Our problem: Multiple Sclerosis by Cynthia Valencia (Student)

Group Members: Cynthia Valencia, Abigail Urbina-bernal, Anthony Sanchez and Lauryn Silas

lssilas — 2023-08-29 19:56:09 UTC

afsanch9 — 2023-08-29 19:57:09 UTC

What is MS?

aurbina81 — 2023-08-29 20:01:34 UTC

Multiple Sclerosis, or MS, is a chronic and debilitating disease of the CNS (central nervous system). The protective myelin sheath covering the nerves is worn down by the body and results in nerve damage that causes many different symptoms, including vision loss, pain, fatigue, and impaired coordination.

What are some of the identified causes of multiple sclerosis?

ctvalenc1 — 2023-08-29 20:02:27 UTC

Immunology (the study of the body's immune system)
Epidemiology (the study of disease patterns in large groups of people)
Genetics (understanding the genes that may not be functioning correctly in people who develop MS)
Infectious agents (such as viruses)

Who is More likely to Suffer?

lssilas — 2023-08-29 20:13:03 UTC

Investigations have shown that women are 3x more likely at risk than men to suffer from Multiple Sclerosis. Though the disease is prevalent in various ethnic groups such as African American, Latinx and Asian American, it is mainly women who are between the ages of 20-50 and who are of Northern European descent who suffer the most. Furthermore studies have shown that those who have low vitamin d levels and smoking habits tend to develop the disease.

ctvalenc1 — 2023-08-29 20:18:15 UTC

Affected Anatomical Structures

aurbina81 — 2023-09-05 19:33:17 UTC

MS affects the CNS through the deterioration of nerve cell myelin sheaths, hindering brain and spinal cord use. Inflammation of the protective covering ultimately causes slowed or stopped signal transmissions.

Involved process of Multiple Sclerosis

lssilas — 2023-09-05 19:38:09 UTC

Cytotoxic T cells that mediate the inactivation of CD4+ T cells and through these cells increase vascular permeability, glial cells destroy and trigger of oligodendrocyte, as well as CD4+ T cells increasing cytokines and therefore promoting inflammation of B lymphocytes and cytokines.

What causes Multiple Sclerosis?

ctvalenc1 — 2023-09-05 19:46:48 UTC

Exposure to certain viruses or bacteria
Gene Mutation
Autoimmune disease- This occurs because your immune system mistakenly attacks healthy cells.

Triggers

afsanch9 — 2023-09-05 19:53:36 UTC

What could potentially trigger MS is stress, heat, childbirth, sick, vaccines, poor diet, lack of sleep, or Vitamin D deficiency.

Symptoms / Treatment

ctvalenc1 — 2023-09-12 19:25:37 UTC

Symptoms / Treatment

Tingling/Electrical Shock

aurbina81 — 2023-09-12 19:28:49 UTC

Over time, the damage to the CNS destroys the nerves, and in turn, can cause unusual sensations, including tingling or electrical shock sensations, especially in certain neck movements

Vertigo

aurbina81 — 2023-09-12 19:32:19 UTC

Lesions or damaged areas along the nerve pathways (in the cerebellum or medulla oblongata) that coordinate balance cause vertigo, a sudden internal or external spinning sensation

Multiple Sclerosis Hug (Dysesthesia)

lssilas — 2023-09-12 19:34:20 UTC

MS hug also known as Dysesthesia can be defined as a symptom that causes discomfort in the chest area.

Muscle relaxants

afsanch9 — 2023-09-12 19:39:25 UTC

The common treatments with people dealing with MS is they would use muscle relaxants for the pain. The Dantrolene is the most common used substance for muscle relax.

Walking (Gait) Difficulties

lssilas — 2023-09-12 19:42:47 UTC

Gait difficulties can also be a symptom of Multiple Sclerosis causing the patient to have balance problems and numbness in their feet leading them to have something called sensory ataxia.

MRI

ctvalenc1 — 2023-09-12 19:45:10 UTC

Magnetic resonance imaging (MRI): A diagnostic tool
- Magnetic resonance imaging (MRI) is the diagnostic tool that currently offers the most sensitive, noninvasive way of imaging the brain, spinal cord or other areas of the body.
- It is the preferred imaging method to help establish a diagnosis of MS and to monitor the disease course. MRI has made it possible to visualize the effects of MS and understand much more about it.

Physical Therapy

afsanch9 — 2023-09-12 19:46:00 UTC

People diagnosed with MS would go to therapy. The most common therapy people go to while have MS is physiotherapy for mobility and strength.

Neurological

ctvalenc1 — 2023-09-12 20:00:46 UTC

Although there is no one specific feature that diagnoses MS it's a combination.
- History of the patient
- Examination
- Relapses that last days or weeks where they have neurological symptoms such as losing vision in one eye, getting numb from the waste down, and getting double vision.

Assistive devices

lssilas — 2023-09-12 20:07:14 UTC

-Using assistive devices such as canes will help improve the patients walking/balance problems.

Putting pressure on your chest with a hot or cold cloth

lssilas — 2023-09-12 20:08:26 UTC

-Adding pressure on your chest with a hot or cold cloth can reduce the burning sensation as well as the tightness of the muscles in your chest.

Mobility

ctvalenc1 — 2023-09-19 19:59:57 UTC

Mobility: As the disease progresses, some people with MS will eventually develop limited or a complete lack of mobility. Roughly 33% of people with MS will lose their ability to walk. The other two-thirds will still be able to walk and move independently, but some will need mobility aids such as a cane, crutches, or a wheelchair.

Brain Atrophy/Deterioration

aurbina81 — 2023-09-19 20:01:42 UTC

Brain decay occurs at significantly higher rates in MS patients, averaging .5-1.35% annually
Demyelination affects cognitive functions, dependent on disease progression

Loss of Vision

afsanch9 — 2023-09-19 20:05:44 UTC

A common long term effect is losing of the vision as the person starts to see burr. Its very rare for a person to be completely blind but it could occur. The cause of the losing vision is because MS is affecting the optic neuritis.

Gradual Loss of Speech

lssilas — 2023-09-19 20:06:32 UTC

-Dysarthria happens when there's damage to the frontal lobe which causes the speech of the person with MS to worsen.
-The speech pattern is disrupted and the person speaks with abnormally long pasues..

Fingolimod (Gilenya)

aurbina81 — 2023-09-26 20:12:24 UTC

Fingolimod, or Gilenya, is an immunosuppressant that treats MS flare-ups.

The expected cost of Gilenya is roughly $9053-$9,664 for a 30-day (1-month) supply of 0.5 g. capsules. 96-99% of people with commercial/private health insurance or who are eligible for Medicare or Medicaid are covered for Gilenya.

If a patient who takes Gilenya no longer has access to the drug or cannot pay its bill, flare-ups associated with MS won't be treated with the immunosuppressant.

Ocrevus

lssilas — 2023-09-26 20:15:48 UTC

Ocrevus is a medication used to treat primary Multiple sclerosis and relapse MS.

Annual cost of Ocrevus is $75,102
But if you have you have...
-Medicare it'll be between $0- 14,500
-Medicaid it'll be dependent on your income and state regulations

Likelihood Of Insurance Coverage: 3
(Some individuals have all their costs covered but their are some who have half of it covered)

If a patient doesn't seek treatment then it'll cause Multiple sclerosis to relapse and come back worse.

Corticosteroids Shot

ctvalenc1 — 2023-09-26 20:20:01 UTC

One treatment for MS would be Corticosteroids. The expected cost of a Corticosteroids shot would be between $25-$300 without insurance. On a scale of 1-5, the likelihood of this treatment being full covered would be a 4.

The side effects of the shot would be

increased appetite – which may lead to weight gain if you find it difficult to control what you eat.
acne.
rapid mood swings and mood changes – becoming aggressive, irritable and short-tempered with people.
thin skin that bruises easily.
muscle weakness.
delayed wound healing

If they didn't receive the shot they would get more frequent relapses and more frequent disability accrual, and they'll have a higher chance for developing secondary-progressive multiple sclerosis (SPMS).

Cognitive Behavioral Therapy

afsanch9 — 2023-10-02 22:34:31 UTC

The social problem is likely to help with depression, drug use, and social anxiety. This is used for talking and being open to the feelings you received and distress they might be in with themselves.
In long term it wont stop but i would help the patient find new ways to over come them. in short term they are getting the treatments they need at the moment.
Psychologists, social workers, and professional counselors are the people to deliver the treatments to their patients!

Risperidone

lssilas — 2023-10-02 23:01:33 UTC

It's recommended to take antipsychotics such as Risperidone. It's an atypical psychiatric medication pill that treats bipolar disorders, mania, and other neurological problems that may occur. Risperidone is usually a treatment for Schizophrenia and can be prescribed by a general doctor or a psychiatrist.

Psychotherapy

aurbina81 — 2023-10-03 18:22:38 UTC

Counseling and certain psychotherapies may be required to treat some of the identified problems of MS patients, and are available through online, local, regional, and national support groups. These treatments aim at helping a person identify and change troubling emotions, thoughts, and behaviors, especially those linked or related to MS. Therapists, psychiatrists, and behavioral therapists are some personnel who offer this mental support and assistance to MS patients.

Occupational Therapy

aurbina81 — 2023-10-17 20:04:10 UTC

Occupational therapy is one option for the management and treatment of multiple sclerosis in addressing impairments and preserving the quality of life. Maintaining regular contact with the respective occupational therapist is crucial to creating a customized treatment plan that can reduce symptoms and enhance day-to-day functioning. An OT may assist in the patient's work, carrying on with a hobby, or basic tasks such as eating, bathing, or getting dressed.

Physical Therapy

lssilas — 2023-10-17 20:05:46 UTC

- Used for Ataxia
- A rehabilitation method to improve peoples independency once their motor and cognitive skills have come negatively affected by MS
- Therapists will use multiple exercises to challenge the persons affected side and make it progressively intense.

Citations:
https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Walking-Gait-Balance-Coordination
https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Walking-Gait-Balance-Coordination

Diet

aurbina81 — 2023-10-24 20:11:18 UTC

MS patients should follow a traditional, healthy, balanced diet that consists of fresh vegetables and fruits, whole grains, nuts and lean meats. One diet, the overcoming MS (OMS) diet is a plant-based diet that also includes fish and seafood but cuts out all processed foods, eggs, meat, dairy, and saturated fats. The diet usually includes daily supplements of flaxseed oil or fish oil.

Support Groups

lssilas — 2023-10-24 20:12:13 UTC

MS support groups can lead to the awareness that the patient is not alone and that there are others just like them. A support group is where people come together because they have a common disease they are struggling with and talk to others just like them.

Adjustment scale: 5

Just because some may not accept their disease.

-A psychotherapist can be involved in support groups.

Cite:

Mayo Foundation for Medical Education and Research. (2019, March 16). Cognitive behavioral therapy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610Links to an external site.

Geriatric Populations

aurbina81 — 2023-10-31 20:09:06 UTC

Certain movement concerns can be difficult to manage in the elderly on top of any possible age-related mobility impairments, making it more challenging to cope with the physical tolls of MS. Geriatric MS patient's should ensure their care team factors in respective physical, emotional, and social requirements.

Hispanic/Latinx Women

lssilas — 2023-10-31 20:09:28 UTC

Hispanic/Latinx women are more likely to contract MS because of Vitamin D deficiency and sun light exposure. Not only that but hormones can also affect the population. Hispanic/Latinx women might face money problems where they can't really afford care, they might not know how to deal with such a disease, or just not having access to the care they need due to the environment.

Vitamin D

aurbina81 — 2023-11-07 19:28:12 UTC

Numerous studies have found a link between low vitamin D levels and an increased risk of developing multiple sclerosis. MS is more frequent in areas with less sunlight, and the "sunshine vitamin" is generated in the skin when exposed to sunlight. This has prompted research into the potential protective function of Vitamin D in MS. Vitamin D is known to impact the immune system and may have an anti-MS effect. It has a role in immune response control and has anti-inflammatory effects. Vitamin D has a critical role in MS pathogenesis, particularly throughout adolescence/young adulthood, but there is still not enough data to recommend any oral vitamin D supplements.

Exercise

afsanch9 — 2023-11-07 19:33:35 UTC

Many studies has shown by doing Exercise it increase blood flow within the body. Being obesity could cause lots of health risk. Since people started doing the exercise the blood flow was better to the brain where it was more alert and active causing a prevention towards MS. MS is a big factor in the brain and limiting or getting rid of the risk where a healthy life style with daily activity to keep the body moving.

Mobile Applications for Multiple Sclerosis

ctvalenc1 — 2023-11-14 17:41:37 UTC

Smartphone apps are a popular way to manage health-related behaviors such as Multiple Sclerosis. Studies show apps can help monitor MS symptoms, diagnosis and disease management and help track physical activity and nutrition behavior.

These applications can contribute to empowerment of the patients, and help their adherence to the therapeutic and management regimen of their conditions.
This information may provide health care professionals with evidence to help their patients toward enhancing self-management of their disease.

DMTs

aurbina81 — 2023-11-14 18:37:14 UTC

Disease Modifying Therapies or DMTs are immunosuppressing medication treatments that allow for a modification/slowing of MS progression. These therapies aim to reduce relapse frequency and severity, as well as to postpone the progression of impairment.

Interferons, glatiramer acetate, and newer medicines such as ocrelizumab, natalizumab, and fingolimod are examples of DMTs.

MIT-Manus

lssilas — 2023-11-14 19:12:36 UTC

The MIT-manus is a robot assisted therapy that treats Multiple sclerosis where it assists the patients to perform common functions in order to improve the neuro plasticity of the brain and increase the function the patients upper body by reducing cerebellar ataxia symptoms. The only downside is that patients will have to adapt to an unfamiliar presence such as the robotic assistance.

To clarify MIT-Manus is a lot like a robot arm that's attached to the effected parts of the upper body and can either help with improving movement or with resistance training.

Citations:

Vergaro, E., Squeri, V., Brichetto, G., Casadio, M., Morasso, P., Solaro, C., & Sanguineti, V. (2010, July 29). Adaptive robot training for the treatment of incoordination in multiple sclerosis. Journal of neuroengineering and rehabilitation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927907/Links to an external site.
Multiple sclerosis (MS) rehabilitation. University of Maryland Medical System. (n.d.). https://www.umms.org/health-services/rehabilitation/services/neuro/ms-rehabilitationLinks to an external site.

Functional Electrical Stimulation

lssilas — 2023-11-14 20:12:14 UTC

Electrical Stimulation treats walking and hand functions the patient will tend to suffer from by sending electrical signals to muscles to cause them to contract and move. They are administered through blue patches that are attached to your body and are relatively painless. Some negative effects of using FES is the patients might become depressed because of false hope.

Citations:

Functional electrical stimulation (FES) and multiple sclerosis. National Multiple Sclerosis Society. (n.d.). https://www.nationalmssociety.org/Treating-MS/Rehabilitation/Functional-Electrical-Stimulation-(FES)

MB;, B. (n.d.). The effect of participating in a functional electrical stimulation exercise program on affect in people with spinal cord injuries. Archives of physical medicine and rehabilitation. https://pubmed.ncbi.nlm.nih.gov/8002768/#:~:text=In%20particular%2C%20the%20results%20show,participants%20who%20have%20unrealistic%20expectations.

Vitamin D

aurbina81 — 2023-11-21 20:14:52 UTC

According to epidemiological and experimental research, high levels of vitamin D, a powerful immunomodulator, may reduce the incidence of multiple sclerosis. Vitamin D supplements have been identified and encouraged as a public health approach for lowering the risk of multiple sclerosis, particularly in areas with little sun.

There are no prospective studies that explore the hypothesis, however, but the notion is still encouraged.

Endorsement of Medicine

lssilas — 2023-11-21 20:15:39 UTC

Another is WHO endorsing medicines that may help to treat Multiple sclerosis. It's been said that the medicine they have passed is to slow/delay the progression of MS and add it to the EML. Not only that but with the addition of these 3 medicines (cladribine, glatiramer acetate, and rituximab) they hope that anyone with MS can get easier access to these treatments since the medicines will be listed at different prices. This endorsement is to reach special populations such as minorities and young women affected by MS that need these types of medicine. The only challenge this tactic might face is backlash from skeptical people who might not trust these medicines as yet.

Citation:

World Health Organization. (n.d.). Who endorses landmark public health decisions on essential medicines for multiple sclerosis. World Health Organization. https://www.who.int/news/item/26-07-2023-who-endorses-landmark-public-health-decisions-on-essential-medicines-for-multiple-sclerosisLinks to an external site.

COPY & PASTE

lssilas — 2023-11-28 19:12:33 UTC

Special populations that should have concern over MS are minorities such Hispanic/Latinx Women and African Americans because it's been studied that women and minorities lack the necessary vitamin D needed for bone strength. There's also Geriatric populations such as people with old age due to them being mobility impaired.

ctvalenc1 — 2023-11-28 19:14:17 UTC

What were the key features of the condition such as symptoms and physiology?

Vertigo= a sudden internal or external spinning sensnsation
Walking difficulties= Having balance problems and numbness in their feet
Dysesthesia or MS hug= Discomfort in the chest area
Tingingling Electrical Shock= Unusual sensations like an electrical shock sensation especially neck movements

What challenges do you see with prevention, diagnosis, or treatment of the condition, including challenges in the healthcare system itself.

afsanch9 — 2023-11-28 19:17:34 UTC

A challenge I see is a person's ability to walk as it affects a person's ability to do movement without the use of a cane. Since MS affects the brain another could be a person could forget to take their medication for the pains. They might face the challenge to ask for help in a healthcare environment as people lose their voices slowly.