Multiple Sclerosis Kristen Meyer

• • • • • • • • • • • • Definition Epidemiology Symptoms Diagnosis Tests and Evaluations Complications Treatment Effects on Exercise Medications Effects of Exercise Exercise Prescription Summary

Indroduction

Definition

• Autoimmune disease that damages the insulating myelin of the CNS.

Epidemiology

• • • • First diagnosed between the ages of 16-60 Peaks at age 30 More common in women- 2 or 3:1 ratio Benign and rapidly progressing

Symptoms

• • • • • • • • • Spasticity Incoordination Impaired balance Fatigue Muscle weakness, partial paralysis, paralysis Sensory loss and numbness Cardiovascular dysautonomia Tremor Heat sensititivy

Diagnosis

• • • 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

Example of onset of cases

• • 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

Diagnosis

• • • • • • • No single test, only accepted criteria Imperfect system Neurologist evaluates symptoms Based on medical history Neurological Exam ( function of brain and spinal cord) Skill of doctor to ask the right questions to uncover info to 10% of MS cases are misdiagnosed

Tests

• • • • • MRI Spinal taps Lumbar punctures ( exam of cerebrospinal fluid) Evoked potentials Lab analysis of blood samples

Accepted Criteria for Diagnosis

• • • • • • Age 20-60 Signs and Symptoms idicate disease of brain or spinal cord Evidence of ≥ 2 leasions—or abnormal areas on the brain (from MRI scan) Objective evidence of disease of brain or spinal cord on doctor’s exam ≥ 2 episodes lasting at least 24 hrs. at least one month apart No other explanation for the symptoms

Complications

Treatment: Disease-Modifying Agents

Disease-Modifying Agent

Interferon beta-1a (Avonex, Rebif) Interferon beta-1a (Betaseron) Glatiramer acetate (Copaxone) Mitoxantron (Novantrone) Natalizumab (Tysabri)

Side effects that may effect exercise

Flu-lik symptoms, injection site irritation Flu-like symptoms, injection site irritations Injection site irritation Fever or chill, swelling of legs, cough or shortness of breath Fatigue, joint pain, depression

Treatment: Symptom Management

Symptom Management Side effects that may effect exercise

Amantadine, modafanil (Provigil) May reduce fatigue Baclofen (Lioresal), tizandidine (Zanaflex) May cause muscle weakness and fatigue Amitriptyline (Elavil), fluoxetine (Prozac) Prednisone May cause muscle weakness May cause muscle weakness reduced sweating, hypertension, diabetes, osteoporosis

Treatment