Multiple Sclerosis[1]
- 1. Lena Horne Richard Pryor
- 2. Montel Williams Clay Walker
- 3. What do all of these celebrities have in common? They all have Multiple Sclerosis
- 4. Multiple Sclerosis Peter Valenzuela, MD, MBA Assistant Dean for Clinical Affairs/Assistant Professor Texas Tech University Health Sciences Center at the Permian Basin
- 5. Overview Description including prevalence and possible causes Signs and Symptoms Diagnosis including differential Treatment
- 6. Incidence/Prevalence Affects 400,000 Americans; 2.5 million people worldwide 2-3 times more common in Caucasian women Most often in people between 20-50 years old Greater frequency in higher latitudes (above 40 degrees)
- 7. Description Myelin-covers axons and improves conduction between neurons Auto-immune destruction of myelin results in scarring or sclerosis Symptoms depend on location of myelin destroyed
- 8. Cause/Risk Factors Cause- Unknown, immune-mediated Genetics? Northern European descent Higher incidence in direct relatives Infection? Chlamydia pneumoniae, HSV, EBV
- 9. Cause/Risk Factors Geographic location? 40 degrees latitude above equator Risk level varies with length of time spent in area
- 10. Cause/Risk Factors Hormones More common in women Exposure Clusters- Lead, Arsenic, Zinc
- 11. Signs and Symptoms Neuro: Paralysis, altered sensation Tremors, poor coordination Visual loss, optic neuritis Musculo-skeletal: Fatigue Spasticity
- 12. Signs and Symptoms GI: Constipation Diarrhea Incontinence Gu: Urgency Hesitancy Incontinence
- 13. Signs and Symptoms Cognitive and Emotional Poor memory Delayed processing Depression- 50% of patients Sexual Dysfunction Impaired libido Sexual inadequacy Sexual dysfunction
- 14. Differential Diagnosis Auto-immune Polyarteritis Nodosa, Systemic Lupus Sjögren's, Sarcoidosis Infection Lyme Disease, Neurosyphilis HIV, JC Virus-Progressive Multifocal leuko-encephalopathy
- 15. Differential Diagnosis Genetic Disorders Leukodystrophy, Mitochondrial disease Compressive Disorders Tumor, Herniated disc, Chiari malformation B12 Deficiency
- 16. Diagnosis MRI: Multiple white matter lesions (plaques) in different areas of CNS at different points in time
- 17. Diagnosis CSF Analysis Oligoclonal bands by electrophoresis high IgG levels Increased WBCs (>5 cells/µL) Evoked Potentials VER, BAER, SER VER is most sensitive
- 18. Diagnostic Criteria for MS Clinical Presentation Additional Data McDonald’s Criteria
- 19. Course/Prognosis Benign: 10% Relapsing-Remitting: 40% Secondary Chronic Progressive: 40% Primary Progressive: 10%
- 20. Treatment Immune modulators Avonex, Betaseron, Copaxone, Rebif Anti-spastic drugs Stretching & Exercise (Yoga, PT) Lioresal, Neurontin, Zanaflex Dysesthesias Dilantin, Elavil, Neurontin, Tegretol
- 21. Treatment Bladder and Urine Ditropan, Detrol, Cardura Self-catheterization Tremor INH, Neurontin, Inderal, Xanax Fatigue/Depression Eldepryl, Symmetrel, Provigil Prozac, Paxil
- 22. Treatment for Relapses Treat source of exacerbation Sinusitis, bronchitis, UTI Steroids
- 23. Annual Cost for Medications Immune Modulators- $18,000 Anti-spastics- $1,700 Dysesthesia- $2,600 Tremor- $1,200
- 24. Annual Cost for Medications Fatigue- $3,100 Depression- $300 Bladder and Urine- $2,160
- 25. Total Annual Cost for Medications Could Reach over $30,000!
- 26. Summary Description including prevalence and possible causes Signs and Symptoms Diagnosis including differential Treatment
- 27. Questions?
- 28. References Calabresi P. Diagnosis and Management of Multiple Sclerosis. American Family Physician 2004; Vol. 70:10, 1935-43. Dynamed website (Accessed October 2, 2006) National Multiple Sclerosis Society at www.nationalmssociety.org (Accessed October 2, 2006) www.jsumption.com (Acessed October 3, 2006)
- 29. References www.msfocus.org (Accessed October 4, 2006) http://www-medlib.med.utah.edu / (Accessed October 6, 2006) Epocrates database (Accessed October 10, 2006 http://www.mult-sclerosis.org/famous.html
Editor's Notes
- #2: Jazz singer Richard Pryor-after school, I’m going to bite off your foot, and I believe him because he always had a shoelace hanging out of his mouth