Introduction

Multiple Sclerosis (MS) Handout

Name of Disorder: Multiple Sclerosis

Formal Name: Multiple Sclerosis (MS)

Demographic Information:

• Incidence: Approximately 2.5 per 100,000 people per year
• Prevalence: Estimated at around 1 in 1,000 people in the United States
• Gender: More common in women than men, with a ratio of about 3:1
• Onset Age: Typically between 20 and 50 years old, though it can occur at any age

Coding:

• ICD-11: 8A40
• OMIM: 126200
• UMLS: C0026769
• MeSH: D009103
• GARD: 7314

Medical Features and Pathophysiology:

• Etiology:

• Pathology:

• Symptoms:

- Muscle weakness and spasticity - Coordination and balance problems - Tremors - Gait difficulties - Sensory Symptoms: - Numbness or tingling - Pain - Visual disturbances (optic neuritis, double vision) - Cognitive and Emotional Symptoms: - Memory and concentration difficulties - Depression and anxiety - Fatigue - Autonomic Symptoms: - Bladder and bowel dysfunction - Sexual dysfunction

• Diagnosis:

Assistive Suggestions and Requirements:

• Requirement Percentage for Assistive Technology:

• Assistive Technology Suggestions:

- Canes or Walkers: To assist with balance and prevent falls. - Wheelchairs: For individuals with severe mobility impairments. - Communication Aids: - Voice Amplifiers: To assist with dysarthria (speech difficulties). - Speech Generating Devices (SGDs): For individuals with severe speech difficulties. - Home Modifications: - Grab Bars and Handrails: To enhance safety and prevent falls. - Adjustable Beds: To improve comfort and ease of movement. - Feeding Aids: - Adaptive Utensils: For individuals with tremor or reduced hand dexterity.

• Access Modalities:

- Voice-Controlled Systems: Beneficial for those who retain good vocal strength. - Touchscreen Devices: Useful for those with adequate hand dexterity.

Care Management and Therapeutic Techniques:

• Aims:

- To provide supportive care and address complications through a multidisciplinary approach. - To offer education and support to patients and caregivers.

• SLP Suggestions:

- Regular speech and swallowing assessments to monitor changes and adjust therapy plans accordingly. - Techniques to improve speech clarity and address dysarthria. - Swallowing techniques to ensure safe swallowing and reduce the risk of aspiration. - Augmentative and Alternative Communication (AAC): - Introduction of AAC devices early in the disease progression to ensure familiarity and ease of use as the disease progresses.

• Special Educator Suggestions:

- Activities designed to enhance executive function, memory, and attention. - Use of memory aids, such as notebooks or electronic organizers. - Behavioral Strategies: - Structured routines to manage apathy and maintain engagement in activities. - Positive reinforcement to encourage participation and effort in tasks.

• Occupational Therapist Suggestions:

- Training in the use of adaptive equipment for self-care activities (e.g., dressing, grooming). - Techniques to conserve energy and manage fatigue. - Home and Environmental Modifications: - Assessing and modifying the home environment to ensure safety and accessibility. - Recommendations for ergonomic furniture and tools to support independence.

Recommendations on AAC and Other Details:

• Text-Based AAC:

- Predictive text features to speed up communication.

• Symbol-Based AAC:

- Dynamic display devices that can grow with the user’s needs.

References:

• Lublin, F. D., & Miller, A. E. (2014). Multiple sclerosis phenotypes: Current and future considerations. Neurology, 83(3), 278-286.
• Compston, A., & Coles, A. (2008). Multiple sclerosis. The Lancet, 372(9648), 1502-1517.
• Hauser, S. L., & Goodin, D. S. (2012). Multiple sclerosis and other demyelinating diseases. In D. L. Longo (Ed.), Harrison's Principles of Internal Medicine (18th ed., pp. 3395-3409). McGraw-Hill.

Additional Information:

Multiple Sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system (CNS), leading to a wide range of symptoms and disability. The disease is characterized by the immune system attacking the myelin sheath, the protective covering of nerve fibers, resulting in demyelination and neurodegeneration. The exact cause of MS is unknown, but it is believed to involve a combination of genetic and environmental factors.

MS can present in various forms, including relapsing-remitting MS (RRMS), primary progressive MS (PPMS), secondary progressive MS (SPMS), and progressive-relapsing MS (PRMS). RRMS is the most common form, characterized by episodes of new or worsening symptoms (relapses) followed by periods of partial or complete recovery (remissions). PPMS involves a gradual worsening of symptoms without relapses, while SPMS begins as RRMS and transitions to a progressive course. PRMS is a rare form characterized by progressive worsening of symptoms with occasional relapses.

Diagnosis of MS involves a combination of clinical evaluation, imaging studies (such as MRI), and laboratory tests. The McDonald criteria are commonly used to diagnose MS, which include evidence of CNS lesions disseminated in time and space. Cerebrospinal fluid (CSF) analysis may show the presence of oligoclonal bands, indicative of an inflammatory process in the CNS. Evoked potentials, which measure the electrical activity of the brain in response to stimuli, can also aid in the diagnosis.

Management of MS requires a multidisciplinary approach to address the diverse needs of affected individuals. Pharmacological treatments, such as disease-modifying therapies (DMTs), are commonly used to reduce the frequency and severity of relapses and slow disease progression. Symptomatic treatments, such as medications for spasticity, pain, and bladder dysfunction, are also important for improving quality of life. Non-pharmacological interventions, including physical therapy, occupational therapy, and speech-language therapy, are essential for maintaining function and enhancing independence.

Support groups and advocacy organizations provide valuable resources and support for individuals with MS and their families. Engaging in advocacy efforts can help improve access to services, funding for research, and public awareness. Ongoing research into the underlying mechanisms of MS and the development of new treatments offers hope for future advancements in MS care.

In conclusion, Multiple Sclerosis is a complex and multifaceted disorder that requires comprehensive management and support. Early diagnosis and intervention, along with ongoing care from a multidisciplinary team, can significantly improve the quality of life for individuals with MS.

Epidemiology and Demographics

Etiology and Pathophysiology

Clinical Features and Stages

Diagnosis

Clinical Recommendations

Care Management

Transition Planning