Multiple Sclerosis (MS)
Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms,including problems with vision, arm
or leg movement, sensation or balance. MS is an autoimmune disorder in which the cells in your body begin to attack the healthy cells of the central nervous
system, causing cell damage and death.
With MS, the immune cells begin attacking the myelin sheath of the nerve cells. This damages the nerve and inhibits the action potential from effectively moving
through the nerve.
It is unknown exactly what causes the immune system to act in this way, but most experts think a combination of genetic and environmental factors is involved.
In many cases, it's possible to treat symptoms. Average life expectancy is slightly reduced for people with MS. It's most commonly diagnosed in people in their
20s, 30s and 40s although it can develop at any age. It's about 2 to 3 times more common in women than men (NHS, 2022).
Axonal Degeneration Steps:
1. Antigen-specific T cells and B cells in the CNS
release cytokines that activate microglia and
macrophages.
2. Microglia and macrophages induce the
production of reactive-oxygen species (ROS) and
nitric oxide (NO).
3. ROS and NO induce neuronal mitochondrial
dysfunction.
4. Mitochondrial dysfunction causes reduced
production of ATP (= energy failure) and increased
calcium concentrations.
5. Acidosis and glutamate-mediated excitotoxicity
contribute to increased intracellular
concentrations of calcium.
6. This lead to apoptosis of oligodendrocytes, and
degeneration of axons and consequent neuronal
death.
There are two types of disease presentations: Relapsing
Remitting MS and Primary Progressive MS.
Approximately 80%-90% of patients have relapsing remitting
MS with only 10% having primary progressive MS.
Relapsing Remitting MS:
• This is the most common type of MS.
• Someone with relapsing remitting MS will have episodes
of new or worsening symptoms, known as relapses.
• Symptoms will typically worsen over a few days, last for
days to weeks to months, then slowly improve over a
similar time period.
• Relapses often occur without warning, but are sometimes
associated with a period of illness or stress.
• The periods between relapses are known as remission and
remission periods can last years.
• After many years (usually decades) many people will then
go on to develop secondary progressive MS.
Primary Progressive MS:
• This is the least common of the two types.
• This occurs when symptoms gradually worsen over a
period of time.
• These worsening of symptoms come without any periods
of remission.
Signs and Symptoms: Treatable Symptoms as a Physiotherapist:
• Fatigue. • Fatigue.
• Difficulty walking. • Bladder and bowel dysfunction.
• Vision problems, such as blurred vision. • Walking and movement.
• Problems controlling the bladder. • Tremor.
• Numbness, tingling or loss of sensation in different parts of the body. • Depression and Anxiety.
• Muscle stiffness and spasms. • Oscillopsia.
• Problems with balance and co-ordination. • Spasticity.
• Problems with thinking, learning and planning. • Sensory symptoms and pain.
Neurological Conditions Page 1
Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms,including problems with vision, arm
or leg movement, sensation or balance. MS is an autoimmune disorder in which the cells in your body begin to attack the healthy cells of the central nervous
system, causing cell damage and death.
With MS, the immune cells begin attacking the myelin sheath of the nerve cells. This damages the nerve and inhibits the action potential from effectively moving
through the nerve.
It is unknown exactly what causes the immune system to act in this way, but most experts think a combination of genetic and environmental factors is involved.
In many cases, it's possible to treat symptoms. Average life expectancy is slightly reduced for people with MS. It's most commonly diagnosed in people in their
20s, 30s and 40s although it can develop at any age. It's about 2 to 3 times more common in women than men (NHS, 2022).
Axonal Degeneration Steps:
1. Antigen-specific T cells and B cells in the CNS
release cytokines that activate microglia and
macrophages.
2. Microglia and macrophages induce the
production of reactive-oxygen species (ROS) and
nitric oxide (NO).
3. ROS and NO induce neuronal mitochondrial
dysfunction.
4. Mitochondrial dysfunction causes reduced
production of ATP (= energy failure) and increased
calcium concentrations.
5. Acidosis and glutamate-mediated excitotoxicity
contribute to increased intracellular
concentrations of calcium.
6. This lead to apoptosis of oligodendrocytes, and
degeneration of axons and consequent neuronal
death.
There are two types of disease presentations: Relapsing
Remitting MS and Primary Progressive MS.
Approximately 80%-90% of patients have relapsing remitting
MS with only 10% having primary progressive MS.
Relapsing Remitting MS:
• This is the most common type of MS.
• Someone with relapsing remitting MS will have episodes
of new or worsening symptoms, known as relapses.
• Symptoms will typically worsen over a few days, last for
days to weeks to months, then slowly improve over a
similar time period.
• Relapses often occur without warning, but are sometimes
associated with a period of illness or stress.
• The periods between relapses are known as remission and
remission periods can last years.
• After many years (usually decades) many people will then
go on to develop secondary progressive MS.
Primary Progressive MS:
• This is the least common of the two types.
• This occurs when symptoms gradually worsen over a
period of time.
• These worsening of symptoms come without any periods
of remission.
Signs and Symptoms: Treatable Symptoms as a Physiotherapist:
• Fatigue. • Fatigue.
• Difficulty walking. • Bladder and bowel dysfunction.
• Vision problems, such as blurred vision. • Walking and movement.
• Problems controlling the bladder. • Tremor.
• Numbness, tingling or loss of sensation in different parts of the body. • Depression and Anxiety.
• Muscle stiffness and spasms. • Oscillopsia.
• Problems with balance and co-ordination. • Spasticity.
• Problems with thinking, learning and planning. • Sensory symptoms and pain.
Neurological Conditions Page 1
