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Multiple Sclerosis. Walter Royal, III, MD Associate Professor, Department of Neurology University of Maryland School of Medicine Director, Maryland Center for Multiple Sclerosis Treatment and Research. What is Multiple Sclerosis?.

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Multiple sclerosis l.jpg

Multiple Sclerosis

Walter Royal, III, MD

Associate Professor, Department of Neurology

University of Maryland School of Medicine

Director, Maryland Center for Multiple Sclerosis Treatment and Research


What is multiple sclerosis l.jpg
What is Multiple Sclerosis?

  • Multiple Sclerosis (MS) is an chronic inflammatory demyelinating disease of the brain and spinal cord.


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Areas affected by MS

Brain

Spinal cord

Optic nerves

The Human Nervous System

(http://web.lemoyne.edu/~hevern/psy340/lectures/psy340.04.2.ns.structure.html)


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MS is an Immune-Mediated Disease

BBB=blood-brain barrier; APC=antigen-presenting cell.

Adapted from Miller et al. Continuum: Multiple Sclerosis (Part A). 1999;5:7.


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How Common is MS and Who Gets It?

  • 8,000 – 10,000 new cases are diagnosed annually

  • Affects nearly 500,000 individuals in the U.S.

  • Occurs most frequently between ages 25 - 35

  • Female: male ratio = 2:1

  • More frequent in populations native to areas further away from the equator



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What Causes MS?

  • Genetics

  • Environmental factors



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Monozygotic (identical) twins

Dizygotic (non-identical) twins

Child of parent with MS

Sibling of person with MS

25 – 30%

3 – 4.5%

1.9%

0.9%

Family Studies

Up to 19% of patients have an affected relative


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Groups for Which MS Genetic Traits Have Been Identified:

  • Japanese

  • African American

  • Mexican

  • Arabian

  • Sardinian (Italy)

  • Swedish

  • Norwegian

  • French Canadian

  • Multi-ethnic Caucasian

  • Finnish

  • Etc.


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Not Everyone with a Genetic Risk Will Develop MS – Why?

  • Risk is modified by Environmental factors

    • Sunlight

    • Diet (e.g., vitamin D)

    • Other lifetime experiences (infections?)




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Relapsing-remitting

Secondary-progressive

Disability

Disability

Disability

Disability

Time

Time

Primary-progressive

Progressive-relapsing

Time

Time

Multiple Sclerosis Clinical Subtypes

Lublin FD et al. Neurology. 1996;46:907-911.


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How Is MS Diagnosed?

  • At least two episodes of symptoms

    • Occur at different points in time

    • Result from involvement of different areas of the central nervous system

  • Absence of other treatable causes for the symptoms

  • Results of neurological testing


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Examples of MS Onset

  • Case 1: 26 year old woman

    • Decreased vision in the right eye in 9/05

    • Left leg numbness in 1/06

    • Right face numbness, right arm and leg weakness in 4/06

    • Left leg weakness in 8/06

  • Case 2: 45 year old man

    • Left arm weakness in 2/93

    • Numbness below the waist in 4/07


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Other Potential Causes ofMS-like Symptoms

  • Lyme disease

  • Lupus

  • Migraine

  • Non-recurrent inflammatory process

  • Encephalitis

  • Stroke

  • Tumor of the brain or spinal cord


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How Is MS Diagnosed?

  • Neurological examination

  • Magnetic resonance imaging (MRI) Scan

  • Blood tests

  • Lumbar Puncture (spinal tap): occasionally performed

  • Other testing: infrequently performed


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Assessment of the Appearance of

MS Lesions Over time

Time lapse = 1 year


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Images acquired over the course of 7 years from a single person with untreated MS

Brain Atrophy (Shrinkage) in Untreated MS


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Brain Atrophy (Shrinkage) person with untreated MS in Untreated MS


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How is MS Treated and Managed? person with untreated MS

  • Drug therapy

    • Treat new attacks (exacerbations)

    • Prevent the occurrence of future attacks

    • Slow or prevent disease progression

    • Treat the chronic symptoms of the disease

  • Physical therapy

  • Psychosocial support


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Treatment of New MS Exacerbations person with untreated MS

  • Drug therapy

    • Corticosteroids

    • Intravenous immunoglobulin

    • Plasma exchange

  • Physical therapy


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Prevention of Future Attacks and Disease Progression person with untreated MS

  • Immune modulating drugs

    • Beta-Interferon

    • Glatiramer acetate

    • Humanized monoclonal antibodies

  • Immunosuppressant drugs

    • Anti-cancer agents

  • Combination therapies


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Symptom Management – Examples person with untreated MS

  • Pain control

  • Management of impaired bladder and bowel function

  • Anti-spasmodic drugs

  • Treatment of fatigue

  • Splinting for contractures

  • Counseling


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MS Therapies: What Lies Ahead? person with untreated MS

  • Neural protection

  • Regenerative therapies

  • Cell replacement (stem cells)

  • Dietary approaches (vitamin D)


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Multiple Sclerosis Research at the University of Maryland person with untreated MS

  • Drug therapies

    • Injectable drugs with increased efficacy

    • New oral agents

  • Cell replacement therapies

    • Stem cell research

  • MS “vaccine”

  • Novel rehabilitation techniques

    • Robotics

  • Dietary approaches

    • Studies of the role of vitamin D in MS


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Summary person with untreated MS

  • MS is a common inflammatory disease of the CNS that affects females more frequently than males.

  • The cause of MS appears to be a combination of genetic and environmental factors.

  • The symptoms of MS can be quite variable.

  • MRI is a sensitive test for making the diagnosis of MS.

  • Treatments are available for reducing the number of MS attacks and for slowing MS disease progression.


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