Muliple Sclerosis

Multiple sclerosis (MS) is the primary demyelination and neurodegeneration over disperse areas of the grey and white matter of the brain and spinal cord; caused by chronic inflammation of the CNS. Most patients with MS initially present with relapsing-remitting multiple sclerosis (RPMS), which is then followed by a second phase known as the secondary progressive multiple sclerosis (SPMS). However, patients that do not experience both RPMS and SPMS suffer from primary progressive multiple sclerosis (PPMS) which results in an uninterrupted progression of the disease (Mahad, Trapp, Lassmann, 2015). Due to the nature of this disease half of the patients diagnosed with MS need assistance with mobility 20years after being diagnosed. Progressively 50 percent of the patients will have developed noticeable cognitive deficits (Sawcer, Franklin, Ban, 2014).

The chronic nature of this disease allows it so that a patient may develop a disability over time due to an incomplete recovery from the previous attack. MS is a disease with no fixed symptom and is proved to be difficult to predict in an individual patient. Thus the most appropriate treatment for patients with MS is to educate them about the variable nature of this disease (Tullman, 2013).

MS can be clinically characterized by individual distinct episodes known as “attacks” and “relapses” of neurologic dysfunction. The symptoms produced by these individual episodes may vary depending on the location of neurologic involvement.
Some common symptoms may include:
– Numbness
– Tingling
– Weakness
– Loss of vision
– Gait impairment
– Incoordination
– Imbalance
– Loss of bladder control

More commonly a patient who suffers from multiple sclerosis may experience motor weakness. Motor weakness is usually associated with upper motor neuron signs such mild spasticity, hyperreflexia and pathologic signs (Rose, Houtchens, Lynch, 2000). In between when the symptoms occur the patient may experience neurological stability, often with no symptoms this is known as the relapsing-remitting phase (RRMS). 10 – 20 years after the first occurrence of the symptoms RRMS may progress to SPMS, which results in an insidious worsening of function and neurologic disability.

As MS progresses further the signs first observed may worsen and new presentations may occur (Rose, Houtchens, Lynch, 2000). In the recent criteria provided by McDonald it states that an earlier diagnosis of MS from MRIs can be gathered. However, despite the advanced technology we have today, clinical evaluation and a careful evaluation of the differential diagnosis prove to be the best method to diagnose MS (Milo, Miller, 2014). Although there are no set clinical presentations or diagnostic tests that can help distinguish specifically for MS; many orthopedic tests observed appearances and other neurological tests can be performed that can help narrow down the possibility of MS.

In a study performed by Alacantra and Mullin, (2012) demonstrated that chiropractic care relieved symptomatic relief and reduced the formation of lesions when observed using MRI. The study was performed using the atlas orthogonal percussion instrument, adjusting the upper-cervical region. The adjustments were performed on a 42 year old female with MS presenting with severe muscle spasms and contortion of the arms and hands. With the help of some dietary modifications the presenting symptoms resolved except for mild tingling and fatigue (Alacantra, Mullin, 2012).

In another study, adjustments to the thoracic and lumbar spine and soft tissue therapy appeared to show effectiveness to the patient’s symptoms. The series of adjustments were performed on a 26 year old patient with MS. The patient was diagnosed with strain of her right lower extremity, posterior joint dysfunction in both lumbar and thoracic region and posterior cervical strain secondary to MS. The patient was treated 2 times a week for 6 weeks and reported a significant improvement, then later on she was discharged from care. However upon not receiving any care the patient’s symptoms worsened. The patient returned for care, coming in once in 10 days for 8 weeks. The patient reported a significant reduction in pain (Southerst, Labrecque, Mior, 2012).

An integrative care with multidisciplinary health care professions is the way to approach care of multiple sclerosis. There is no, one care that can help benefit a patient with multiple sclerosis. However a care that can help in the reduction of the number of attacks, the severity, addressing the adverse effects on daily living and how the disease affects the psychosocial aspects of the patient is the best management scheme possible (Burkhart 2015).

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References
Alcantara, J., & Mullin, L. (2012). Wellness Care in a Chiropractic Practice-Based Research Program. Retrieved on 24th of April 2014 from http://www.journalchiroed.com/doi/pdf/10.7899/1042-5055-26.1.116
Burkhart, L, A. (2015). DCs Treating the Multiple Sclerosis Patient. Retrieved on March 9th from, http://www.chiro.org/research/ABSTRACTS/DCs_Treating_the_Multiple_Sclerosis_Patient.shtml
Goodin, D.S., (2014). Multiple Sclerosis and Related Disorders: Hand Book of Clinical Neurology (3rd ed.). Amsterdam, Netherlands: Elsevier B.V. Retrieved 23rd of April 2016 from
Mahad, D. H., Trapp, B. D., & Lassmann, H. (2015). Pathological mechanisms in progressive multiple sclerosis. The Lancet Neurology, 14(2), 183-193. Doi: 10.1016/S1474-4422(14)70256-X
Milo, R., & Miller, A. (2014). Revised diagnostic criteria of multiple sclerosis.Autoimmunity reviews, 13(4), 518-524. Doi: 10.1016/j.autrev.2014.01.012
Rose, J.W., Houtchens, M., Lynch, S.G. (2000). Multiple Sclerosis. Retrieved on 23rd of April 2016 from http://library.med.utah.edu/kw/ms/index.html
Sawcer, S., Franklin, R. J., & Ban, M. (2014). Multiple sclerosis genetics.The Lancet Neurology, 13(7), 700-709. Doi: 10.1016/S1474-4422(14)70041-9
Southerst, D., Labrecque, M., & Mior, S. (2012). Pain and pain-related disability in patients with multiple sclerosis: A case series of two patients treated with chiropractic management. Clinical Chiropractic, 15(3), 169-176. Doi: 10.1016/j.clch.2012.11.002
Tullman, M. J. (2013). Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis. Am J Manag Care, 19(2 Suppl), S15-20.
https://books.google.co.nz/books?hl=en&lr=&id=JbTVAQAAQBAJ&oi=fnd&pg=PA269&dq=presentation+of+multiple+sclerosis&ots=LDPf1yHgbv&sig=UK3s15_5gpPVZ0TWWAJho_-3KK8#v=onepage&q=presentation%20of%20multiple%20sclerosis&f=false