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OBJECTIVES

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  • 1) Describe the demographics, risk factors, etiology, pathophysiology, common symptoms, and diagnosis of multiple sclerosis (MS)

  • 2) Differentiate between the general progression and prognosis of the different types of MS

  • 3) Discuss the medical management of MS

  • 4) Design a physical therapy intervention program with appropriate goals and outcomes for the individual with MS

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CASE A, PART I: MULTIPLE SCLEROSIS

Sheila Dillman is a 37-year-old white female. She came to Neurology Clinic for evaluation of her long-term neurologic complaints. Ms. Dillman relates that for the last 2 years she has noticed some strange symptoms, PARTicularly heat intolerance which precedes the onset of difficulty with walking. She admits to several near falls and describes her gait during these episodes as a “stumbling gait.” She also relates that over the last 2 years she goes through periods where her vision is blurry. Two months ago she underwent a divorce and moved to her own apartment. At this time she got sick with the flu and her condition worsened. At that time, she could not hold objects in her hands and had severe exhaustion. She also had several falls and intermittent joint pain on the left side of her body that was spread diffusely across multiple joints. More recently, her chart indicates that she abruptly developed a left hemisensory deficit. The MRI scan was performed at that time and revealed a multifocal white matter disease – areas of increased T2 signal in both cerebral hemispheres. Spinal tap was also done which revealed the presence of oligoclonal bands in CSF. Visual evoked response testing was abnormal with slowed conduction in optic nerves.

Findings on exam: She remains weak and numb on the left side; has impaired urinary bladder function, requiring multiple voids in the mornings and nocturia at times. She has become incontinent and now has to wear a pad during the day. She also has ongoing balance problems with some sensation of spinning, continuous tinnitus with mild hearing loss, and she is extremely fatigued. She complains of impaired short-term memory and irritability.

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WHAT IS MULTIPLE SCLEROSIS?

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Multiple Sclerosis (MS) is a chronic, progressive, inflammatory disease that affects neurons in the central nervous system. Jean-Martin Charcot is credited with the first comprehensive description of the disease in 1868. He described its clinical and pathological features and outlined the symptom triad known as Charcot’s triad: intention tremor, nystagmus, and scanning speech.

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EPIDEMIOLOGY/RISK

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The incidence of MS is 30–80 per 100,000 population; about 400,000 people are affected with the disease in the United States. It is one of the most common causes of neurologic disability in young adults and typically affects individuals between the ages of 20 and 50, with the mean age of onset being 32 years. Children (≤18 years) and adults over the age of 50 are rarely affected. MS is two to three times more common in women ...

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