MULTIPLE SCLEROSIS

 MULTIPLE SCLEROSIS 

Multiple sclerosis is a progressively degenerative disease of the central nervous system of unknown cause . It is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate resulting in physical and psychiatric problems. It affects largely young adults between the ages of 20 and 40. It is slightly more in females than males.

CAUSES: 

The cause is unknown 

Immune deficiency: Autoimmune disease in which the body’s immune system attacks its own tissues. This immune system malfunction destroys myelin sheath, this Myelin is a fatty substance that coats and protects nerve fibers in the brain and spinal cord .

Hereditary factors: Affected women transmit the disease to offspring more frequently than affected men suggesting that mitochondrial genes contribute to inheritance. 

Viruses may be important in the development of disease and the infection perhaps occurring in a genetically susceptible host. The viruses are varicella zoster, measles, rubella and herpes simplex

Signs and symptoms: 

> Lack of energy 
> Headache 
> Depression 
> Aches in limbs 
> Limb weakness 
> Sensory disturbance like numbness, paraesthesia and dysaesthesia- an unpleasant feeling of burning,coldness or warmth, with associated sensory loss to pain and temperature.
> Motor symptoms like monoparesis and paraparesis are most common symptoms. Hemiparesis and quadriparesis occurs less commonly. 
> Loss of vision 
> Increase in muscle tone 
> Diplopia ( Double vision)
> Nystagmus ( lateral gaze of the eye) 
> Hearing loss is rare 
> Vertigo 
> Sphincter disturbance with urgency of micturition ( incontinence)
> Mental changes 
> Emotional liability like uncontrolled outbursts of crying or laughing
> Lack of balance and coordination while walking 
> Difficulty in speech 
> Tremors

DIAGNOSIS : 

A complete neurological examination and medical history are needed.The diagnosis of multiple sclerosis is made by a neurologist based on 
> History 
> Clinical findings
> Supportive Clinical tests 
> Blood Tests 
> Lumbar puncture 
> MRI scan 
> Spinal fluid analysis 

TREATMENT : 

There is no cure for multiple sclerosis, only to slow the progression of the disease and managing the symptoms. 
In acute relapses , rest and steroid therapy are the mainstay of medical management. Long term use of steroids have some side effects. So many other types of medical intervention are utilised to manage the symptoms of the disease, such as Antispasmodic medication to reduce the effects of Spasticity.
> The treatment consists of multidisciplinary team comprising of 
Neurologist
Physiotherapist 
Speech therapist 
Occupational therapist 
Ophthalmologist
Psychologist
Nutritionist 
>Neurological treatment consists of symptomatic treatment, like Controlling spasticity or tightness in the joints by drugs , Advising assistive and adaptive devices like splints , casts and callipers if needed 
> Speech therapy for speech difficulties 
> Clinical psychologist will give counselling based on the assessment and their plans of the treatment. 
> occupational therapy constitutes an important adjunct to the overall treatment to make them independent in daily living activities
> Diet counselling 
> Physiotherapy treatment
Proper assessment should be taken initially and have to plan the treatment accordingly 

For joint stiffness: 
•Passive movements and stretching 
• Ultrasound treatment to increase blood supply & to relax the muscles 
• Massage also helps to relax the tight muscles 
• Joint mobilisation techniques 

For increased muscle tone 
• Assisted Exercises 
• Active assisted Exercises 
• Stretching Exercises 
• Applying splints

For Respiratory complications: 
• Chest mobilisation Exercises 
• Breathing Exercises 
• Ballon blowing exercise 

For Balance and coordination: 
• Wobble board exercises
• Swiss ball exercises
• Frankels Exercises
• Hippotherapy performed on horse back 
• Hydrotherapy treatment

For sensory stimulation : 
Techniques of stimulation like 
• Brushing 
• Icing 
• Stroking 
• Pressure
• Slow and quick muscle stretches  

For strengthening body : 
• Active exercises 
• Resisted Exercises 
• Bicycling 
• Treadmill training 
• Ball squeezing Exercises for wrist and fingers 
• Quadriceps table Exercises for knee

For Pain management: 
Regular stretching 
Massage 
Ultrasound therapy 
Postural retraining and correction of faulty movement patterns along with orthotic and adaptive seating devices can reduce malalignment and pain. Pressure stockings or gloves can also be used . 

For incontinence : 
Pelvic floor exercises 
Kegels Exercises 

> Group Exercise classes can provide valuable motivation and social support 
> Proper posture and Gait training
> Yoga and meditation to relieve from stress 
> Walking and aerobics 

PRECAUTIONS : 

Avoid exposure to heat because multiple sclerosis symptoms often worsen when your body temperature rises.Precautions should be taken to manage core body temperature and prevent overheating. Air conditioning is a medical necessity in many climates. Additional cooling can be achieved through the use of fans, wet neck wraps and spray bottles for misting the skin with cool water and immersion in cool water with aquatic exercises. 
> Exercise sessions should be scheduled on alternate days and during optimal times , such as in the morning when body core temperatures tend to be lowest and before fatigue sets in. 

NOTE: 
Please consult your doctor before starting any exercise program