MULTIPLE SCLEROSIS - most commonly diagnosed neurological disease that can cause disability in young adults - 400,000 people

in the US have MS - causes severe disability in some people, but many continue to lead active, productive lives and are not severely disabled

-diagnosis of MS is based on findings of the history, neurological examination, and overall clinical picture -additional tests: analysis of CSF, MRI -signs of MS include weakness, hyperreflexia, positive Babinski sign, dysmetria, nystagmus, and impaired vibratory or position sensation -Expanded Disability Status Scale (EDSS) and the MS Functional Composite (MSFC), impairment rating instruments in both clinical and research settings

- therapists have a skewed perspective because it is the relatively severely disabled people who are typically referred for therapy The Course of MS - tremendous window of opportunity has passed for interventions such as upgrading ambulation skills, fatigue management, and employment modifications -categorized into four types

Relapsing-remitting (RRMS) -therapists should work to alert physicians and other referral sources to the need for early intervention with persons -produces clearly defined relapses of acute worsening of neurological function followed by partial or complete with MS improvement and then stable periods of remission between attacks -cause of MS remains unknown -the most common course of MS at the time of diagnosis, RRMS often becomes SPMS with time -present theory: environmental trigger initiates the autoimmune response in people with genetic susceptibility Secondary progressive (SPMS) -multiple in MS refers to both time and location -start with a RR course of up to 10-15 years following diagnosis -sclerosis refers to the hardened and sclerotic plaques that are the scar tissue resulting from autoimmune attacks on -typically made when there is continued neurological deterioration the CNS (axons and myelin covering) Axonal Transection -considered as significant as demyelination in MS damage -temporarily, demyelinated axons may remyelinate and provide conduction of nerve impulses -transected axons are permanently destroyed and lose all potential for conduction Primary progressive (PPMS)

-have continuously declining neurological function from onset Progressive-relapsing (PRMS)

-differs from RRMS because disease progression continues through the period between relapses

-demyelination and axonal damafe occur in the presence of inflammation, which may explain the rapid improvement Benign and Malignant MS often seen in the treatment of relapses with corticosteroid anti-inflammatory agents Benign MS Diagnosing MS -are fully functional 15 years after the disease onset -between the ages 15-50 Malignant MS -children are increasingly diagnosed -rapid progression leading to significant disability or death in a short period -peak age of onset is 20-30 years -women are two to three times as likely to get MS as men