TOPIC:

Multiple Sclerosis

NAME: Akash Kumar Kadapa

CLASS: XII B
 CERTIFICATE
This is to certify that Akash Kumar Kadapa of
class XII ‘B’ has successfully completed the
biology project on the topic “Multiple
Sclerosis” during the academic year 2019-20.

Hall ticket number:

Examiners signature:Teacher in charge:

Date: Institution rubber stamp:

 Acknowledgement

The present work titled “Multiple sclerosis” has

been accomplished due to the able guidance given
to me by our Biology teacher Dr C Srilatha. She
had been encouraging us all through the project
and the real reason is behind the execution of
work.
I would like to thank our principal for providing all
the necessities as well as my parents as without
them the project would not have been possible.
I would also like to thank Dr Balaji, for providing
with all the essential information and a written
account of all the medicines.
 Contents
I. Introduction
II. The discovery of MS
III. Causes
IV. Symptoms
V. Diagnosis
VI. Treatment
VII. Prognosis
VIII. Epidemiology
IX. Statistics
X. History and Culture of MS
XI. Case study
XII. Questionnaire
XIII. References and Full forms
XIV. Bibliography
 Introduction
Multiple sclerosis (MS), also known as Disseminated
sclerosis or encephalomyelitis disseminata, a
potentially disabling disease of the brain and spinal
cord (central nervous system).

In MS, the immune system attacks the protective

sheath (myelin) that covers nerve fibres and causes
communication problems between our brain and the
rest of our body. Eventually, the disease can cause
permanent damage or deterioration of the nerves.
The French neurologist Jean Martin Charcot (1825-
1893) was the first person to recognise Multiple
sclerosis as a distinct disease in 1868. We celebrate
National MS day on 30th May.
 The discovery of MS
The Discovery of MS Until the early years of the 19th
century, physicians relied on superstition, hearsay,
and “the wisdom of the ancients” to care for the
sick. Medical ideas were not scientifically tested.
Even so, physicians were often good observers and
we can look back today and identify people who
undoubtedly had MS from descriptions written as
long ago as the Middle Ages. Once doctors began to
analyze illnesses scientifically, MS was among the
first diseases to be described. Drawings from
autopsies done as early as 1838 clearly show what
we now recognize as MS. Then, in 1868, Jean-Martin
Charcot, a professor at the University of Paris who
has been called “the father of neurology,” carefully
examined a young woman with a tremor of a sort he
had never seen before. He noted her other
neurological problems including slurred speech and
abnormal eye movements, and compared them to
other patients he had seen. When she died, he
examined her brain and found the characteristic
scars or “plaques” of MS. Dr. Charcot wrote a
complete description of the disease and the
changes in the brain that accompany it. However, he
was baffled by its cause and frustrated by its
resistance to all of his treatments, including
strychnine, a deadly poison that in small doses can
stimulate nerves. He also tried injections of gold and
silver, as they were standard treatments for the
other major nerve disorder common at that time—
syphilis.
 Causes
The cause of multiple sclerosis is unknown. It's
considered as an autoimmune disease in which the
body's immune system attacks its own tissues. In
case of MS, this immune system malfunction
destroys the fatty substance that coats and protects
nerve fibers in the brain and spinal cord (myelin).

There's no cure for multiple sclerosis. However,

treatments can help speed recovery from attacks,
modify the course of the disease and manage
symptoms.
 Symptoms
Early Signs of MS:
For many people, the first brush with what’s later
diagnosed as MS is what doctors call clinically
isolated syndrome (CIS). This episode of neurological
symptoms usually lasts 24 hours. It happens when
your immune systemmistakenly tells your body to
attack myelin, the protective sheath over nerve cells in
your brain and spine. You may hear your doctor call
this demyelination. It causes scars, or lesions, that
make it harder for signals to travel between
your brain and your body.
The most common symptoms in CIS are:
 Optic neuritis: This condition damages the nerve
that connects your eye to your brain. It usually
affects just one eye, but in rare cases, it involves
both. You might notice:
1. Blurry vision
2. Colours appear dull
3. Pain in your eye, especially when you move it

 Numbness & Tingling: It usually affects your legs.

You might feel:
 An electric shock-like feeling when you move
your head or neck. It may travel down
your spine or into your arms or legs.
 Numbness, often in your face
 Not everyone who has CIS will get MS. The odds
are higher if you have lesions in your brain from
loss of myelin. If you have another CIS or
other MS symptoms later, your doctor will do a
test called an MRI that takes a picture of your
brain to scan for the defect.

Primary MS Symptoms:
These come from ongoing damage to your myelin.
They aren’t pleasant, but your MS treatmentteam can
help you keep most of them under control
with medication, rehabilitation, and other tactics. The
most common symptoms are:
 Bladder and bowel problems:
You may have to pee more often, need to go at
night, or have trouble emptying your bladder fully.
Bowel issues like constipation are also common.
 Clumsiness or lack of coordination: MS can make
it hard to get around. You might have:
1. Trouble walking
2. A hard time keeping your balance
3. Changes in your gait
 Dizziness:
You may feel lightheaded. You probably
won't have vertigo, that feeling that the room is
spinning.

 Emotional changes and depression:

 It’s tough to adjust to the idea that you
have a chronic disease, let alone one that’s hard
to predict and that will take a physical toll. Fear of
the unknown can make you anxious. Plus the
disease damages nerve fibers in your brain, and
that can affect your emotions. So can
medications, like corticosteroids, used to treat
MS.
 Eye problems:
In addition to the optic neuritis that comes
with CIS, MS can cause:
1. Nystagmus: involuntary eye movements
2. Diplopia: double vision
 Fatigue:
You may feel very tired. It often comes on in
the afternoon and causes weak muscles, slowed
thinking, or sleepiness. It isn’t usually related to
the amount of work you do. Some people with MS
say they can feel tired even after a good
night's sleep.
 Heat-related problems:
You might notice them as you warm up
during exercise. You could feel tired and weak or
have trouble controlling certain body parts, like
your foot or leg. As you rest and cool down, these
symptoms are likely to go away.
 Muscle spasms :
They usually affect your leg muscles. They’re
an early symptom for almost half the people with
MS. They also affect people with progressive MS.
You might feel mild stiffness or strong, painful
spasms.
 Sexual troubles:
These include vaginal dryness in women and
erection problems in men. Both men and women
may be less responsive to touch, have a
lower sex drive, or have trouble reaching orgasm.
 Speech problems:
MS could cause long pauses between your words
and slurred or nasal speech. You might have
swallowing problems as the disease advances.
 Thinking problems:
It might be hard to focus from time to time. This
will probably mean slowed thinking, poor
attention, or fuzzy memory. Some people have
severe problems that make it hard to do daily
tasks, but that’s rare. MS doesn’t usually change
your intellect or ability to read and understand
conversation.
 Tremors:
About half of people with MS have them. They
can be minor shakes or so intense it’s hard to do
everyday activities.
 Trouble walking:
MS can cause muscle weakness or spasms,
which make it tough to walk. Balance problems,
numb feet, and fatigue can also happen.
 Unusual sensations:
 In addition to the pins and needles sensation
that’s part of CIS, you might also have
severe itching, burning, stabbing, or tearing
pains. You could feel tightness around your ribs
or upper belly known as the MS hug. Doctors call
these uncomfortable symptoms dysesthesia.

Secondary Symptoms:
These are problems created by your primary MS
symptoms, not by damaged myelin.
 Not being able to empty your bladder can lead
to a bladder infection.
 If you have trouble walking and are often
fatigued, you’re likely to become less active.
That can take a toll on your muscle tone, make
your breathingshallow, and even affect
your bone density.
Doctors can treat secondary symptoms, but the goal
is to avoid them by treating the primary symptoms.

Tertiary Symptoms:
These are the social, psychological, and job-related
problems of life with MS.
 If MS makes it hard for you to walk or drive,
you may not be able to do your job well.
 Because it’s tough to get around and hard to
talk to people about what life with a chronic
 disease is like, you may not be as social as
you once were.
 You could get depressed. It’s a by-product of
the changes MS makes in your brain and in
your life.
Because MS varies so much, it's best not to
compare yourself with other people who have it.
Your experience is likely to be different. Most people
learn to manage their symptoms and can keep
leading full, active lives.
 Diagnosis
There are no specific tests for MS. Instead, a
diagnosis of multiple sclerosis often relies on ruling
out other conditions that might produce similar
signs and symptoms, known as a differential
diagnosis.

Your doctor is likely to start with a thorough medical

history and examination.

Your doctor may then recommend:

 Blood tests, to help rule out other diseases

with symptoms similar to MS. Tests to check
for specific biomarkers associated
 with MS are currently under development and
may also aid in diagnosing the disease.
 Spinal tap (lumbar puncture), in which a small
sample of fluid is removed from your spinal
canal for laboratory analysis. This sample can
show abnormalities in antibodies that are
associated with MS. A spinal tap can also
help rule out infections and other conditions
with symptoms similar to MS.
 MRI, which can reveal areas of MS (lesions)
on your brain and spinal cord. You may
receive an intravenous injection of a contrast
material to highlight lesions that indicate your
disease is in an active phase.
 Evoked potential tests, which record the
electrical signals produced by your nervous
system in response to stimuli. An evoked
potential test may use visual stimuli or
electrical stimuli, in which you watch a
moving visual pattern or short electrical
impulses, are applied to nerves in your legs
or arms. Electrodes measure how quickly the
information travels down your nerve
pathways.
In most people with relapsing-remitting MS, the
diagnosis is fairly straightforward and based on a
pattern of symptoms consistent with the disease
and confirmed by brain imaging scans, such as MRI.

Diagnosing MS can be more difficult in people with

unusual symptoms or progressive disease. In these
cases, further testing with spinal fluid analysis,
evoked potentials and additional imaging may be
needed.
 Treatment
There is no cure for multiple sclerosis. Treatment
typically focuses on speeding recovery from
attacks, slowing the progression of the disease and
managing MS symptoms. Some people have such
mild symptoms that no treatment is necessary.

Treatments for MS attacks:-

 Corticosteroids, such as oral prednisone and

intravenous methylprednisolone, are
prescribed to reduce nerve inflammation.
Side effects may include insomnia, increased
blood pressure, mood swings and fluid
retention.
  Plasma exchange (plasmapheresis). The
liquid portion of part of your blood (plasma)
is removed and separated from your blood
cells. The blood cells are then mixed with a
protein solution (albumin) and put back into
your body. Plasma exchange may be used if
your symptoms are new, severe and haven't
responded to steroids.

Treatments to modify progression:-

For primary-progressive MS, ocrelizumab (Ocrevus)

is the only FDA-approved disease-modifying therapy
(DMT). Those who receive this treatment are slightly
less likely to progress than those who are untreated.

For relapsing-remitting MS, several disease-

modifying therapies are available.

Much of the immune response associated

with MS occurs in the early stages of the disease.
Aggressive treatment with these medications as
early as possible can lower the relapse rate and
slow the formation of new lesions.

Many of the disease-modifying therapies used to

treat MS carry significant health risks. Selecting the
right therapy for you will depend on careful
consideration of many factors, including duration
and severity of disease, effectiveness of
previous MS treatments, other health issues, cost,
and child-bearing status.

Treatment options for relapsing: -

remitting MS include injectable medications,
including:

 Beta interferon’s. These medications are among

the most commonly prescribed medications to
treat MS. They are injected under the skin or
into muscle and can reduce the frequency and
severity of relapses.

Side effects of beta interferon’s may include flu-

like symptoms and injection-site reactions.
You'll need blood tests to monitor your liver
enzymes because liver damage is a possible side
effect of interferon use. People taking interferon’s
may develop neutralizing antibodies that can reduce
drug effectiveness.

 Glatiramer acetate (Copaxone, Glatopa). This

medication may help block your immune
system's attack on myelin and must be injected
beneath the skin. Side effects may include skin
irritation at the injection site.
 Oral treatments include, Fingolimod
(Gilenya). This once-daily oral medication
reduces relapse rate.
You'll need to have your heart rate monitored for six
hours after the first dose because your heartbeat
may be slowed. Other side effects include rare
serious infections, headaches, high blood pressure
and blurred vision.

 Dimethyl fumarate (Tecfidera). This twice-daily

oral medication can reduce relapses. Side
effects may include flushing, diarrhoea, nausea
and lowered white blood cell count.
 Teriflunomide (Aubagio). This once-daily oral
medication can reduce relapse rate.
Teriflunomide can cause liver damage, hair loss
and other side effects. It is harmful to a
developing foetus and should not be used by
women who may become pregnant and they —
or their male partner — are not using
appropriate contraception.
 Siponimod (Mayzent). Research shows that this
once-daily oral medication can reduce relapse
rate and help slow progression of MS. It's also
approved for secondary-progressive MS.
Possible side effects include viral infections,
liver problems and low white blood cell count.
Other possible side effects include changes in
 heart rate, headaches and vision problems.
Siponimod is harmful to a developing foetus, so
women who may become pregnant should use
contraception when taking this medication and
for 10 days after stopping the medication.
Infusion treatments include:

 Ocrelizumab (Ocrevus), This humanized

immunoglobulin antibody medication is the
only DMT approved by the FDA to treat both the
relapse-remitting and primary-progressive
forms of MS. Clinical trials showed it reduced
relapse rate in relapsing disease and slowed
worsening of disability in both forms of the
disease.
Ocrevus is given via an intravenous infusion by
a medical professional. Infusion-related side
effects may include irritation at the injection
site, low blood pressure, a fever and nausea,
among others. Ocrevus may also increase the
risk of some types of cancer, particularly breast
cancer.
 Natalizumab (Tysabri), this medication is
designed to block the movement of potentially
damaging immune cells from your bloodstream
to your brain and spinal cord. It may be
considered a first line treatment for some
people with severe MS or as a second line
treatment in others.

 Alemtuzumab (Campath, Lemtrada), this drug

helps reduce relapses of MS by targeting a
protein on the surface of immune cells and
depleting white blood cells. This effect can limit
potential nerve damage caused by the white
blood cells. But it also increases the risk of
infections and autoimmune disorders, including
a high risk of thyroid autoimmune diseases and
rare immune mediated kidney disease.
Treatment with Alemtuzumab involves five
consecutive days of drug infusions followed by
another three days of infusions a year later.
Infusion reactions are common with
Alemtuzumab.The drug is only available from
registered providers, and people treated with
 the drug must be registered in a special drug
safety monitoring program.

 Mitoxantrone. This immunosuppressant drug

can be harmful to the heart and is associated
with development of blood cancers. As a result,
its use in treating MS is extremely limited.
Mitoxantrone is only rarely used to treat severe,
advanced MS.
 Prognosis
The information of 349 cases of multiple sclerosis,
seen in a neurological department over a twenty-
year period and followed up for a mean of nine
years, was analysed by computerized data
processing.
The mean age at onset was 30.0 years for the
remittent onset types (82 per cent cases) and 37.3
years for the progressive onset types (18 per cent
cases). During the course of the disease the age of
the 'pure relapse' stage was 29.2 years and of the
progressive phase 38.0 years. The interval between
the first two relapses in the remittent-progressive
type was important, the shorter the interval the
sooner the progressive phase occurred.
A late onset of the disease, a short interval between
the first two relapses and the occurrence of the
progressive phase were associated with a poor
outcome. Sex of patient, the symptomatology of the
initial relapses, and the constituents of the CSF had
no prognostic value.
Have been sought, because only 30–70% of patients
with a CIS develop MS.
When clinically silent brain lesions are seen on MRI, the
likelihood of developing MS is high. MS can be diagnosed
within 3 months of CIS presentation with certain MRI and
CSF criteria. Disability from MS is less likely in patients
with a CIS of optic neuritis or sensory symptoms only, few
or no MRI lesions, a long period to the first relapse, and
no disability after the first 5 years. Development of more
reliable prognostic markers will enablenew treatments to
be targeted for those who are most likely to benefit.
Weencourage continued clinical and laboratory
assessment of patients with a CIS.
 Epidemiology
Two main measures are used in epidemiological
studies are:

Incidence: It is the number of new cases reported

per new person.
Prevalence: It is the total number of disease in the
population at any time.

The uneven distribution of multiple sclerosis (MS)

across populations can be attributed to differences
in genes and the environment and their
interaction. Prevalence and incidence surveys could
be affected by inaccuracy of diagnosisand
ascertainment, and prevalence also depends
on survival. These sources of error might play a part
in the geographical and temporal variations. Our
literature search and meta-regression analyses
indicated an almost universal increase in prevalence
and incidence of MS over time; they challenge the
well accepted theory of a latitudinal gradient of
incidence of MS in Europe and North America, while
this gradient is still apparent for Australia and New
Zealand; and suggest a general, although not
ubiquitous, increase in incidence of MS in females.
The latter observation
should prompt epidemiological studies to focus
on changes in lifestyle in females. New insights into
gene–environment and gene–gene interactions
complicate interpretations of
demographic epidemiology and have made obsolete
the idea of simple causative associations
between genes or the environment and MS.

Concerning mortality, in a large French court of

27,603 patients, there was no difference between MS
patients and controls in the first 20 years of the
disease, although life expectancy was reduced by 6-
7 years in MS patients. In 2004, the prevalence of MS
in France was 94.7/100,000 population, according to
data from the French National Health Insurance
Agency for Salaried Workers (Caisse nationale
d'assurance maladie des travailleurs Salariés
[CNAM-TS]), which insures 87% of the French
population.
 Statistics
Multiple sclerosis affects about 400,000 people in
the United States, and about 2 1/2 million worldwide.
In the United States, the prevalence of the condition
— that is, the number of people who have it
compared with the general population — is nearly 90
cases per 100,000 people.

The prevalence of MS varies with location and

increases with distance from the equator. We don’t
know whether this has to do with an environmental
influence, a genetic influence, or something else.
MS usually shows up when a person is between 20
and 40 years of age, with 32 the mean age. It can
occur in young children, however.
MS is more common is women than men, with
recent studies suggesting a female to male ratio as
high as three to four women with MS against one
man.
The last study of the prevalence of MS in the United
States was in 1975. This is mainly because
the Centres for Disease Control and Prevention do
not require U.S. health practitioners to report new
cases. Since MS is sometimes invisible — that is, its
symptoms are not showing — the U.S. prevalence of
MS can only be estimated. The National MS
Society is trying to establish a registry to track the
number of people with MS. It has also made a
commitment to re-evaluating and updating the
numbers.
 History and Culture
The history of multiple sclerosis (MS) is a detective
story spanning more than a century. MS is one of
the most common diseases of the nervous system,
affecting people of almost all ages in many parts of
the world, although it has a special preference for
young people, for women, and for those in northern
latitudes. MS has a genetic susceptibility, but it is
not directly inherited. It usually causes attacks of
neurologic symptoms including vision loss,
paralysis, numbness, and walking difficulties. These
symptoms can be diverse and confusing, often
coming and going without any pattern—making it
difficult to diagnose, even today.
These symptoms appear because nerves in the
brain and spinal cord lose their ability to transmit
signals. Myelin, a complex substance that
surrounds and insulates nerve fibers, is essential
for nerves to conduct electricity and carry out their
function. Myelin is damaged in MS, as well as some
of the nerve fibers themselves. The attacks strike
when cells and proteins of the body’s immune
system, which normally defend the body against
infections, leave the blood vessels serving the
central nervous system, pour into the brain and
spinal cord, and destroy myelin. The specific
triggering mechanism that releases the immune
system to attack its own healthy tissue remains
unknown, however, and the cause of MS is still its
biggest mystery. How its other puzzles have been
solved is a fascinating story.
References and full forms

 MS – Multiple Sclerosis

 CIS – Clinically isolated syndrome

 MRI – Magnetic resonance imaging

 Gilenya, Ocrevus, Tysabri, Lemtrada,

Mitoxantrone – These are the medicines
name for the medication of MS.
 Bibliography
 https://mymsaa.org/ms-information
 https://www.nationalmssociety.org
 https://www.webmd.com
 https://www.mayoclinic.org
 https://www.ncbi.nlm.nih.gov
 https://en.wikipedia.org