An Introduction to Multiple Sclerosis

What is MS?

Common symptoms.

Diagnosis & potential treatments.

Case Studies

Support for people with MS and carers

Multiple Sclerosis

An autoimmune condition - nerve fibres100,000 people affected in the UKCause unknown No CureUsually diagnosed from 20-40 yrsNot contagious Not fatal – life expectancy reduced ~ 5-10 years

Causes

Research suggests a combination of genetic and environmental factors:

• Genetics

• Climate/ geography

• Viruses/ bacteria?

Prevalence of MS - Worldwide

DiagnosisClinical examination

MRI– visualisation of inflammation

Evoked potentials- measure speed of nerve conduction

Lumbar puncture

MS – What is happening?

Central Nervous System

The brain and spinal cord are surrounded by the blood brain barrier (BBB)• Lets in e.g. oxygen & sugar • Keeps out e.g. viruses & bacteria

Few immune cells enter the CNS

In MS the blood brain barrier breaks down

Skin barrier breaks down

Immune cells move to the area causing redness and swelling (inflammation)

Immune cells identify “foreign material” and destroy it

Healing or scar development

Myelin Sheath

Permanent disability

SymptomsRelapses

Lost messages

What types of MS?

Relapsing Remitting

Secondary Progressive

Primary Progressive

Benign

4 types of MSRelapsing

Remitting MS Primary

Progressive MS

Benign MS Secondary Progressive MS

MS ManagementMain types

• Relapse treatments

• Symptom treatments – Quality of Life

• Disease Modifying Drugs

Common symptoms

What are the common symptoms of MS?

Common symptomsVisual problems Sensory problemsFatigueVertigoBladder problems Bowel problemsSexual problems Tremor

Spasticity/Spasm PainDepressionCognitionPersonality changesLoss of mobilitySpeechSwallowing

MS & FatigueMost common symptom - variableOverwhelming, unrelated to physical activityCannot be seen by youAffects thought, vision, physical abilities

~~HeatPhysical exertionInfectionDisturbed sleepMedication

What to do?Understand variety

Go at the person’s rate – plan activities etc

OT can assess

MS & Cognition

As many as 65% affected

Learning and memory (recent events and remembering to do things)

Attention, concentration and mental speed

Problem solving

Word finding

Things that make it worse are often some of the symptoms of MS.

Wider consequencesPsychological impact (depression/ cognitive problems)Loss of mobilityHomeRelationships and familyFinances (Incl. insurance)Employment issues Unplanned hospital admissions

Case studies

Mental Capacity Act 2005

The five key principles in the Act are:Every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. A person must be given all practicable help before anyone treats them as not being able to make their own decisions. Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision. Anything done or any decision made on behalf of a person who lacks capacity must be done in their best interests. Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.

Safeguarding & Capacity

Safeguarding

Mental Capacity Act

Capacity Assessment

Best Interests

DOLS

Court of Protection & OPG

Good Practice

MS effects

people

differently

Be responsive, flexible and ready

to adapt to changes.

My care needs can & will change

– sometimes overnight!

Not all

changes

may be due

to MS

Remember the MS Nurse

It is obvious –

but listen to meLet’s

discuss

contingency

plans in

regards to

any changes

in need

MS Society SupportEducation & InformationService DevelopmentProfessional NetworkPolicy & CampaignsGrants to IndividualsPeer SupportBranch NetworksResearchFundraisingVoluntary Opportunities

Thank You!