle spasms.
• Numbness & tingling.
• Pain.
• Walking difficulty.
• Weakness.

Question 3

What are some factors which can contribute to Multiple Sclerosis (MS)?

Answer 3

Environmental:
- Viral agents (Epstein-Barr).
- Smoking/obesity/diet.
- Sunlight exposure/Vitamin D.

Genetic:
- Multiple gene involvement demonstrated.

Question 4

What are the different classifications of Multiple Sclerosis (MS)?

Answer 4

• Relapse Remitting.
• Primary Progressive.
• Secondary Progressive.

Question 5

Describe relapse remitting Multiple Sclerosis (MS)?

Answer 5

• Around 90% of patients initially have this, most of them ultimately developing secondary progression.
• Periods of significantly worse symptoms followed by periods of near complete symptom resolution.

Question 6

Describe secondary progressive Multiple Sclerosis (MS)?

Answer 6

• 65% of those with relapse remitting enter secondary progressive.
• Symptoms can fluctuate but continual slow progression of symptoms.

Question 7

Describe primary progressive Multiple Sclerosis (MS)?

Answer 7

• Around 10% of patients have it.
• Progression from outset.
• Currently no disease-modifying treatment.

Question 8

How can Multiple Sclerosis (MS) be diagnosed?

Answer 8

• Neurological signs & symptoms (Multiple episodes, separate in time and location within the CNS).
• MRI (Contrast methods reveal active & burnt-out plaques, and location - But should not be used alone).
• Evidence of CNS lesions in space & time.
• Cerebrospinalfluid via a lumbar puncture reviewed for the presence of inflammation (Oligoclonal bands - Immunoglobulins).

Question 9

What is a pharmacological treatment for multiple sclerosis (MS) relapses?

Answer 9

Corticosteroids (Oral, Intravenous).
- Hasten recovery from relapses but do not modify underlying disease.

Question 10

Explain whether disease-modifying therapies (DMT’s) able to help patients with multiple sclerosis (MS)?

Answer 10

• Don’t ‘cure’ but can slow down disease progression.
• Frequency in relapses and MRI outcomes(Lesion number &volume).
• Not always available with progressive subtypes.
• Haematopoietic stem cell transplantation (HSCT).
• Cannabis (Sativex).

(Around 20 drugs available in the UK).

Question 11

What symptoms of multiple sclerosis (MS) that can be treated with pharmacological treatment?

Answer 11

• Anxiety and/or Depression.
• Fatigue.
• Pain.
• Spasticity.

Question 12

What is a recommendation for people with Multiple Sclerosis (MS) to manage their condition?

Answer 12

Regular exercise:
- Progressive resistance training.
- Aerobic exercise.
- Balance exercises (Yoga, Pilates).

Cognitive Behavioural Therapy (CBT).

Assess for factors that may worsen spasticity (E.g.: pressure ulcers, bladder & bowel dysfunction and infections, poor posture, pain).

Question 13

What objective assessment things need to be considered with patients with Multiple Sclerosis (MS)?

Answer 13

• Balance (Perturbation,reactions)
• Cognition.
• Fatigue.
• Function (Vary from wheelchair bound to marathon running, depending on the stage of the disease).
• Gait .
• Mood.
• Pain.
• Spasm/Stiffness.
• Tremor.

Question 14

What treatments may we provide as physios for patients with Multiple Sclerosis (MS)?

Answer 14

• Aerobictraining.
• Aids equipment &orthoses.
• Balance re-education, Fallsstrategies.
• Fatigue management.
• Functional Electrical Stimulation (FES or E-stim).
• Health promotion, Self management.
• Mood & cognitive deficits need addressing.
• Painmanagement.
• Respiratory review.
• Sign posting/advice.
• Spasticity/spasm management.
• Strengthening.
• Stretching/Positioning.
• Upper Limb (Gaming, dexterity,task specific practice, VR, CIMT).