Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a chronic condition that affects the central nervous system.

This system includes the brain and spinal cord. It contains the nerves that control everything your body does, such as thinking, feeling, seeing, smelling, tasting, and moving.

  • autoimmune based demylination in CNS
  • onset 20-40 yrs
  • incidence 2X higher in women than men

Etiology

  • unclear
  • HLA genes affected on MHC portion of the chromosome
  • familial tendency
  • genetic susceptibility of immune response on HLA gene
  • viral trigger (EBV) – Ab attack myelin

Pathophysiology

  • demylination in white matter
  • inflammation
  • edema
  • destructive plaque formation resulting in conductive disorders
  • plaque (sclerotic patches) show lymphocytes and macrophage infiltration
  • death of oligodendrocytes which produce myelin
  • motor and sensory neurons are affected

Manifestations

  • depend on location and extent symptoms vary
  • may be a chronic pattern of remission and relapse
  • paresthesia – burning, tingling in extremities of regions where myelin sheathing is being destroyed
  • fatigue
  • decreased muscle strength, gait and coordination

Symptoms

Diagnosis

proteins in CSF – indicative of:

  1. compromised blood brain barrier
  2. autoimmune damage is occurring
  3. inflammation is occurring in the CNS
  • MRI for plaques

Treatment

  • steroid use for acute phases after relapse
  • disease modification eg interferon to manage antiviral, anti-inflammatory and autoimmune

Martin, Glenn and Porth, Carol, Mattson. 2009. Pathophysiology Concepts of Altered Health States. 8th ed. Lippincott Williams and Wilkins. Philadelphia

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