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Multiple Sclerosis (MS), References - Coggle Diagram

- - - - (3) This causes communication issues between the brain and the peripheral nervous system
        
        (4) Different body systems may be affected more than others depending on where the demyelination is occuring.
  - - - T cells travel in the blood to the CNS where they release chemicals that cause inflammation and damage to the myelin sheath and nerve fibers.
      - The T regulatory cells that are supposed to stop inflammation do not function correctly, so the inflammation and the resulting damage take a toll.
      - Cytotoxic T cells cause direct damage to cells.
      - T cells activate B cells. B cells cause more damage through the antibodies they produce and the proteins they activate.
      - All together, these immune cells wreck havoc on the myelin sheath, nerve fibers, axons, and oligodendrocytes (myelin-producing cells). Damage to the myelin sheath interrupts conduction of nerve signals, and can cause nerve and brain atrophy.
- - - - Corticosteroids: used to decrease nerve inflammation; ex. prednisone PO, methylprednisolone IV, dexamethasone
      - Plasma exchange (plasmapheresis): plasma is removed from blood and separated from your blood cells. The blood cells are mixed with albumin and put back into circulation; used if your symptoms are new, severe, and have not responded to corticosteroid therapy. This works for MS because it removes inflammatory factors from the plasma, therefore decreasing nerve inflammation.
    - - For PPMS, ocrelizumab is the only disease-modifying therapy (DMT) that is FDA approved.
      - For RRMS, there are many disease-modifying therapies (DMTs) available.
        
        Injectable therapies: interferon beta medications- reduce the frequency and intensity of relapses; glatiramer acetate- block the immune system from damaging the myelin sheath
        
        Oral therapies: fingolimod, dimethyl fumarate, diroximel fumarate, teriflunomide, siponimod, cladribine- all targeted at reducing relapse rate.
        
        Infusion therapies: ocrelizumab, natalizumab, & alemtuzumab
        
        Ocrelizumab decreases the rate of relapses and slows the process of disabilities worsening in both RRMS and PPMS.
        
        Natalizumab prevents potentially destructive immune cells from moving into the the central nervous system.
        
        Alemtuzumab decreases the amount of nerve damage caused by white blood cells by depleting white blood cell count.
      - For SPMS, siponimod and cladribine can be used PO.
      - In children diagnosed with MS, it is especially important to control the disease progression because otherwise they will have more severe disabilities are they age.
    - - Physical therapy: by practicing stretching and strengthening exercises with a physical therapist or occupational therapists, patients can learn how to more easily perform the activities of daily living. Symptoms such as unsteady gait and leg weakness can become more controlled.
      - Muscle relaxants: can help alleviate pain and stiffness or spasms in muscles; ex. baclofen, tizanidine, cyclobenzaprine, onabotulinumtoxina.
      - Medications to reduce fatigue: amantadine, modafinil, and methylphenidate can be used to reduce fatigue caused by MS.
      - Treatment for other symptoms: selective serotonin reuptake inhibitors may be given for depression; baclofen for spasticity; amantadine, methylphenidate, or fluoxetine for fatigue; tricyclic antidepressants for pain; phosphodiesterase type 5 inhibitors PO for sexual dysfunction; methylprednisolone IV for optic neuritis
        
        Medication might also be needed to treat bowel or bladder issues and insomnia.
      - Medications to increase walking speed: ex. dalfampridine, an extended-release PO potassium channel blocker that increases the strength of the signals sent to your brain from nerves damaged by MS
- - - - The combination of MS and old age can increase the severity of health problems.