Multiple Sclerosis: An Idiopathic Neurodegenerative Disorder

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Multiple sclerosis is defined as an idiopathic neurodegenerative disorder where the immune system affects the myelination of the axons of neurons in the central nervous system affecting the brain and spinal cord. This autoimmune disease attacks the protective sheath that guards and promotes the conduction of action potentials causing communication problems between the brain and the body. The different areas affected by the disease develops scars tissue which it gives the name of multiple areas of scaring or multiple sclerosis. All this process creates inflammation damaging the oligodendrocytes, which oversee the myelinization of neurons in the central nerve system. The cause of multiple sclerosis is still unknown but is believed to be a combination genetic and environmental factors that might contribute of acquiring MS. [1,2,5]

Multiple Sclerosis is a disease that can have a variety of unpredicted symptoms. Some people affected with MS might experience severe fatigue, numbness, pain and spams while other patients might experience vision problems, bladder issues balance and cognitive problems. This autoimmune disorder is characterized by relapsing and remitting conditions, or RRMS. A relapse would have to last at least 24 hours and symptoms get worse. On the other hand, remission would indicate symptoms relieved partially or completely. It is important to emphasize that the dependence of the symptoms is based in the area of the central nervous system affected. Some of the symptoms include:

  • Vision problems like double vision, nystagmus and vision loss.
  • Dizziness
  • Bowel or bladder problems
  • Muscle fatigue
  • Cognitive problems
  • Hypersensitivity to heat
  • Sexual problems
  • Numbness and tingling
  • Anxiety and mood swings including depression
  • Poor balance and vertigo
  • Lack of muscle coordination/ Ataxia

Symptoms can be personalized to each person, but fatigue is mostly present reaching an 80 % of the cases. Walking is also affected by producing incoordination, loss of balance and spasticity making an assistive device a necessity. The optical nerve is one the first symptoms for many patients experiencing blurred vision, poor contrast and pain with eye movement. Other problems like sexual function, bladder, and bowel are also a possibility. Emotional swings like depression and cognitive problems are possible symptoms. People with MS express having problems with processing information, focusing attention and problems-solving capacities. [1,2,5]

It is usually a little complicated to determine MS in an early stage but there some ways to be diagnosed. Neurological examination and Magnetic resonance imaging (MRI) Scan. Patients should undergo MRI imaging of the brain and should include the spinal cord. Blood tests and Lumbar Puncture which is also known as spinal tap are occasionally performed due that Cerebral spinal fluid (CSF) analysis is helpful in identifying MS. [1,2,5]

MS is treated with medications and with Physical Therapy. Medications are used to decrease the frequency of relapse and slow the progression of the disease. The most common drugs currently used are Interferon-beta drugs and Glatiramer drugs. Interferon-beta is a drug that has been used since the 1990’s to reduce demyelination in the CNS by preventing T-cells from crossing the blood brain barrier. The T-cells do not reach the CNS and cannot create an inflammatory response that would be destructive to myelin. Glatiramer acetate was approved in 1997. The Glatiramer molecule is similar to that of the myelin protein molecule acting as a decoy and it is thought that the T-cells attack the Glatiramer acetate instead of the myelin.

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During periods of relapse, inflammatory symptoms are treated with corticosteroids such as methylprednisolone, prednisone, and ACTH (Adrenocorticotropic hormone), although they do not provide any long-term benefit. MS patients are also commonly prescribed medication for depression and anxiety.

There are some risk factors that might increase chances to develop Multiple Sclerosis.

The usual age to develop MS ranges from 20 to 50 years old where women are more predictable two to three time to inherit it than men. It is also a possibility for children and adults to develop MS. It has been documented that people are more prone to develop MS in countries with temperate climates, smoking, Epstein-Barr virus and low levels of vitamin D where It is related the lack of sunlight. Caucasians women are being considered at the highest risk. [5,4]

In the process of rehabilitation, the patient should be educated and advised to avoid hot environment or excessive physical exhaustion. Strengthening exercises should be done to both weak upper and lower limbs particularly the foot dorsiflexors using Faradism (electrical stimulator later manual resistance using PNF technique, massage in form of soothing, stroking and effleurage to both upper and lower limbs. Finally, ice therapy was done to cool down the parts of the body exercised. Energy conservation techniques, assistive devices and breathing exercises are used to avoid fatigue. A wide or narrow base cane combined with weigh cuff and a collar help to deal with balance and tremors. If a wheelchair is needed for mobility, safety and pressure relief education should be advised. [6]

Another approach was made through a study made in New Zealand based in 12 weeks programs for patients with multiple sclerosis that included two sets of 12 weeks. It was a telerehabilitation system containing more than 200 exercises consisting of video clips audio and text description with a Personalized program for each patient. This program was based in the necessity of people living in rural areas. Different types of questionnaires were used to track progress on patients and the results were positive, but some patients showed a lack of motivation and technology problems. In order to try telerehabilitation a support group would be highly recommended for patients to increase motivation. [3]

Physical therapy treatment should be functional, task specific, weight bearing or closed chain and rigorous enough to create improvements in strength. It has been widely thought that resistance training should be contraindicated since this type of training causes greater fatigue and potential for inducing symptoms. However, the fatigue and symptom exacerbation are short lived and are outweighed by the long-term benefits obtained by resistance training. In MS, the decrease in muscle fiber diameter and mass is greater in fast twitch fibers than in slow twitch fibers. ADL’s require fast twitch muscle activation, and resistance training provides the most effective method of improving fast twitch muscle strength, as the goal is to increase strength, endurance, cardiac fitness, and reduction in fatigue.

During training, it is important to keep the patient’s body temperature from becoming too high. Exercises should be strenuous but kept at a moderate level in order to avoid overheating the patient. Room temperature should be kept slightly lower than normal and frequent breaks should be incorporated to allow for recovery. It is also beneficial for the patient to take a cool shower prior to exercise to lower the body temperature. [9]

There is still no known cure for MS, however research is currently finding new medications to either prevent T-cells from entering the CNS or preventing an inflammatory response. A new drug called Siponimod was approved in March of this year (2019).[10] Also, transplantation of human embryonic stem cells (hESC) have been shown to remyelinate damaged neurons and prevent demyelination of neural cells.[8] Patients are being diagnosed earlier, they begin treatment earlier, and in combination with an effective exercise program, the outlook for a productive and functional quality of life is brighter than ever.


  1. National Multiple Sclerosis Society. (2019). Definition of MS. [online] Available at: [Accessed 1 Dec. 2019].
  2. Mayo Clinic. (2019). Multiple sclerosis – Symptoms and causes. [online] Available at: [Accessed 1 Dec. 2019].
  3. Sangelaji, B., Smith, C., Paul, L., Treharne, G. and Hale, L. (2017). Promoting physical activity engagement for people with multiple sclerosis living in rural settings: a proof-of-concept case study. European Journal of Physiotherapy, 19(sup1), pp.17-21
  4. Ivashynka, A., Copetti, M., Naldi, P., D’Alfonso, S. and Leone, M. (2019). The Impact of Lifetime Alcohol and Cigarette Smoking Loads on Multiple Sclerosis Severity. Frontiers in Neurology, 10.
  5. Harbo, H., Gold, R. and Tintoré, M. (2013). Sex and gender issues in multiple sclerosis. Therapeutic Advances in Neurological Disorders, 6(4), pp.237-248.
  6. Hanif, S. and Lamina, S. (2017). Physiotherapy Management of Multiple Sclerosis: Case Report on Combined Approach. Indian Journal of Physiotherapy and Occupational Therapy – An International Journal, 11(3), p.123.
  7. National Multiple Sclerosis Society. (2019). Glatiramer Acetate Injection. [online] Available at: [Accessed 3 Dec. 2019].
  8. Fattahi, M., Nahid Eskandari, N., Sotoodehnejadnematalahi, F., Shaygannejad, V. and Kazemi, M. (2019). Comparison of The Expression of miR-326 between Interferon beta Responders and Non-Responders in Relapsing-Remitting Multiple Sclerosis. Cell J, 22(1), pp.92-95.
  9. Canavan, Paul. (2016). Evidence Based Therapeutic Exercise Recommendations for Patients with Multiple Sclerosis: A Physical Therapy Approach. Journal of Gerontology & Geriatric Research. 05. 10.4172/2167-7182.1000271.
  10. UPDATE, F. (2019). FDA Approves Siponimod – Brand named Mayzent® – for Relapsing Forms of MS Including Active Secondary. [online] National Multiple Sclerosis Society. Available at: [Accessed 3 Dec. 2019].


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