Marco R. Jerez 18 September 2015 Reflection Paper Multiple Sclerosis and Guillain-Barré Syndrome are two autoimmune disorders of the nervous system that occur when the myelin sheath surrounding the axons of a nerve degenerate. Multiple sclerosis (MS) affects the central nervous system while Guillain-Barré Syndrome (GBS) involves the peripheral nervous system.1,2 MS is a gradually regressing disease that usually occurs in one of four ways. The first is relapsing-remitting MS (RRMS) and is the most common. Patients typically experience relapses where the symptoms are aggravated and enhanced followed by episodes of remissions during which the symptoms cease or calm down. 3 The second type is called secondary-progressive MS (SPMS). This type mimics RRMS but undergoes a steadier decline that may or may not include relapses3. The third type is primary-progressive MS (PPMS) where the disease progresses at a more regular rate from onset. PPMS, however, may speed up, slow down, or even plateau for a bit, but no remissions are present.3 Lastly, progressive-relapsing MS (PRMS), the least common type, presents similarly to PPMS in that the decline is steady, but this type of MS has exacerbations that the patient may or may not recover from.3 Unlike MS, Guillain-Barré does not present in types and characteristically attacks more rapidly.2 It is a poorly understood disease, however, research has shown that it is generally preceded by a bacterial or viral infection.4
C. jejuni is a curved, Gram-negative rod with polar flagella. It requires a microaerophilic atmosphere to grow. The bacteria are unique in that it does not metabolize carbohydrates, but instead is dependent on amino acids for its energy source.
The purpose of the radiological test is to diagnose accurately and efficiently of the neurological pathology including Guillain- Barre Syndrome (GBS). Performing diagnostic imaging is essential to health care professionals because consulting a patient regarding their medical history and other present health problems and thorough physical examination is not adequate to confirm a patient's particular neurological condition (McKinnis, 2014). Furthermore due to advanced medical technologies, it is essential that the physiotherapist should improve their education in the field of neurological imaging to provide an extensive history, clinical examination and interpretations (McKinnis, 2014). Therefore, as a clinician having the knowledge and expertise with neuro-musculoskeletal imaging promotes a routine interaction with patients by educating accurate information regarding the disease and for providing an optimal patient care.
There are three different versions of multiple sclerosis (“What is MS?”). The least severe being relapsing-remitting; this occurs when a person has an attack and then there are no further
The first is a relapsing-remitting course, commonly referred to as RRMS, which is characterized by partial or complete recovery following a series of attacks. This is also the most common form of MS and effects approximately 85% of people with MS in the initial stages of the disease. A relapsing-remitting course can become more progressive at a steady rate and is then referred to as secondary-progressive multiple sclerosis, or SPMS. Studies show that 50% of patients with relapsing-remitting disease will develop SPMS within ten years, and 90% within twenty-five years. A progressive version of the disease from onset without any attacks is called primary-progressive multiple sclerosis, or PPMS. Many of the symptoms that occur during the course of the disease, generally speaking do not remit and the patient does not relapse. Ten percent of those with MS are also diagnosed with PPMS, however, this clinical course cannot be determined until after the patient has been living for a certain period of time with no attacks and PPMS. Fourth and finally, the last progressive course is called progressive-relapsing. This occurs when the patient has obvious and acute attacks throughout the progression of the disease. This is the most rare course of the disease and only occurs in five percent of those with Multiple Sclerosis. As of right now, this is the most common way to determine the course of ones
Multiple sclerosis is an unpredictable, crippling neurological disease of the central nervous system, which affects the flow of information within the brain, and between the brain and body. The name is this disease refers to multiple areas of scarring throughout the brain and spinal cord. This scarring is a result of what happens when the body attacks itself. A substance called Myelin surrounds the nerves to help protect them (Healthline.com, 2015). Multiple Sclerosis is thought to occur in a genetically susceptible individual (although there is no evidence to show that the disease is directly inherited) influenced one or more environmental factors. MS is thought to be an autoimmune disease, however others disagree as the target of the immune
Multiple Sclerosis is a chronic autoimmune disease that attacks a person Central Nervous System which includes the spinal cord, brain and optic nerves. MS is a very difficult condition to diagnose due to its exacerbations. It also is difficult to treat because no one person has the same signs and symptoms. In MS the myelin sheath that protects the CNS becomes inflamed and scarred that end up causing lesions.. The lesions cause interruption in the messages to the nerves. MS can happen at any age but mostly found in ages 15-60 and are twice as likely in women. Currently there is no known cure for MS , researchers are working tirelessly to find one.
A 21 years old man with multiple sclerosis (MS) is admitted. The interdisciplinary team feels he may need a feeding tube for nutritional purpose. They ask the patient about this in the morning and he agrees. However, before the tube has been placed in the evening, the patient becomes disoriented and seems puzzled about his verdict to have the feeding tube placed. He tells the team he doesn't want it in. The team goes back to the question in the morning when the patient is again coherent. Incapable of recollection of his feelings from the previous evening, the patient again reach a decision to proceed with the procedure.
The four main types of Multiple Sclerosis are Relapsing-remitting MS, Secondary Progressive MS, Primary Progressive MS, and Progressive Relapsing MS. “Symptoms occur in any area served by the myelinated nerves of the central white matter of the brain, brain stem, and spinal cord” (Murray, 2005). Symptoms include: weakness or sensory changes in the limbs (legs); unsteadiness; difficulty with bladder control; visual changes; vertigo; facial numbness or weakness; or double vision (Murray, 2005). Because different areas of the brain and spinal cord are responsible for different kinds of movements and sensations, the neurologic deficit that results from an area of scarring depends on the exact location of the abnormality (Schapiro, 2007). These abnormalities Schapiro (2007) means are lesions in any part of the Central Nervous System. These symptoms and harshness of the symptoms all vary depending on where that damage in the Central Nervous System has occurred. No case of Multiple Sclerosis is exactly alike from patient to patient and because of that, symptoms vary considerably.
The other main difference is that people recover from Guillain-Barre syndrome whereas MS is a disease for a life. Guillain-Barre syndrome can be devastating for the patient and their family due to its rapid and unexpected onset. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90% of all patients are at their weakest. (11) The first typical symptoms are numbness, pain, and paraesthesia. Due to the fact that paralysis can follow as quickly as 1-3 weeks after onset obviously is hugely debilitating on the patient and their family. The patient has little or no quality of life when the disorder is at its worse. There is very little time for adjustment so it takes a huge mental toll on all involved. In severe cases weakness of the respiratory muscles requires artificial ventilation. (4) Involvement of the Autonomic nervous system is common due to the fact that this disease attacks the peripheral nervous system. ‘This can cause urine retention, sinus tachycardia, hypertension, cardiac arrhythmia, and postural hypotension.’ (4) These kind of symptoms require round the clock care and monitoring in the hope that muscle wasting does not occur. Most patients have a full recovery but the recovery time varies from case to case. It may be as little as a few weeks or it can last as long as a few years. About 30% of those with
Guillain-Barre syndrome (GBS), an acquired autoimmune mediated polyneuropathy, is classically characterized by an acute, non-febrile, post-infectious illness which usually manifest as symmetrical ascending weakness and areflexia with and without paresthesias.1, 2 However, sometimes sensory, autonomic, and brainstem abnormalities may be seen. The annual incidence of GBS estimated to be 0.3 – 1.3 cases per 100,000 per year in children.3
One important thing to know about multiple sclerosis is that there are many different types. There are four, vaguely defined, types of MS: Relapsing- remitting, Primary-progressive, Secondary-progressive, and Progressive- relapsing (Dangond). Relapsing-remitting MS, most common, is when patients experience a series of attacks followed by the disappearance of symptoms. So, in this type, multiple sclerosis attacks and then goes in to remission until another attack occurs. Its alternates back and forth. Primary-progressive MS is when there is a continuous decline in a person’s physical abilities. Secondary-progressive is when relapses are rare but the patient accumulates more disability (Dangond). Lastly, we have progressive-relapsing which is the more complex type. It is very similar to primary-progressive MS but it includes small periods where the symptoms and disease become worse (Blackstone).
In the past, steroid hormones were used as a treatment, but was not effective (Heller & DeJong, 1963). The etiology of this syndrome is unknown; however, it is speculated that autoantibodies for ganglioside or myelin proteins (Gabriel et al., 2000; Linington et al., 1992). Usually, GBS occurs after an infection of Campylobacter jejuni or flaviviruses (Winer, 2001). The main diagnostic symptoms are motor and sensory weakness (Asbury & Cornblath, 1990). These symptoms vary ion severity and location depending on the subtype of GBS (Vedanaryanan & Chaudhry, 2000). The most common subtype observed in the United States is acute inflammatory demyelinating polyradiculoneuropathy (Vedanaryanan & Chaudhry, 2000). The first time GBS was documented was in 1859 (Kusunoki, 2016). Future studies discover other infections that may cause GBS and determine if vaccines can an agent of GBS. In conclusion, Guillian-Barré syndrome is a rare autoimmune disorder of particular interest for neuroscientists and
Multiple sclerosis (MS) is a genetic disorder that affects the nervous system, brain, and spinal cord. There are four types of disease courses linked to the genetic disorder MS. Relapsing-remitting multiple sclerosis (RRMS), primary-progressive multiple sclerosis (PPMS), secondary-progressive multiple sclerosis (SPMS), and progressive-relapsing multiple sclerosis (PRMS) are the four disease courses of MS. MS is an autoimmune disease, where the body's own defense mechanism attacks itself. In MS, the immune system attacks the myelin sheath, which is a material that protects the nerve cells, and causes it to slow down or block signals between the body and brain. These blockages may lead to to the symptoms of MS, which are usually problems with
The last type of MS is Progression-relapsing (PRMS). This is the least common type of MS. Just like PPMS this type is also characterized by the gradual worsening of symptoms over the course of time. Patients will also experience relapses and remissions. Unlike RRMS, people with this type of MS do not usually regain complete functioning after a symptom relapse.
Multiple Sclerosis (MS) is a neurologic disease that affects the Central Nervous System (CNS) through cellular immune response and the demyelination of CNS white matter (McCance et al., 2014, pp. 630–633). The initial causes of MS are unknown however, it is believed that it could possibly be due to an immune response to an initiating infection or an autoimmune response to CNS antigens on the myelin itself (Brück, 2005) (Miljković and Spasojević, 2013). MS is a result of the degradation of the myelin sheath surrounding neurons and therefore disrupts the transmission of action potentials along these cells. MS can display itself in the form of symptoms ranging from muscle weakness to trouble with sensation and coordination (NHS, 2016). The degradation of myelin leads the body to attempt to remyelinate the neurons, a process that in turn leads to the thickening of the cell by glial cells and this causes lesions to form (Chari, 2007). It is this thickening (sclerae) from which the disease gets its name. Sufferers of MS can either have a relapsing type of MS, in which there are episodes that lead to the worsening of symptoms for a period of time, or a progressive type of MS where symptoms gradually progress and worsen (McCance et al., 2014, pp. 630–633).