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While the causes of multiple sclerosis aren't completely known yet, there are some factors of everyday life that can contribute to the diagnosis of MS.

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Due to MS's destructive effect on the brain, this can destroy multiple parts of the brain that affect social interaction and mood changes, drastically affecting the person's ability to socialize.

For example:

-Dissatisfaction with quality of life, causing anxiety, depression, and negatively impacting relationships.

-Isolation from friends and family.

-Increases in mood changes and can cause separation in relationships.

To help with this, many scientists have encouraged keeping a healthy lifestyle and healthy communication with friends, family, and other forms of support.

For example, you can do these things:

-Keeping a healthy and happy mind, like thinking positively.

-Talking with friends and family about issues.

-Working out, drinking water, staying active, etc.

-Meditating, allowing time to rest, and working on hobbies.

-Asking for medical or therapeutic support.

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MS can cause multiple mental health problems

Depression:

Depression affects %50 of MS paitents. This can manifest as sadness, irritability, loss of interest in activities, and decreased appetite.

Anxiety:

MS can weigh heavily on patients' minds, with the potential for symptom development, such as cognitive impairment or more neurological effects that may lead to more pain signals to the brain.

Stress, Grief, Fear:

These emotions can be amplified after receiving a diagnosis of MS. Paitents may also experience frustrations with cognitive impairments such as memory loss.

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MS developing in patients is usually a multifactorial issue, related to issues such as environmental factors, lifestyle, genetics, etc.. But having a healthier diet usually helps manage MS problems.

As stated by studies, nutrition and dietary factors affect the mechanisms of MS pathology, its development, and the degree of activity. Although studies have shown the important role of nutrition in MS, the current therapy is not combined with any specific nutritional or lifestyle recommendations.

Possible recommendations for diet in MS patients include:

-Plant-based foods, including fruits, vegetables, whole grains, beans, legumes, nuts, and seeds

-Gut-healthy food with probiotics

-Fatty Fish

-Low-fat milk and dairy products

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Multiple Sclerosis affects the parts of the nervous system that control; muscle movement, balance, and coordination.

Muscle Weakness

Muscles in the feet, legs and truck become weak, making basic movement difficult.

Balance Problems

Challenging to maintain stability; falling become more common.

Spasticity

Muscles become stiff and tight, making it painful and hard to move.

Foot Drop

Weakness in muscles that lift feet, causing them to drag.

Fatigue

Difficult engaging in activities like walking.

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Individuals who are diagnosed with MS face a multitude of challenges in their daily life. Challenges include:

Cognitive Challenges- MS can affect people's memory, concentration, and information processing.

Emotional Challenges- Anger and grief are common among those with MS. These emotions can be exacerbated by the uncertainty of the disease's progression.

Physical Limitations- MS can lead to physical limitations like brain fog, fatigue, and spasticity. These symptoms can make an individual's daily routine challenging.

Social Relationships- MS can create challenges in maintaining social relationships. The unpredictable nature of the disease can lead to reduced productivity at work, school, and difficulties maintaining social connections.

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Multiple Sclerosis is primarily considered an autoimmune disorder, where the immune system mistakenly attacks the protective covering of nerve fibers, known as the myelin sheath. This attack leads to inflammation and damage, disrupting communication between the brain and the rest of the body.

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More and more evidence suggests that smoking can play a role in multiple sclerosis.

Compared to non-smokers, smokers are almost two times more likely to be diagnosed with MS. This has been seen in both adult and children even just exposed to smoke.

Once diagnosed with MS, smokers may experience more severe symptoms, increased relapsed frequency, and greater disability compared to non-smokers.

The relapse rate in smokers may have increased due to an increased risk of infection, and smokers have been found to have more enhancing lesions on MRI compared to non-smokers with MS.

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Several studies show that obesity in childhood and adolescence increases the risk of MS. These studies highlight a risk, particularly in girls. Other studies show that obesity in early adulthood may also contribute to an increased risk of MS. Obesity may contribute to inflammation and more MS activity in those already diagnosed with MS. This includes a rise in relapses and lesions in MRI.

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Who is more likely to suffer from MS? (Definite Causative Factors)

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Who is more likely to suffer from MS? (Definite Causative Factors)

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Sex: Women are 3 times more likely to develop MS in comparison to men.

Age: MS can develop at any age, but the onset of MS most likely develops between the ages of 20 and 40 years old.

Genetics: If one of your parents or siblings has MS, you have a higher probability of obtaining MS.

Ethnicity: People of Northern European descent or people of white skin have the highest distribution of MS. Though there might be some evidence of a larger percentage of Hispanic and Black populations having MS.

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Geography: MS is more so found in countries/regions farther from the equator such as North America and Europe.

Smoking: Increases the risk of MS and can lead to a faster progression of the disease

Vitamin D Levels: This is often linked to less sun exposure, which increases the risk of MS.

Obesity: particularly during adolescence, can increase the risk of MS

Infections: Certain viruses (ex. Epstein-Barr virus) have been linked to an increased risk of MS

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Growing evidence suggests that vitamin D plays an important role in MS. Vitamin D is a nutrient needed for good health. Scientists have identified a low vitamin D level in the blood as a risk factor for developing MS. Some researchers believe that sun exposure might be linked to MS. People who live closer to the equator are exposed to greater amounts of sunlight year-round. As a result, they tend to have a higher level or naturally produced vitamin D. Researchers think this supports immune function. It may help protect against immune-mediated diseases like MS. Currently, researchers are trying to find out if taking vitamin D supplements helps prevent and manage MS.

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Multiple sclerosis is a central nervous system autoimmune disease where lymphatic macrophages infiltrate and degrade the myelin sheaths of neurons, causing inefficient communication between neurological pathways.

2 Main Theories that cause MS:

"Outside-in" Theory, where an unknown antigen triggers proinflammatory T-cells attachment to the CNS endothelium and crossing of the blood-brain barrier, causing an immune attack via cross-reactivity.

"Inside-Out" Theory, where there is an intrinsic CNS abnormality causing inflammatory tissue attacks.

Depending on the region of "legions" or plaques, where the local inflammation occurs, neurological symptoms can differ. Because MS affects myelin sheaths, they can also affect other structures such as:

Cortical gray matter

Periventricular and juxtacortical white matter

Optic nerves

Spinal cord

Cerebellum

Meninges.

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Multiple Sclerosis affects the brain and spinal cord, leading to a variety of effects on the body such as:

Vision Problems: Such as blurred or double vision

Movement Issues: Including muscle weakness and difficulties with coordination

Cognitive Difficulties: Problems with memory and thinking

Emotional Changes: Mood swings and emotional instability

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About 15% of people with MS receive an initial diagnosis of PPMS. This type of MS progresses slowly from its onset. It can involve periods of active disease and periods of remission. However, even during remission, you may experience increasing disability. In essence, PPMS involves a fairly continuous progression of the disease. You might experience minor, temporary improvements over time and occasional plateaus in the progression of symptoms. The symptoms of PPMS can overlap with those of RRMS. But PPMS typically involves difficulty walking, worsening mobility, and increasing disability. PPMS tends to involve less inflammation than RRMS. PPMS lesions are also more likely to appear on the spinal cord, whereas RRMS lesions occur more in the brain. PPMS affects men and women equally.

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SPMS is another progressive form of MS. It's thought of as the second phase of RRMS. That's because it initially follows the relapsing-remitting disease course, with symptom flare-ups followed by recovery periods. Symptoms of SPMS can overlap with those of RRMS. But SPMS involves nerve damage or loss, leading to more steady disease progression. With SPMS, the disability of MS does not disappear between cycles, instead, this period of fluctuation is followed by a steady progression of the condition. If you have SPMS, you might experience minor remissions or plateaus in your symptoms, but this isn't always the case. Without treatment, 50% of people with RRMS go on to develop SPMS within a decade, and 90% develop SPMS within 25 years.

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RRMS is the most common type of the disease with about 85% of the people with MS have RRMS at the time of diagnosis. With RRMS you might experience periods of increased symptoms (relapses) followed by periods of partial or complete recovery (remission). Common symptoms of RRMS include:

fatigue

numbness

motor and muscle weakness

vision changes

spasticity

bowel issues

bladder issues

difficulty thinking

Disease activity in RRMS is usually marked by inflammation and new lesions on your brain, but you might develop new lesions without experiencing symptoms. It's also possible for RRMS to be stable, with no new MRI activity or worsening symptoms.

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CIS is a single episode of neurologic symptoms that lasts 24 hours or longer. CIS symptoms cannot be connected to fever, infection, or other conditions. Rather, they result from inflammation or demyelination in your central nervous system. You might have only one symptom (a monofocal episode) or several symptoms (a multifocal episode). If you have CIS, you may never experience another episode. But this episode could instead be your first MS attack. If an MRI detects brain lesions similar to those found in people with MS, there's an increased risk that you'll experience another episode and receive a diagnosis or MS in the coming years. When undergoing testing for CIS, you might receive an MS diagnosis if an MRI detects older lesions in different parts of your central nervous system. That would mean you've had a previous attack, even if you were not aware of it. A doctor might also diagnose MS if your cerebrospinal fluid contains oligoclonal bands.

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Multiple Sclerosis has many risk factors. One of these risk factors is contracting a common virus known as the Epstein-Barr virus (EBV), classified as a gamma herpesvirus. Another name this virus is known for is Mono or the Kissing disease. Epstein-Barr virus is its own virus, but its side effect is Mono. All paitents who have MS have had EBV. Lifestyle factors also contribute to the possibility of contracting MS, such as obesity and smoking. Childhood obesity to adulthood doubles the risk factor percentage of MS. Obesity causes the body to be in a constant state of inflammation. This information lowers the effectiveness of the immune system in the blood and brain.

Citations: Hedström A. K. (2023). Risk factors for multiple sclerosis in the context of Epstein-Barr virus infection. Frontiers in immunology, 14, 1212676. https://doi.org/10.3389/fimmu.2023.1212676

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Numbness: A lack of sensation, similar to an area of the body being asleep, "pins and needles".

Tingling: Prickling, crawling, or burning sensations.

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Blurred Vision: unclear or temporary loss of vision

Double Vision: Seeing two of an object

Optic Neuritis: Inflammation of the optic nerve, which can cause the two mentioned above as well as eye muscle problems.

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Memory Loss: also known as amnesia, is the inability to recall or retain information.

Difficulty concentrating: Poor focus or attention

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The symptoms for multiple sclerosis vary depending on the type of multiple sclerosis someone could be developing, however a common sign of MS is muscle weakness/loss. Patients developing MS commonly lose the ability to walk or control a part of their body.

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Symptom of MS: Loss of balance and coordination

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Symptom of MS: Loss of balance and coordination

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MS can cause damage or destruction of the myelin sheath, causing ataxia which causes movements to be uncoordinated

Symptoms: Vertigo, dizziness, tripping or falling, impaired coordination with hands and other parts of the body

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-Multiple sclerosis is diagnosed by a combination of symptoms, family history, and diagnostic testing.

Paitents would be examined to look into their own medical history and family history of MS after experiencing MS symptoms.

Doctors commonly look for eyesight problems, numbness, weakness, and brain/spinal cord damage.

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Treatment 1# for MS (Oral/Injection/Fusion)

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Treatment 1# for MS (Oral/Injection/Fusion)

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-There is no true cure for MS, only management of symptoms and medication to stop severe relapses. During an MS attack, you can be treated with either Corticosteroids (help with nerve inflammation) or plasma exchange.

-Treatment for progression in symptoms varies and can depend on what form of MS the patient has. It's important not to put extreme aggressive treatments on a patient when first diagnosed, as that could worsen symptoms and increase attacks.

-Injectable treatments include:

Interferon beta medicines (reduce relapses, decrease inflammation, and increase nerve growth)

Glatiramer acetate (Copaxone, Glatopa) (blocks the immune system's attacks on myelin

Ofatumumab (Kesimpta, Arzerra) (decrease risk of new lesions or worsening symptoms)

-Oral treatments include:

Teriflunomide (Aubagio)

Dimethyl fumarate (Tecfidera)

Diroximel fumarate (Vumerity)

Monomethyl fumarate (Bafiertam)

Fingolimod (Gilenya)

Siponimod (Mayzent)

Ozanimod (Zeposia)

Ponesimod (Ponvory)

Cladribine (Mavenclad)

-Infusion treatments include:

Natalizumab (Tysabri).

Ocrelizumab (Ocrevus).

Ublituximab (Briumvi).

Alemtuzumab (Campath, Lemtrada).

Citations: Mayo Clinic. “Multiple Sclerosis.” Mayo Clinic, Mayo Clinic, 1 Nov. 2024, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.

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-Other treatments for symptoms include:

Therapy: Physical and occupational therapy can help with stretching, and a mobile aid (when necessary) can help with walking.

Muscle relaxants: relief from muscle stiffness and spasms.

Medicines to reduce fatigue: decrease MS-related fatigue and depression.

Medicine to increase walking speed: helps increase the speed of walking.

Other medicines: medicines can also be prescribed to help with depression, pain, sexual dysfunction, insomnia, or bladder/bowel dysfunction.

Citations: Mayo Clinic. “Multiple Sclerosis.” Mayo Clinic, Mayo Clinic, 1 Nov. 2024, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.

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-MRIs are utilized to take X-ray images to see if paitents have plaques building in the brain.

These plaques consist of scarred tissues of dead brain cells caused by MS.

Other measures are taken, such as taking blood tests to rule out any other autoimmune disorders.

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Multiple sclerosis can disrupt signals between the brain and the urinary and bowel systems, resulting in bladder and bowel issues such as issues such as increased frequency, urgency, incontinence, constipation, and fecal incontinence.

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Multiple sclerosis can cause optic neuritis, leading to blurred or dim vision, double vision, and other visual complications. Early treatment with DMT's may help reduce the severity and frequency of these complications.

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Because MS is a neurological condition, many functions related to the brain or cognition are impaired as autoimmune cells attack the myelin sheaths of varying parts of the brain. These can include issues in:

Information-processing speed

Memory

Executive Functions

Due to the other varying symptoms, mental problems like depression, anxiety, PTSD, etc, can occur alongside these issues.

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MS can cause emotional distress not only with the diagnosis but also cause long-term changes to the brain as well.

Depression is part of this disease, as the neurons are destroyed and create scarring. Depression can become a part of the paitents personality after the diagnosis of MS.Anxiety can also become more frequent. Inappropriate laughter or crying can also occur as the disease progresses because of the damage the brain is going through. This is called pseudobulbar affect (PBA).

Mood swings are also common as a long-term side effect.

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Physical: Difficulty with mobility, balance, & coordination

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Physical: Difficulty with mobility, balance, & coordination

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Difficulty with Mobility: reduced ability to move or navigate one's environment.

Balance Issues: Feelings of unsteadiness, dizziness, or disorientation, making it difficult to stay steady.

Coordination Problems: Aligning joint movement, can lead to problems with basic functions.

These can impact daily lives, leading to isolation or depression.

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DMTs or Disease-modifying therapies are medications/ treatments that aim to stop/slow the progression of the disease.

These include:

Immunomodulators

Monoclonal antibodies

Oral medications

Stem cell transplant

Overall, these treatments can cost between $57,000 and over $92,000 annually. They could surpass $100,000 before discounts and rebates.

Insurance coverage varies depending on the type of insurance. For example, most FDA-approved DMTs are covered under programs like Medicare and are subject to strict approval requirements. High out-of-pocket costs are a huge barrier to patients, but generally, major insurance plans will cover a significant piece of the cost.

If someone chooses not to seek treatment, the disease will progress faster, have more relapses, and accrue greater disability over time. The underlying immune activity of MS continues to damage the central nervous system, increasing the risk of physical disability, cognitive impairment, and decreased quality of life.

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One important long-term treatment option for multiple sclerosis is physical therapy (pt). MS often causes muscle weakness, spasticity, balance problems, and fatigue. Physical therapy helps maintain mobility, strength, and coordination through regular exercises, stretching, and mobility training. Over time, this can help patients stay independent and reduce the risk of falls or muscle contractures. Physical therapy for MS can cost anywhere from $75 to $350 per session in the United States. The total yearly cost depends on frequency- for example, weekly sessions could total $4,000-$10,000 per year. Many therapists also provide home exercise plans to help reduce overall costs. Most health insurance plans, including Medicare and Medicaid, cover physical therapy when it's prescribed as medically necessary. However, there are usually limits on the number of sessions per year or per diagnosis, and patients may still have to pay co-pays or coinsurance. If the patient exceeds the allowed sessions, they may need to appeal for continued coverage. If a person avoids physical therapy due to cost or access issues:

Muscles can weaken over time, leading to more difficulty walking or standing

Balance and coordination may worse, increasing the risk of falls

Joint stiffness and spasticity can become permanent or painful

Overall mobility and independence may decline, requiring more assistance later on

In short, physical therapy doesn't stop MS itself, but it's crucial for preserving function, independence, and quality of life over the long term.

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There are some other long-term treatments that don't include DMTs or forms of physical therapy that are recently being studied.

Bruton's tyrosine kinase (BTK) inhibitor: works for relapsing-remitting MS and secondary-progressive MS in which it alters the function of B-cells (important immune cells in the CNS).

-Can cost $99,000-110,000 without insurance.

-With insurance coverage, it can be as low as $0.

-This might be very difficult to be coverage on due to expensive and particular form of therapy. Medicare users also might have to deal with larger payments and difficulty in obtaining therapy.

Stem cell transplantation: completely removes the patients immune system and replaces it with a healthy person's stem cells. Almost "resets" someone's immune system.

-Can cost $20,000-150,000 without insurance.

-Most likely will not be covered by insurance as its still an experimental treatment.

Research in CD40L: a type of protein that has shown a role in MS. Blocking this protein can possibly reduce symptoms or relapses.

-Not covered and no cost as its experimental and still being researched.

Phosphodiesterase inhibitor: a new medicine that works to reduce inflammation by changing damaging autoimmune attacks in MS.

-Can cost from $10-1,000 without insurance.

-Can cost as low as $0 with insurance.

-Most likely to be covered in comparison to other treatments.

These are all varying forms of new treatments for MS and not necessarily the most common treatments for MS. New treatments are still being researched and not or doing these treatments does not remove other opportunities for oral/injectable/infusion medicine or physical therapy as well.

Citation: Mayo Clinic. “Multiple Sclerosis.” Mayo Clinic, Mayo Clinic, 1 Nov. 2024, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.

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Cognitive rehabilitation therapy helps patients manage memory, attention, and problem-solving difficulties that can result from Multiple Sclerosis. It involves structured exercises, compensatory strategies, and therapist guided training. A long-term effect of cognitive rehabilitation therapy is improved cognitive functioning and better daily life management, even as the disease progresses. To receive this treatment, individuals would have to go see a neuropsychologist or an occupational therapist.

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Stress Management Training involves teaching and practicing relaxation techniques such as:

Mindfulness Meditation: focusing on the present moment by observing your surroundings.

Deep Breathing Exercises: Taking deep breaths to include the body's relaxation response.

Progressive Muscle Relaxation: A relaxation technique where you systematically tense and then release different muscle groups throughout the body.

The goal is to build a person's ability to cope with daily and long-term stressors related to MS.

Since stress can worsen MS symptoms, this treatment is designed to help reduce the physical and mental impacts of stress. It can decrease the risk of anxiety and improve the overall quality of life.

This training can be done by multiple types of health professionals. This includes:

occupational therapist

psychologist

other mental health providers

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Pseudobulbar Affect (PBA) directly affects paitents with MS and their communication skills. PBA is when the patient uncontrollably starts laughing, crying, or has an inappropriate response to communication. This is a condition that the patient needs to learn how to manage long-term. Medications can be prescribed to help this condition.

Psychological counseling is very beneficial for newly diagnosed paitents by providing support and educating paitents about the condition.

Occupational therapy can help MS paitents by teaching them proper coping mechanisms when they feel an episode coming on with day-to-day tasks.

Some coping mechanisms may look like mental distractions, such as counting objects or practicing deep breathing to relax and remain in control. Changing bodily positioning can also help the patient distract themselves from an episode.

A neurologist specializing in MS is most recommended for treating symptoms of MS.

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Studies have shown that antidepressants (like sertraline or desipramine) are effective at reducing depressive symptoms, but they haven't been shown to help fully recover from depressive symptoms. More research needs to be conducted to show a more conclusive effect of antidepressants on MS patients. Pharmacotherapeutic medication can help with mental health symptoms, but probably shouldn't be the most reliable form of therapy.

Some short-term effects of medication can be:

-Improved brain chemistry

-Reduced stress response

-Increased neuroplasticity

But they can also have effects of:

-Cognitive Impairment

-Sexual Dysfunction

-Metabolic and Gastrointestinal Issues

-Addiction and Withdrawal Symptoms

Some long-term effects of medication can be:

-Other mental issues arising

-Mental numbness and changes in brain chemistry over time

-Weight loss or gain

-Fatigue

-Insomnia

This, of course, does not apply to all patients who take antidepressants or any form of pharmacotherapeutic medication, and symptoms vary from person to person.

Specialists that assign this form of medication can be:

-Psychiatrists

-Primary Care Doctor

-Neurologists

-Therapists

-Counselors

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Speech & Voice Exercises

Used to strengthen the muscles of the mouth, face, and respiratory system.

Treats long-term dysarthria effects, such as imprecise articulation, low voice volume, impaired breathing control, and maintains/improves speech clarity.

Treated by Speech-Language Pathologist

Techniques for Clearer Speech

These involve behavioral strategies like slowing down speech, over-articulating, and self-monitoring using recordings.

Treats short-term and long-term communication difficulties by teaching practical coping mechanisms that improve speech intelligibility.

Treated by Speech-Language Pathologist

Alternative Communication Methods

This involves using augmentative and alternative communication (AAC) devices or other tools like writing or communication boards.

Treats severe and worsening speech loss by providing alternative ways to communicate, which helps preserve long-term independence.

Treated by Speech-Language Pathologist

Swallowing Strategies

This treatment includes exercises, postural changes (like the "chin tuck"), and dietary modifications to make swallowing safer and easier.

Treats dysphagia (swallowing difficulty) to prevent short-term complications like choking and aspiration while mitigating the long-term risk of malnutrition.

Treated by Speech-Language Pathologist

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Symptoms:

-Memory Problems: difficulty in repetition and remembering storage in the brain.

-Information Problem: trouble keeping up with information (from TV shows, conversations, books, school, etc.)

-Attention and Concentration: easily distracted by interruptions and competing stimuli. Having difficulty moving from one task to another.

-Executive Functions: difficulty in planning, prioritizing, and problem-solving. Have more problems with moving from one concept to another and struggle in completing more complex problems.

-Perception: difficulty in describing the distance of objects or the direction.

-General Intelligence: people with MS tend to feel “dumber”. General intelligence is not really affected by MS, but other functions like memory, executive functions, and perception make up intelligence. They are usually slowed or regressed.

-Cognitive Rehabilitation:
+Restorative Activities: practicing memorization, combining modes of learning, practicing intervals, and using memory aids.

+Compensatory Activities: centralize things and place things in a very clear location, planning (schedule planner, mobile apps/computer programs with all activities, appointments, and educational things), recording (recording yourself doing something and to-do lists), reminders, removing distractions (TV, phone, etc.), taking breaks, and doing one thing at a time.

+Reduce Stress

+Sleeping more consistently and overall

+Healthy Physical Activity

-Medication:

+Though there haven’t been any large-scale clinical trials of medication that have proven truly effective, any form of stimulants that help with attention, information processing, and memory problems will be useful. Some forms of DMT (disease-modifying therapies) could increase the rate of cognitive slowing.

Professionals Involved:

-Physical therapists

-Counseling

-Therapists

-Physical Trainers

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Multiple sclerosis causes much damage to the brain. These damages can affect many areas of living and functioning. Hearing loss and tinnitus are common amongst paitents. Tinnitus is when the paitent experiances ringing in the ears. To treat hearing loss caused by MS, corticosteroids are prescribed by a neurologist or an ENT Doctor. This is a strong steroid to help with inflammation, in this case, to treat cases of MS causing hearing loss. Of course, usual measures such as prescribing hearing aids are recommended for hearing loss. Any audiologists and hearing aid dispensers would be authorized to dispense hearing aid treatment options. Another treatment that is possible is the patient learning Lipreading.

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Physical therapy is a common rehabilitation treatment for people with multiple sclerosis. It involves exercises and movement-based activities that help maintain or improve strength, flexibility, balance, and mobility. A physical therapist designs individualized exercise programs that may include stretching, gait training, and balance or coordination exercises. Physical therapy helps slow down loss of mobility, reduces the risk of falls, and maintains independence in daily activities as MS progresses.

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Possible Occupational Treatments for MS:

-Fatigue:

+Energy Conservation Strategies

+Tracking periods of long-term fatigue to identify patterns

-Pain:

+Track locations of intensity, at rest, at activity, and which activities exacerbate pain or possible flares of MS.

+Physical agent modalities

+Manual Therapy Techniques

-Mobility:

+Therapeutic Exercise (like Tai-Chi, yoga, dance, swimming, weightlifting, etc...)

+Transfer Training (wheelcair training and management).

Overall, utilizing any of these exercises and techniques can help with MS flare-ups or has shown evidence of lower intensity attacks. Continuation of simply occupational therapies like these have shown better quality of life.

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Maintaining a healthy diet or changing eating habits:

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Maintaining a healthy diet or changing eating habits:

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A steady and healthy body is correlated with having decreased symptoms of MS. Maintaining a healthy diet has a strong relationship with body weight and cardiovascular risk factors, such as high blood pressure, high cholesterol, and diabetes. All of these risk factors have shown evidence of correlation with higher MS activity. Dietary metabolites (fatty acids and amino acids that form proteins) have direct effects on metabolic activity in the brain and the body.

+Here are some ways that you can maintain a healthier diet or healthier eating habits:

Prepare meals at home as much as possible.

Incorporate colorful, fresh fruits and vegetables daily.

Choose lean proteins and healthy fats.

If you eat grains, choose whole grains over refined grains.

Consider adding herbs and spices to add flavor to meals.

Avoid or limit processed foods and added sugars as much as possible.

5/10: On a scale from 1-10, maintaing a healthy diet eating more whole foods, prepped meals, protien-full, and sugar-free food can be more difficult. Sometimes with more extreme symptoms, especially with mobility issues, eating can be difficult and maintaining a more healthy diet can be even more difficult. A healthy diet can be learned from dieticans, nutristionists, and even some personal trainers or physical therapists. A caretaker can help with a more healty diet as well. Unhealthy eating habits can be hard to break and eating healthier will take time and practice over a long period of time.

Professionals who can suggest recommendations for lifestyle modifications:

Primary Care Physician

Mental Health Professionals (Therapists)

Lifestyle Medicine Physician

Physical or Occupational Therapist

Dietitian or Nutritionist

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Regular, moderate physical activity helps improve strength, balance, coordination, and energy levels, while reducing fatigue and spasticity. This involves establishing a consistent exercise routine tailored to individual abilities and limitations, often focusing on low-impact activities like swimming or yoga.

Difficulty: 7/10

Reliance on Others:

Moderate to High. MS-related symptoms like fatigue, heat sensitivity, and mobility issues can make starting and maintaining exercise challenging. Reliance on others includes healthcare professionals to create a safe plan, family for encouragement, and potentially a workout partner or support group for motivation and social engagement. Assistive devices or exercising in a climate-controlled environment (like a cool pool) might also be necessary.

Professionals:

Physical Therapist

Occupational Therapist

Neuro Exercise Specialist

Neurologist

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An increase in brain stimulation such as transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) are beneficial to people struggling with multiple sclerosis by improving symptoms such as fatigue, pain, cognitive issues, and motor control through enhancing neuroplasticity, strengthening rehabilitation

Difficulty: 6/10 due to these specific stimulations being medically provided and supervised so accessibility might not come easy

Professionals:

Neurologists

Neuropsychologists

Psychiatrist

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During adolescence, the difference in MS population percentage between women and men is small. But the difference becomes clearer when women are older teenagers or young women. Many factors might make women more likely to develop MS. For example, the role of sexual hormones and differential development, pregnancy (relapses may start after childbirth), and higher rates of body fat/obesity (higher correlation with inflammation and higher body fat), and higher rates of Vitamin D deficiency (higher correlation with inflammation and relapses).

-Problems that many women will face with MS include:

+Possible risks during pregnancy and post-partum (including increased inflammation and mental/physiological issues).

+Possible developmental issues while growing up, as MS inflammation can develop earlier during childhood and develop largely during adulthood.

+Menstruation issues, as many women will face worse symptoms during the menstrual phase.

+General mental health issues (Depression, mood swings, fatigue, emotional numbness, etc.)

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Cases of children having MS are rare,              but 3-5% of MS patients are children.

Children living with any chronic illness are terrible. Children should be able to enjoy their childhood. Kids might have a hard time in school with their symptoms and making friends if they have sudden, intense emotional outbursts. Children with MS may struggle with development, along with dealing with a chronic illness so early on in life.

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Low vitamin D levels have been linked to a higher risk of MS. Vitamin D plays a role in immune system regulation, and getting enough- through sunlight exposure, diet, or supplements- may help lower the risk of developing MS. Although, there are challenges that individuals may face trying to get adequate vitamin D levels.

Limited sunlight exposure: People living in northern climates, indoor workers, or those with long winters may not get enough natural sunlight.

Skin sensitivity or skin cancer risk: Some people must limit sun exposure for medical reasons, making it harder to maintain vitamin D naturally.

Diet and Supplement Barriers: Not everyone can afford supplements, and vitamin-D rich foods are not commonly consumed in all diets.

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Prioritizing consistent, high-quality sleep and actively managing chronic stress may help reduce MS risk.

Both poor sleep and high stress levels can contribute to; immune system dysregulation and a pro-inflammatory bodily state, potentially triggering autoimmune responses in susceptible individuals.

Challenges:

Modern Demands: Demands from work, school, and personal life often lead to chronically high stress levels and insufficient sleep in adults and adolescents alike.

Subjective Nature: Stress and sleep quality are subjective experiences that are difficult to objectively measure and manage, as effective strategies (ex., meditation, therapy, sleep hygiene improvements) vary greatly among individuals.

Mental Health Stigma: Seeking help for stress or sleep disorders may face stigma, and access to effective mental health and sleep medicine professionals can be limited or costly.

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Avoiding smoking is one of the most important measures to take. If you are a smoker, then stopping smoking would also prolong the progression of MS. Maintaining a healthy weight also helps the body stay in homeostasis, and Studies have shown that children who are overweight are more likely to develop MS later in life. Exercising regularly can help fight against inflammation and boost the immune system. People may find out that smoking can cause MS a little too late if they have been smoking all of their lives and have already been diagnosed with MS. Some people want to make excuses for not working out regularly, like being too busy for the gym or for any type of workout at home. Sometimes hormones can be thrown off, and maintaining a healthy body weight can be harder for some people, even if they're eating the same foods.

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Robotics Limbs and Voice-Activation Systems 

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Robotics Limbs and Voice-Activation Systems 

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-Voice-activated systems:
+If MS has made movement or coordination control difficult, Apple and Android voice activation have had significant developments in their technologies. A phone with a voice-activation system can type text, emails, and answer calls, or open and close apps with your voice. On computers, voice recognition systems can assist with writing documents, composing emails, and opening and closing tabs.

+Other voice activation systems include virtual personal assistants (such as Alexa and Google), automotive systems, smart home devices (like thermostats, refrigerators, and dishwashers), and other specialized equipment that can be modified to accommodate certain disabilities. These assist with treatment and everyday life.

-Assistive Robotic Arms or Legs:
+For example, the Kinova Jaco Assistive Robotic Arm is flexible and has 16 different movements that correspond to the human arm. Assistive robotics can allow for more autonomy, enabling more independence in eating, drinking, pushing buttons, and coordination. Though these modifications can be quite expensive, especially without insurance, and can cost thousands of dollars. These are best for treatment after diagnosis.

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Transcranial Direct Current Stimulation Device and MS Management Apps

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Transcranial Direct Current Stimulation Device and MS Management Apps

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-Transcranial Direct Current Stimulation Devices:

+A type of noninvasive brain stimulation that can treat cognitive, motor, and speech issues for people with PPMS and other neurological conditions. You can enroll in a personalized program (virtual or in-real life) that provides an electrode headset, which applies a low-grade electrical current to the scalp. The program also offers physical activity and cognitive rehabilitation activities.

+Shows evidence of helping mood and depressive episodes in people with MS.

-MS Managament Apps:

+Specific apps can help track PPMS symptoms and medical appointments. It also can help you and your MS care provider share more information about symptoms.

+Adding symptoms like pain metrics, ability to peform motor functions, etc... can help show disease progession and find treatments for PPMS.

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Low Vitamin D levels are associated with an increased risk of MS. Public health programs may include awareness campaigns, recommending supplementation, improving food fortification, or encouraging safe sunlight exposure. The targets for this are individuals (supplement use, behavior change) and the environment (food supply fortified with Vitamin D). Challenges with this include:

Ensuring people consistently take supplements

Equity issues: limited sun exposure in northern regions

Misinformation about vitamin D or fear of skin cancer leading people to avoid sunlight

Cost or logistical barriers to expanding fortified foods

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Smoking Prevention and Cessation Programs

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Smoking Prevention and Cessation Programs

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Smoking is a major modifiable risk factor for MS. Interventions include school-based smoking prevention, free or subsidized quitting programs, public health campaigns, and anti-smoking taxation. The targets for this are individuals and policy/laws. Challenges include:

Addiction makes quitting very difficult

Communities with high smoking rates may resist policy changes

Tobacco industry influence

Lack of access to cessation services for low income populations

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Smoking Prevention and Cessation Programs

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Epstein-Barr Virus Prevention or Vaccination Research

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Epstein-Barr Virus Prevention or Vaccination Research

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EBV infection-especially infectious mononucleosis- is strongly linked to MS. Public health measures may involve improving hygiene education, reducing infection spread in schools, or implementing an EBV vaccine if approved. Targets for this are individuals, the environment, and policy/law. Challenges include:

No EBV vaccine exists yet

EBV is extremely common and hard to prevent

Hygiene interventions require consistent behavior

Public acceptance of new vaccines may be low

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Epstein-Barr Virus Prevention or Vaccination Research

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Early Screening and Monitoring for High-Risk Individuals

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Early Screening and Monitoring for High-Risk Individuals

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People with a family history of MS or early neurological symptoms may benefit from earlier screening, lifestyle counseling, and monitoring to reduce delays in diagnosis and promote early intervention. Targets include individuals and policy/laws. Challenges include:

No simple test exists to predict MS with certainty

Stigma or anxiety around being labeled "high-risk"

Primary care clinics may lack time or specialists

Insurance or cost barriers for neurological evaluations