Reference no: EM133733827

Case Study: Multiple Sclerosis

Introduction recap

The nervous system comprises the central nervous system (CNS), which includes the brain and spinal cord, and the peripheral nervous system (PNS), consisting of nerves extending throughout the body. Neurons are the basic functional units of the nervous system, transmitting electrochemical signals. Myelin sheath, produced by oligodendrocytes in the CNS and Schwann cells in the PNS, acts as a protective sheath and an insulating layer around axons, facilitating rapid signal conduction.

Discussion of Multiple Sclerosis (MS)

Pathophysiology

In MS, the immune system erroneously attacks myelin, leading to inflammation and demyelination. This inflammatory response results in the formation of plaques or lesions in the CNS, disrupting nerve conduction. Oligodendrocyte degeneration and axonal damage also occur, contributing to neurodegeneration. Rebuilding of myelin, termed remyelination, can occur in the early stages of the disease but becomes less efficient over time, contributing to disease progression. Some of it is replaced by scar tissue, which explains the partial recovery of the patient.

The exact cause of MS remains unknown, but genetic predisposition, environmental factors, and immune dysfunction are implicated.

Signs, Symptoms, Diagnosis:

Common signs and symptoms of MS include sensory disturbances (e.g., paresthesia, numbness), motor deficits (e.g., weakness, spasticity), visual disturbances (e.g., optic neuritis), fatigue, cognitive impairment, and autonomic nervous system involvement as bladder/bowel dysfunction. Diagnosis relies on a combination of clinical assessment, neuroimaging (e.g., MRI), and laboratory tests (e.g., cerebrospinal fluid analysis, evoked potentials). The McDonald criteria are commonly used for diagnosis, requiring evidence of dissemination of CNS lesions in space and time.

Complications:

MS can lead to various complications, including muscle weakness, gait impairment, falls, depression, anxiety, cognitive decline, and bladder/bowel dysfunction. Additionally, individuals with MS are at increased risk of developing secondary conditions such as osteoporosis, pressure ulcers, and infections.

Treatment:

Treatment aims to manage symptoms, prevent relapses, and slow disease progression. Disease-modifying therapies (e.g., interferons, monoclonal antibodies) can reduce relapse rates and delay disability progression. Symptomatic management may involve corticosteroids for acute exacerbations, immunosuppressants, muscle relaxants, physical therapy, occupational therapy, and symptomatic medications (e.g., for pain, spasticity, bladder dysfunction).

Scenario/Summary

A 30-year-old female with multiple sclerosis (MS) has come for a routine check-up with her neurologist. Her first signs and symptoms were several years earlier. The symptoms were not concerning as they were only tingling sensations that were mild discomforts. Those feelings also went away. It became worrisome when the sensation transitioned into pain and tingling. She began to lose coordination during each cycle, and over time, she never fully recovered from the previous flare.

Deliverables

Question 1. What cellular structure is degenerating and rebuilding in MS?

Question 2. Does this explain the progression we see with the signs and symptoms? Explain why.

Question 3. When there are issues with the neural tissue like this, they will often look into the eye. Why?

Question 4. Here are three early symptoms that we might see in MS. Assign them to whether they are a part of the sensory, motor, or autonomic nervous system. Afterward, try to describe how MS would cause these symptoms.

Dysarthria

Paresthesia

Constipation