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Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system, leading to neurological disability, particularly in young adults. The etiology is not fully understood but involves genetic and environmental factors, with symptoms varying widely among individuals. While there is no cure, treatments focus on slowing progression and managing symptoms, with exercise providing additional benefits for strength and mental well-being.

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26 views18 pages

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system, leading to neurological disability, particularly in young adults. The etiology is not fully understood but involves genetic and environmental factors, with symptoms varying widely among individuals. While there is no cure, treatments focus on slowing progression and managing symptoms, with exercise providing additional benefits for strength and mental well-being.

Uploaded by

makhathinif3
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Multiple

Sclerosis
PRESENTED BY : RAMEEZ & FIKELEPHI
What is Multiple SCLEROSIS

 Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal
cord (central nervous system).
 The name multiple sclerosis is short for “Multiple cere-bro-spinal sclerosis”
 Multiple sclerosis (MS) is an autoimmune demyelinating and neurodegenerative
disease of the central nervous system.
 And the leading cause of nontraumatic neurological disability in young adults
 MS is becoming more common in both developed and developing countries.
(Dobson R, et al 2019)
Etiology and Risk factors

 The precise etiology of MS is still unknown


 Recent studies suggest that it arises from a fusion of genetic vulnerability and
environmental agents from development to young adulthood (Maha Haki et al.,
2024).
 Specific factors that can increase the risk of MS include lack of vitamin D, birth
season, tobacco use, and exposure to the Epstein-Barr virus.
 The age range most of the time is 20 to 40 years (Maha Haki et al., 2024)
 Women have more chances of developing MS
 Family history ( genetic susceptibility)
Types of Multiple Sclerosis
Relapsing-remitting MS (RRMS) is the most common type accounting for 85% at the
onset (Maha Haki et al., 2024)
Characterized by discrete attacks lasting days to weeks and followed by substantial or
complete recovery.
Neurological stability occurs between attacks.
Secondary Progressive MS (SPMS) follows an initial relapsing-remitting course,
characterized by a constant deterioration in function that is not linked to sudden
attacks,
SPMS exhibits more severe and permanent symptoms (Maha Haki et al., 2024)
Cont. types of MS

 Primary Progressive MS (PPMS) has a steadily progressive course with no


distinct relapses or remissions and accounts for about 15% of all MS cases (Maha
Haki et al., 2024) . Onset occurs later in life.
 Progressive/relapsing MS patients are rare, accounting for about 5% of MS
patients (Maha Haki et al., 2024). they experience a steady deterioration since the
onset of the disease but also occasional attacks
 Characteristic of SPMS patients. Each MS patient's journey is unique
Sign and symptoms
According to (WHO) symptoms vary from
person to person
• Vision problems
• Difficulty walking or keeping balance
• Difficulty thinking clearly
• Numbness or weakness especially in the
arms and legs
Pathophysiology
(Stys & Tsutsui, 2019)

 T-cells can become autoreactive due to an unknown antigen presented by MHC


class II molecules, causing inflammation .
 Antigen-presenting cells (APCs), such as dendritic cells and macrophages, play a
crucial role in presenting AGs to T cells.
 Oligodendrocyte precursor cells and other cells also contribute to this process.
 Autoreactive T cells spread into lymphatic tissues and expand- They enter
circulation after being triggered by sphingosine-1-phosphate
 When stimulated, T cells attach themselves to upregulated adhesion molecules
 T cells generate MMP, and MMP causes the breakdown of the blood-brain barrier.
Cont. Pathophysiology
(Stys & Tsutsui, 2019)

 Autoreactive T cells come into contact with APCs in the CNS and begin dividing
 Myelin is under attack
 T-helper cells develop into proinflammatory Th1 cells and anti-inflammatory Th2
cells
 Th2 cells release cytokines that attack Mφ and microglial cells
 Autoreactive T cells initiate the production of B-cell antibodies
 Antibodies cross the damaged section of the blood-brain barrier- Myelin
autoantibodies are formed.
Medication used

 There is no cure for MS


 Medication focuses on slowing the progression of MS
 Corticosteroids work by preventing the activation of inflammatory cytokines and
inhibiting the activation of T and B cells, which leads to a reduction in
inflammation and immune system activity This makes them useful in treating
autoimmune diseases like multiple sclerosis(McGinley et al., 2021) .
Cont. of medication used
(McGinley et al., 2021)

 Injectable disease-modifying therapies, such as interferon (IFN) or glatiramer


acetate,
 have been the first-line treatment for most patients with relapsing types of MS for
many years.
 These medications work by modifying immune system activity to reduce the
frequency and severity of relapses and slow the progression of the disease.
Medication used
Effects of medication used for M.S
on exercise (TOLLÁR et al., 2020)
 Interferon Beta- Flu like symptoms, body aches, fever, fatigue
 Glatiramer Acetate (Copaxone)- Injection site inflammation, sores
 Natalizumab-Headache, fatigue, nausea, important to monitor for Multifocal
Leukoencephalopathy
 Immunosuppressants- Corticosteroids can cause mood changes, appetite changes.
 Muscle relaxants can cause dizziness, drowsiness, weakness
Effect of M.S on Exercise
(TOLLÁR et al., 2020)

 Fatigue- One of the most common symptoms of M.S during exercise


 Muscle weakness and spasticity- Affects coordination and balance
 Heat sensitivity
 Cognitive impairment
Benefit of exercise on M.S
(TOLLÁR et al., 2020)

 Improved strength and mobility


 Improved cardiovascular health
 Enhanced mood and mental well-being
 Increased energy levels
 Management of other health related conditions as a consequence to M.S
References
• Maha Haki, AL-Biati, H. A., Zahraa Salam Al-Tameemi, Inas Sami Ali, & Al-hussaniy, H. A.
(2024). Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment.
Medicine, 103(8), e37297–e37297. https://doi.org/10.1097/md.0000000000037297
• McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and treatment of
multiple Sclerosis. JAMA, 325(8), 765. https://doi.org/10.1001/jama.2020.26858

• Ontaneda, D., Tallantyre, E., Kalincik, T., Planchon, S. M., & Evangelou, N. (2019). Early
highly effective versus escalation treatment approaches in relapsing multiple sclerosis. The
Lancet Neurology, 18(10), 973–980. https://doi.org/10.1016/s1474-4422(19)30151-6
• Stys, P. K., & Tsutsui, S. (2019). Recent advances in understanding multiple sclerosis.
F1000Research, 8, F1000 Faculty Rev-2100. https://doi.org/10.12688/f1000research.20906.1
• TOLLÁR, J., NAGY, F., TÓTH, B. E., TÖRÖK, K., SZITA, K., CSUTORÁS, B., MOIZS, M.,
& HORTOBÁGYI, T. (2020). Exercise Effects on Multiple Sclerosis Quality of Life and
Clinical–Motor Symptoms. Medicine & Science in Sports & Exercise, 52(5), 1007–1014.
https://doi.org/10.1249/mss.0000000000002228

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