Multiple
Sclerosis
[Link] PT
“What does MS mean to
you?”
2.3 million people
20-40 years of age
Women > men
Colder climate of nort us
Family History
Certain infection
“I may not look
sick on the
outside, but on
the inside it’s ”World [Link] Clipart
like my body is
trying to kill me” “An uncertainty about
tomorrow”
• It’s easy to look at the statistics…
• 2.3 million people have multiple sclerosis in the world today.
• That means 3 out of every 10,000 people have multiple sclerosis.
• The statistic can tell you a lot, but they don’ tell the whole story.
• Suffering from MS is more than just a statistic.
• When asked what MS means to them, current patients say that MS
means…
• “uncertainty about tomorrow” ““I may not look sick on the outside,
but on the inside it’s like my body is trying to kill me
Multiple Sclerosis
• a chronic and progressive disease of the nervous system
• that damages the myelin sheath (fatty covering surrounding axon
projections) and underlying axons.
• Multiple Sclerosis is a disease of the central nervous system only,
• impacts oligodendrocytes and axons in the brain and spinal cord.”
Node of Ranvier
• periodic gap in the insulating sheath (myelin) on the axon of
certain neurons
• serves to facilitate the rapid conduction of nerve impulses.
• were first discovered in 1878 by French histologist and pathologist
Louis-Antoine Ranvier,
• The myelin sheath consists of concentric layers of lipids,
• nodes of Ranvier interrupt the insulation at intervals
• this discontinuity enables impulses to jump from node to node in
a process known as saltatory conduction.
What is Multiple Sclerosis?
“Multiple Sclerosis Myelin Sheath Cartoon.” Gene.
“Multiple Sclerosis.” Genentech, [Link]/patients/disease-education/multiple-sclerosis?topic=multiple-sclerosis.
• Multiple Sclerosis is considered an autoimmune disease.
• means that the cells of the immune system attack the body,
mistakenly identifying part of the body as an invading antigen.
• In this case the body identifies myelin as the antigen.
• This image shows a zoomed in section of the blood brain barrier, with
the vasculature shown in the middle and the astroglia and internal
areas of the brain shown on the sides.
MS is an Autoimmune Disease.
“Blood Brain Barrier.” Bioninja.
• The neuron on the bottom represents a neuron inside the brain, and the
molecules on the outside are immune cells in the vasculature outside the
brain.
• The central nervous system is typically separated from the immune system
of the rest of the body, and it protects itself with a different nervous system,
the “neuroimmune system”.
• In cases of multiple sclerosis, however, immune cells can cross the blood
brain barrier and enter the brain.
• They can enter via the choroid plexus and proliferate in the cerebrospinal
fluid or they can simply enter through arteries in the meninges.
• There are many proteins coating the outside of the oligodendrocytes.
• These proteins are recognized by T-cells, a type of immune cell, that crosses the blood brain
barrier.
•
• Upon the incorrect recognition of the proteins as antigens, the T-cells release cytokines
• Cytokines can help increase the permeability of the BBB and allow other immune cells inside
• Other immune cells such as B-cells, which produce antibodies and target the oligodendrocyte for
destruction .
• Once targeted for degradation, the oligodendrocytes are destroyed and digested by natural killer
cells and macrophages
• The cell can then try to repair itself, but often the lesions turn into plaques of damaged myelin.
• This creates permanent damage to the myelin and eventually to the axon beneath the myelin if
the repair processes cannot keep up with the damage.
• The damage to and loss of myelin decreases the amount of saltatory conduction possible.
• Normally, myelin helps insulate the neuron and increases the distance that the passive
current can flow.
• By increasing the distance that passive current can flow, less action potentials need to
happen along the axon, making the overall action potential much faster.
• With damaged or missing myelin, however, there is less insulation around the axon.
• This means that the passive current leaks out of the area where the myelin used to
contain it.
• Now the passive current cannot travel as far and more action potentials need to be fired
along the same length of axon.
• The overall action potential is now much slower and can even be distorted due to the
damage.
Multiple Sclerosis causes changes in
saltatory conduction.
Rose, John W., et al. “Lectures: Pathology.” Multiple Sclerosis, [Link]/kw/ms/[Link]#1.
Symptoms of Multiple Sclerosis
• The demyelination of the neurons and eventual damage to the axon
itself leads to a variety of physical symptoms. The slower and
distorted action potentials often create difficulties with movement
and muscular contraction.”
• “Some of the main symptoms include: fatigue, walking difficulties,
visual problems, and muscle pain/tingling. Although symptoms tend
to vary frequently between individuals. And many symptoms are
possible depending on individual differences”
What are the Symptoms of Multiple
Sclerosis?
BALANCE
and
COORDINATI
VISUAL
ON
PROBLEMS
FATIGUE
MUSCLE PAIN
and
TINGLING
“Black person.” Pixabay.
“Gray Person.” Clicker Clipart.
Agamanolis, Dimitri. “Demyelinative Diseases, Chapter 6.” Neuropathology: An Illustrated Interactive Course for Medical Students and Residents, [Link]/chapter6/[Link].
• In addition to the varying symptoms, there are varying types of disease
progression.
• There are four different types of MS that all have different characteristic
patterns of progression.
• About 85% of all MS cases fall under the category of “Relapsing Remitting MS”.
• This is the type of MS most treatment is targeted towards,
• Relapsing Remitting MS progresses in a cyclical pattern.
• It begins with a period of increased inflammation and symptom flare up
• Then, the inflammation stops and repair within the cells can occur
• Finally, there is a period of stability where there is no more repair but there is
also no inflammation
• These three stages repeat over and over throughout the progression of the
disease
Treatment options target the symptoms, not
the source…
“Corticosteroids.” Healthy Place.
“Physical Therapy for MS.” Behance.
Mayo Clinic Staff. “Multiple Sclerosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Aug. 2017,
[Link]/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.
And we still have a lot of progress
• Based on all of the research performed to study the cellular
degradation and disease progression, we have developed a few main
treatment options for Relapsing Remitting MS. Treatment options
typically focuses on speeding up recovery, slowing the progression of
the inflammation, and managing symptoms.
• Corticosteroids: reduce nerve inflammation
• Physical Therapy: stretching and strength exercises can help manage
weakness
Where do we go from here?
Symptoms
Cellular
Progression
Degradation
Treatment
Options CURE!
• Multiple sclerosis is a chronic disease of the immune system that
impacts millions of people worldwide.
• So the processes of cellular degradation, symptoms, and disease
progression will be important as we continue to search for a CURE!”