What is Multiple Sclerosis?
Multiple sclerosis (MS) is the primary demyelination and neuro-degeneration over disperse areas of the grey and white matter of the brain and spinal cord. Chronic inflammation of the CNS is the primary cause. Most patients with MS initially present with relapsing-remitting multiple sclerosis (RPMS). In addition, a second phase, known as the secondary progressive multiple sclerosis (SPMS), can follow.
However, patients that do not experience both RPMS and SPMS suffer from primary progressive multiple sclerosis (PPMS). It results in an uninterrupted progression of the disease. 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.
The chronic nature of this disease may cause patients to develop a disability over time due to incomplete recovery from the previous attack. MS is a disease with no fixed symptoms and is 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.
Symptoms of Multiple Sclerosis
Clinicians characterize Multiple Sclerosis 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:
– Loss of vision
– Gait impairment
– Loss of bladder control
More commonly a patient who suffers from multiple sclerosis may experience motor weakness. Motor weakness usually associates with upper motor neuron signs such as mild spasticity, hyperreflexia, and pathologic signs. In between when the symptoms occur the patient may experience neurological stability, often with no symptoms; the relapsing-remitting phase (RRMS). As a result, 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.
Progression of Multiple Sclerosis
As MS progresses further the signs first observed may worsen and new presentations may occur. The recent criteria, provided by McDonald, states that MRIs can enable earlier diagnosis of MS. However, despite the advanced technology we have today, clinical evaluation of the differential diagnosis proves to be the best method to diagnose MS. In addition, many orthopedic tests, observed appearances, and other neurological tests can help narrow down the possibility of MS.
Integrative care with multidisciplinary health care professions is the way to approach the care of multiple sclerosis. There is no care that can help benefit a patient with multiple sclerosis. However, 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.
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