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What is Multiple
Sclerosis?
MSIs a n unpredictable an d opften
disabli n g d isease artectin g the CNS
an d disrupts lnf orm auon ttasmlsslon

through che body and brain.

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Multiple
S
cleroKirchner
sis
David

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-
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What is Multiple
Sclerosis?
MS
is an unpredicta ble and opften

disabling disease affecting the CNS

and disrupts information trasmission
through the body and brain.

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Who does it
affect?
Factors include
age, ethnic

background, gender and geograpical

location
Most diagnosed between 20 and 50
Affects most ethnic groups, but
more common in Caucasians
2 to 3 t i mes more common in
women
Geographic location *
More than 2.3 million people
worldwide

Sympt
Fatigue o
ms Wa lking Difficulty
Numbness/
Tingling
Wea kness
Dizziness and
Vertigo
Pain

VisionImpa irment
Bladder Dysfunction
Cognitive Changes
Emotio nal Changes
Depression

..

...

Treatment
Currently
there
Optio
nsis no cure for MS

ORVGSANOSE!F
INJttTIONS

S = =
1HEIIAl'Y

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G

PHYSICAL
EXERCISE
S

PHYSIPTHERAP
Y

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SELF
INJECTIONS

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SPEECH AN
D LEARNING
THERAPY

Key players in the

Body

Im m une System

Autoreactive T-lymphocytes
8-lymphocytes
Macropha ges

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Blood Brain Barrier

Central Nervous System

Myelinated axons

Major Steps of MS
Hells are attractd atJUss tlie BBB illo
t eCNS

l\i
\

Demyelination and complete
neuronal degenatrio1

T-Cells respond with an inflammatory response aimed at

myelin antigens

T-Cells are attracted across the BBB into the CNS

Inflammatory Response against myelin

Demyelination and complete neuronal

degenatrion

The prevalence of multiple

sclerosis inthe world

Sydney Allsion (1929)

updated

G.Rosati. (2001).
22:117-139.
Neurological Sciences
Orignally started to study MS within specific
populations and attempt to define a pattern
geographical differences. Now updated
with more than 400 publications dealing
with prevelance of MS worldwide .

I\

Results within the

United States

Rates of MS are
higher farther from the
equator
NOR THE R N STA TE S

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m nmontte ms, :, nd
r h c n h;)n c""1tomcn l
Q<\1'9, t h t dt!.'lrlbuuor\Ol' MS O r e aty
co ,, """wth ndM dl h )kOl"'O!: t n \

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su,n d!n;f'lo'l!n O gtl'\

37
PARALLEL

SOUTHER N STA
TES

ESTIMATED

37T
H
PAR
LLEL

EST
I

Why the 31th parallel?

The 37th parallel may reflect

migration patterns and genetics
rather than enviromental factoring.
The distribution of MS directly
correlated with individuals of
western
European ancestry,
particularly Scandinavian
origin .

Psychiatric Issues in Multiple

ScLydia
leros A.isChwastiak, MD, MPH., Dawn

M. Edhe, Ph.D. (2007). Psychiatric

Clinics of North America, 30(4): 803

817.

Patients suffering from MS have a

greater prevalence to a number of

psychia tric symptoms and

DepressioPl
and anxiety, in particular,

disorders
have
been. associated with decreased
adherence to treatment,
functionality, and quality of life.

.
.

Rate of Suicide and Prevalance of

Mental Disorder

"Death certificate-based reviews indicate th&t

suicide may be the cause of death for MS
clinic patients in as many as 15% of all
cases."

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Comorbd
i Psychiatric Disorders in
MS

Disorder

Prevalence in MS

Prevalence in general population

Major depressive disorder, 12-rnonth

15.7% [33]

7.4% [33]

Major depressive disorder, lifetin1e

22 .8% [40]

16.2% [97]

Any anxiety disorder, lif etirne

36% [10,62]

25% [63]

Generalized anxiety disorder

18.6% [10,62]

3.0% [98]

Bipolar disorder, lifeti1ne

0.3% [72]

0.2% [99]

Alcohol abuse, lifetin1e

13.6% [77]

7.4% [100]

Substance n1isuse, pa st rnonth

18.7% [78]

11.1% [100]

Options for Treatment of Major

DepressiveMany
Dis
order
instances of depression are left

undiagnosed and untreated with MS patients.

Pharmacotherapy

Psychothera
py

Exercis
e

Pharmacot
he

py

Psychot herapy

Exercise

Other Mental Health

issu
e
s

Anxiety Disorder

Substa
nce and alcohol abuse
PseudobuJbar affect
Resilience and posttra umatic
growth

Discussi
on

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M@dleatlons
Genetic Test.mg
S<cm.CC'll trcatmer-t

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u ,

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!.'tlhal ,.,...,.,..c'C<O" ' " ' ;n

g
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21

c.

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1. ' t l l w o e or d'"',i -.14'.,!

A. l lo e d

C. A1.E1olmmW
1
0 \/fr'i l l

t ob o! d "< ; " -d

Importance of the
Epidemiologic Studies

Geographic Study
Ongoing study (86 years)
Possible correlation
between environmental
factors and genetic
disposition
A wealth of data for
later
research

Psychiatric Study
Raise awareness of
comorbid mental
disorders and the
possible effects and
outcomes
Improve quality of life
to persons living with

MS

Future
Outlook

Medications

Genetic Testing
Stem-Cell treatment
Cure

Revi
ew

1. What is the most common age group to be diagnosed with

MS?
A. 2-8
B. 10-20
C.
D. 18-28
20-50

2. What type of disease is MS?

A. Blood
B. I nfectious
C. Autoimmune

D.Viral