Module 3 Multiple Sclerosis Objectives

1. Describe three basic functions of the nervous system (Workbook 3-5).

Sensory input, integration, and motor output.

2. Differentiate between a nerve and a tract, and a ganglion and a nucleus

(Workbook 3-5).
In the difference between a nerve and tract is the system they are in Nerve
is in the PNS and tract is in the CNS. Ganglion and Nucleus is also the
same but Ganglion is in the PNS and Nucleus in CNS.

3. Diagram the divisions of the nervous system to include the following

(Workbook 3-5, 3-6, 3-7):
a. CNS and PNS
b. Sensory (afferent), motor (efferent)
c. Divisions of the motor system: somatic, autonomic
d. Divisions of the autonomic nervous system: sympathetic,
parasym- pathetic.

A sensory, like the feeling of touch, sight, smell, etc., than a afferent
transduction is sent up the body by nerves/neurons. Then it enters the PNS &
into the CNS. The CNS interprets the nerve and tells the body what to do. Next
it travels back down the PNS where it makes a Automic (automatic response)
or a somatic response (a conscious movement). Automic movements are either
sympathetic or parasympathetic. Sympathetic is fight or flight, which increases
blood flow, heart rate, etc. or Parasympathetic which is rest and digest. It does
the opposite of sympathetic. These both effect the Entric Nervous system. It is
like a scale, where it tilts based on what is happening.

4. Describe the function of a neuron. Identify on a diagram the parts of a

neuron (Workbook 3-8, 3-12)

1. Cell membrane 2. Dendrites 3. axon 4. Node of Ranvier 5. Myelin

sheath 6. Axon Terminal

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 5. Define neuroglia and their respective functions in the PNS and the CNS
(Workbook 3-9, 3-10, 3-13, 3-14). Be able to identify the neuroglia on a
diagram.
CNS Oligodendrocytes: Provide a good chemical environment in the cell.
Astrocytes: Provide form and structure for cells. Microglia: These are
phagcytes that eat bad stuff in cell. Ependymal cell: These cells make cerebro
spinal fluid.
6. Describe the function of a myelin sheath. List two neuroglia that produce
myelin and define in which subdivision of the nervous system each is
found. Describe how multiple sclerosis affects the myelin sheath.
(Workbook 3-11, MS Case Study pgs. 1, 2 and associated links).
Oligodendrocytes and Schwan cells make myelin sheaths in the CNS and PNS
respectively. They are supposed to make the nerves transmit faster. Shwan
wraps around the axon in a whole & can sometimes aid in the repair of a
nerve. Oligodendrocytes wraps around the axon in multiple sections. Because
of this it moves slower than a Schwan cell.
Multiple sclerosis makes the immune system attack the myelin sheaths in the
CNS. It makes it so your nerves don’t work
7. Describe features of Multiple Sclerosis including (Workbook pgs 3-15, 3-
16, MS Case Study pg. 1 (multiple sclerosis) and associated links):
A. Risk factors Genetics, female, vitamin d deficiency, special
viruses
B. Disease process Body attacks CNS nerve system & makes nerve
damage.
C. Four types of MS Relapsing-remitting MS, Primary progressive
MS, Secondary progressive MS, Progressive relapsing MS.
D. Symptoms Fatigue, pain, bad coordination.

8. Diagnostic Testing (MS Case Study pgs. 1, 2 and associated links).

A. Define the principle behind each of the following diagnostic tests
described in the case study. Describe how MS may adversely affect
results of each test:
1. Visual fields : can’t see cause the optic nerve receptors in the eyes may
be damaged.
2. Visual acuity: testing for vision, 20/20 vision test.
3. CT scan : Xray that scans bones and stuff inside the body.
4. MRI : uses magnets to draw very detailed pictures inside your bdy.
5. Evoked potential : The measure of electricity inside the brain.

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 6. Lumbar puncture : done to draw cerebral spinal fluid from
the body.

B. Of the above diagnostic tests, list the three commonly used to diagnose
MS.

Lumbar puncture, evoked potential, and MRI

C. Describe why MS is often a difficult disease to diagnose (MS Case

Study pg. 3 and associated links, Case Summary).
Because only conditions exist. Nothing specifically tells doctors
besides plaque build ups after decades.
9. Describe treatments for MS to include steroids and disease-modifying
therapies (DMTs). Differentiate the difference between treatment using
steroids compared to beta interferons. (Case Study Workbook pg. 3-17,
MS Case Study pg. 3 (Multiple-Sclerosis-treatment) and Case Answers
#19).

Steroids are used for anti-inflammatory. DMT (disease modifying

treatments) slows down diseases in the body. Theirs 2 types. 1 type Beta
Interferons, weakens the immune system to decrease the attack on myelin.
2 type is monoclonal antibodies. Target proteins that are in the autoimmune
attack.

👉(ﾟヮﾟ)👉

[Link] the roles of the following health care providers in the diagnosing
and care of a patient with MS (Case Study pgs. 1-3, Case Summary,
Professionals).
a, Ophthalmologis: Diagnose and
treat eye diseases and performs
eye surgery.
b. Neurologist: someone that does
stuff with nervous system.
c. Radiologist :someone that looks at scans and diagnoses them
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 d. Radiological technician: The person that gets the machinery
ready for x rays and mri’s
e. Medical laboratory scientist: performs normal tests with body
fluids.
f. Home health nurse: help perform daily tasks for disabled
people and give them baths 😐

The Nervous System

The nervous system allows communication throughout the body, and as

such is a key player in maintaining homeostasis. Sending signals to muscles
to control body movements is only one of the many functions performed by
the nervous system. All sensations including touch, pain, temperature, sight,
hearing, and taste are communicated through the nervous system. Speech,
memory, and thought are also responsibilities of the nervous system. In
addition, it regulates the operation of internal organs.

The nervous system is divided into the central nervous system (CNS) and
peripheral nervous system (PNS). The CNS consists of the brain and the
spinal cord. The PNS includes all nervous system structures found outside of
the brain and spinal cord, including cranial and spinal nerves. Clusters of
axons and cell bodies in the PNS and CNS have different terminology:

PNS CNS

Bundle of axons Nerve Tract

traveling together

Group of neuron Ganglion Nucleus

cell bodies

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 Sensory nerves carry signals to the central nervous system from somatic
senses (touch, temperature, pain, and proprioception) and special senses (taste,

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vision, hearing, smell, equilibrium). Sensory nerves are also called afferent
nerves.

Motor nerves or efferent nerves carry signals away from the CNS back
to muscle. Motor nerves are further divided into somatic or autonomic
neurons. Somatic neurons carry impulses to skeletal muscle. We are
consciously aware of these sensations. The autonomic nervous system carries
impulses to smooth muscle, cardiac muscle and glands. You can think of this
division as automatic, we don’t have to think about these impulses. (This is
very convenient if you don’t want to worry about moving your food through
your digestive tract or keeping your heart beating)!

Processing information in the nervous system is called integration.

Often multiple stimuli are arriving. For example, a soccer player who is
considering shooting a goal has visual input, hearing, memory of past
experience, emotion, that all must be integrated forming the muscular
response: shoot or pass!

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 Autonomic Nervous System

Most of our organs are innervated by both the sympathetic and

parasympathetic nervous systems. Notice in this chart the different responses
under each system. If you’re running from a lion (or maybe just taking an
exam) the sympathetic nervous system (fight or flight) is activated. If you’re
watching football after Thanksgiving dinner, the parasympathetic nervous
system is activated (rest and digest).
Neurons

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Nerve tissue consists of neurons and neuroglia. Neurons are able to conduct
an electrical signal called an action potential through the movement of ions
across the cell membrane (including sodium and potassium) These signals
travel one direction down the axon to another neuron or to the effector:
muscle, gland, or organ.

Most neurons consist ofcell

a
body, dendrites, and an axon.
Dendrites receive a signal from
another neuron or from the external
environment. Signals travel one
direction down the axon to the
effector. Neurotransmitters, stored
in theaxon terminals
, communi-
"
cate the signal.

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 Neuroglia

Every star needs a support system. In this case the neuron is the star, and cells
making up the neuroglia (nerve glue) act as supporting players. While neurog-
lia do not conduct action potentials, they play a major role in the nervous sys-
tem. There are many more neuroglia than neurons (5 to 50 times more). They
are generally smaller than neurons but do have the ability to divide.

Neuroglia of the CNS

• Astrocytes: Maintain proper chemical environment around neurons.

• Oligodendrocytes: Produce myelin sheaths around CNS neurons.
• Microglia: Phagocytes of the CNS. Protect CNS from disease.
• Ependymal Cells: Form cerebrospinal fluid and aid in its circulation.

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Neuroglia of the PNS

• Schwann Cells: Produce myelin sheaths around axons.

Myelin sheaths allow for faster conduction of nerve impulses.
• Satellite cells: Regulate the exchanges of materials between neuronal cell
bodies and interstitial fluid.

Myelination

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Schwann cells in the PNS and Oligodendrocytes in the CNS produce
myelin, which covers axons and allows for faster nerve conduction. All cells
are not myelinated. Nerves innervating cardiac muscle, glands, and smooth
muscle need to be a little slower. Nerves innervating skeletal muscle are all
myelinated.

Schwann cells myelinate in a different manner than Oligodendroctyes. They

literally wrap themselves around a single axon. In the CNS,
Oligodendrocytes send out broad, flat processes that wrap around several
CNS axons. One Oligodendrocyte may myelinate parts of several axons.

Schwann cells aid in the repair of a damaged axon. This explains, in part,
why damaged nerves in the PNS may regenerate but typically do not in the
CNS.

Multiple Sclerosis, discussed in this module, is an autoimmune disease

where the body’s own immune system attacks Oligodendrocytes and the
myelin sheath in the CNS.

Identify the Parts of a Neuron

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1. _________________ 4. __________________

2. _________________ 5. __________________

3. _________________ 6. __________________

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Match the glial cell of the CNS with the correct definition.

___Form cerebrospinal fluid

#1. Microglia and aid in circulation

#2. Astrocyte
___Maintain proper
chemical environment
#3. Ependymal Cells ___Phagocytes of the CNS

___Produce myelin sheaths

#4. Oligodendrocytes around CNS neurons

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Cell #1 _________ is the equivalent of ______________ cells in the CNS.
These cells help maintain the proper chemical environment for the neuron.

Cell #2 _________ has a similar function to ____________ in the CNS. These

cells produce ___________ which insulates axons and causes faster nerve
conduction.
Multiple Sclerosis

About 900,000 people in the US are affected by Multiple Sclerosis (MS).

Diagnosis typically occurs in individuals 20-30 years of age. There appears to
be both genetic and environmental causes of the disease. Many genes have
been identified that contribute to this disease. Environmental factors that lead
to increased risk include low levels of Vitamin D, UV radiation, Epstein-Barr
infection, and tobacco smoking. While MS is three times more common in
women, it is usually more severe in men.

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MS is an autoimmune disease. The immune system, specifically T cells,
attack the myelin sheath of nerve axons in the central nervous system causing
demyelination of nerves. As the body tries to heal the myelin, scarring may
occur, leading to characteristic plaques that may be visible by magnetic
resonance imaging.

There are four different types of MS depicted in the graphic below:

• Relapsing-remitting.
Most common form.
Flare-ups
(exacerbations)
followed by periods of
remission.

• Secondary-
Progressive
Begins as relapsing-
remitting MS. After a
time period of relapses,
disease starts a steady
progression.

• Progressive-
Relapsing. Rare form
characterized by
steadily worsening
disease with occasional relapses.

• Primary-Progressive Slowly worsening symptoms with no

periods of remission. This type is not common.
Symptoms of MS vary by patient. Some of the main symptoms are depicted in
the image below.

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Treatment for MS is multi-faceted. Disease modifying treatments (DMTs) are
those that seek to limit the progression of the disease. These include therapies
that suppress the immune system such as beta interferons. Monoclonal
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antibodies, another type of DMT, target proteins involved in the autoimmune
attack. There are currently nine classes of DMTs approved for therapy. The
goal of all DMTs is to reduce inflammation of the nervous system. Another
promising avenue of treatment is stem cell therapies with the goal of
regenerating nervous tissue.

Treatment of symptoms is also important. This may include treatment of

muscle spasticity (increase in muscle tone), pain, spasms, depression, urinary
tract disorders (urgency, incontinence), and decreased cognition to name just a
few.

A healthcare team is necessary in order to treat not only the primary disease
but also for treatment of symptoms and lifestyle. In addition to health care
professionals that treat our patient in the case study, many health care
professionals may be needed over a lifetime. These specialists include:

• Neurologist
• Primary care physician
• Psychologist
• Urologist
• Pain specialist
• Infectious disease specialist
• Physical, occupational, and speech therapists

Case Questions

1. What is a visual field?

2. What conditions may affect the visual field of the eye?

3. What is a visual acuity test?

4. Why is a visual acuity test performed?

5. What happens to the myelin sheath of the nerve in MS?

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6. Why does this occur?

7. How does this affect a patient with MS?

8. What functions may be affected by MS?

9. What happens to the nerve after an assault on the myelin sheath?

10. What is the most common pattern of MS attacks?

11. What is the difference between primary progressive MS (PP-MS) and

relapsing remitting MS (RR-MS)?

12. What symptoms are suggestive of MS?

13. What is a CT scan? What is the purpose of a CT scan?

14. How does an MRI scan differ from a CT scan?

15. What are the advantages of an MRI scan over a CT scan?

16. What is a lumbar puncture?

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17. What causes the characteristic plaques seen in MS?

18. Why are the plaques not always seen in a patient with MS?

19. How do steroids differ from disease-modifying therapies including

B-interferons in the treatment of MS?
References

McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis

and Treatment of Multiple Sclerosis: A Review. JAMA, 325(8), 765-
770. [Link]

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