Cours 11 : Multiple Sclerosis

Question 1

What is MS?

Answer 1

It’s a neuro and immune disease that strikes in 20 to 40 year olds and its not curable
- Chronic, progressive disease that leads to increasing disability in most individuals

Question 2

Why is Kayla falling at the end of her races? Why can’t she feel her legs anymore?

Answer 2

When the body temperature goes up, there’s a problem with the transmission reaction

Question 3

What is multiple?

Answer 3

Many scattered areas of the brain and spinal cord are affected

Question 4

What is sclerosis?

Answer 4

Sclerosed or hardened tissue in damaged areas

Immune system attack the myelin sheath causing communication problems between the brain and the rest of the body

Question 5

Is there a cure for MS?

Answer 5

No cure, but some medications can help with speed recovery from attacks and modify the course of the disease and symptoms

Question 6

What happens to the myelin in MS?

Answer 6

The protective coating on nerve fivers (myelin) in the central nervous system becomes detached and eventually destroyed. This creates a lesion that may cause numbness, pain or tingling in parts of the body + loss of motor control that can cause paralysis

Question 7

How many people are affected by MS?

Answer 7

55 000 to 75 000 Canadians. it’S the most common central nervous system disease among young adults

Avg age of clinical onset is 30-33 years of age.. but the avg age of diagnosis is 37.

The delay is caused by symptoms can come and go, MS gets mixed up with other conditions and symptoms vary from person to person

Question 8

What happened in 1936 with people with MS?

Answer 8

Only 8% of patients were reported to survive beyond 20 years after onset of illness, but a patient can now expect to live the average population life-expectancy minus 7 years because of better treatment and drugs and better knowledge of the disease

Question 9

What are the causes of MS?

Answer 9

Unknown
It’s considered an autoimmune disease in which the body’s immune system attacks it’s own tissue by mistake.

Question 10

What are the risk factors?

Answer 10

There is no single risk factor that provokes MS, but several factors are believed to contribute to the overall risk like :
age (20 to 40 years of age) , sex (more common in females than males), family history (if a parent has it, more chances of getting it), certain infections ( Epstein-Barr), climate (more common in Canada, northern USA, New Zealand, south-eastern Australia and Europe), certain autoimmune diseases (like type 1 diabetes or inflammatory bowel disease), smoking and race (white people are at highest risk)

Question 11

What is the incidence per populations?

Answer 11

Inuit people = 19 per 100 000
Scottish people = 200 per 100 000
Ratio of white to non-white people = 2:1

Question 12

What are the symptoms of MS?

Answer 12

May differ greatly from person to person and over the course of the disease depending on the MS the and location of the lesions within the nervous system

Optic nerve = causes blurred vision

Brain stem = dizziness and may cause double vision

Cerebellum and cerebrum lesions = balance problems, speech problems, uncoordinated movements and tremors

Motor nerve tract lesion = muscle weakness, spasticity paralysis, bladder and bowel impairments

Sensory nerve tract lesion = altered sensation, numbness, prickling, and burning sensations

Other symptoms : fatigue (78% of all patient) + tremor, lack of coordination or unsteady gait

Question 13

Which side of the body for the MS walking pattern is less stable (body support)?

Answer 13

Right

Question 14

What is the course of the disease?

Answer 14

Exacerbation –> remission
Myelin becomes inflates (2 ways) : no scar formation + complete recovery + no loss of function

Scar formation + permanent myelin damage + loss function

Question 15

What is the MS classification based on?

Answer 15

Rate of disease progression and the frequency of the flare-ups

Question 16

What is the relapsing/Remitting MS (RRMS)?

Answer 16

Unpredictable but clearly defined relapses (also known as attacks, exacerbations or flare-ups) during which new symptoms appear or existing ones get worse

In the period between relapses, recovery is complete (figure 1a) or nearly complete (figure 1b) to pre-relapse function (remission)

MEDS CAN HELP

Question 17

What is Secondary Progressive MS?

Answer 17

Follows a diagnosis of RRMS. Over time, distinct relapses and remissions become less apparent and the disease begins to progress steadily , sometimes with plateaus

About half of people with RRMS start to worsen within 10-20 years of diagnosis, often with increasing levels of disability

Question 18

What is primary progressive MS?

Answer 18

Slow accumulation disability, without defined relapses

May stabilize for periods of time, and even offer minor temporary improvement but overall, there are no periods of remissions. Approximately 10% of people diagnosed with MS have PPMS

Question 19

What is progressive-relapsing MS?

Answer 19

The rarest course of MS, occurring in only about 5% of MS cases

People with this form of MS experience relapses with or without recovery and steadily worsening disease from the beginning

Question 20

Can people with MS train?

Answer 20

Adults aged 18-64 years with multiple sceloris who have mid to moderate disability need at least 30 minutes of moderate intensity aerobic activity, 2x/week and straight training exercises for major muscle groups 2x/week (meeting these guidelines may also reduce fatigue, improve mobility and enhance elements of health-related quality of life.

A health professional might include a doctor, a physiotherapist, or a qualified exercise professional

If you are physically inactive, activities performed at a lower intensity, frequency, and duration than recommended may bring some benefit + gradually increasing duration, frequency and intensity as a progression towards meeting the guidelines.

Question 21

How hard does the aerobic activity have to be?

Answer 21

Moderate intensity is usually a 5 or 6 on a scale of 10, and causes your heart rate to go up. As a general rule if you’re doing moderate-intensity activity, you can talk, but not sing a sonf, during the activity

Question 22

How hard does the strength training activity have to be?

Answer 22

Pick a resistance (free weights, cable pulleys, bands, etc.) heavy enough that you can barely, but safely, finish 10-15 repetitions of the last set

Question 23

What are the options of aerobic activity?

Answer 23

Upper body exercises : arm cycling
lower body exercises : walking, leg cycling
combined upper and lower body exercises : elliptical trainer

Question 24

What are the options of strength activity?

Answer 24

Weight machines
Free weights
Cable pulleys

Aquatic exercise

Question 25

What is missing int he program?

Answer 25

Flexibility : exercise mode + daily stretch affected + joint muscles

Question 26

What are the special considerations wit MS and exercise?

Answer 26

Lower level of fitness : cardiovascular, muscular strength and endurance

Fatigue

Heat intolerance

Depression

Exercise does not trigger periods of exacerbation when properly managed