Classification- can be divided:
- On the basis of the cause:
- Demyelinating leukodystropic disease (Primary)
- Myelin is abnormal and degenerates caused by genetics or idiopathic
- Demyelinating myelinoclastic diseases (Secondary)
- Myelin is destroyed by a toxin (alcohol), infectious agents, chemical or autoimmune
- According to the presence of inflammation:
- Inflammatory
- Non-inflammatory
- Into 2 groups of diseases presenting different demyelination conditions:
- Affecting CNS
- Myelinoclastic disorders
- MS
- Devics disease
- Leukodystropic disorders
- Neuropathies due to Vit B12 deficiencies
- Tabes dorsalis
- Affecting the peripheral nerves
- Guillain Barre syndrome
- Chronic inflammatory demyelinating polyneuropathy
Treatment
- No cure, only palliative care
- Minimizing the effects of attacks and managing symptoms
- Modifying the course of the disease
- Muscle relaxing drugs and medications for pain and fatigue
Cervical myelopathy
Cervical myelopathy is a loss of function in upper and lower extremities because of compression of the spinal cord within the neck. Can involve the arms, hands, legs, bowels and bladder function.
Multiple Sclerosis
A chronic, immune-mediated disease of the CNS, characterised by multiple inflammatory demyelinating lesions in the brain and spinal cord with subsequent astrogliosis and a varying degree of axonal and neuronal loss.
Epidemiology: women are affected more than men (2.5:1). Highest incidence in north and central Europe, North America, Australia and New Zealand. Age onset: between 20 and 40 years.
Risk factors: Geographic latitude, Caucasian race, Vit D deficiency and Viral infections.
Etiology: Multifactorial disease:
- Genetic: monozygotic twins (20%), MHC and non MHC susceptibility genes
- Environment: pathogens (viral exposition), Vit D, smoking, diet, commensal flora.
- Epigenetic
Clinical manifestation
- Visual disturbance
- Motor dysfunction
- Sensory disturbances
- Brainstem symptoms
- Cerebellar (coordination) disorders
- Bowel and/or bladder dysfunctions
- Cerebral symptoms - psychoemotional disturbances, cognitive impairment, epileptic seizures
- Paroxysmal symptoms, MS-related fatigue, heat intolerance (Uhthoff’s phenomenon).
Classification
- Relapsing Remitting MS - 70%, severe attack followed by complete or incomplete recovery
- Primary Progressive MS –the disease runs a steady deteriorating course that may be interrupted by periods without improvement
- Secondary Progressive MS – RRMS frequently develops into secondary progressive MS
- Progressive Relapsing MS – when patients with a progressive form have superimposed relapses with no significant recovery
- Benign MS –about 20% of all patients
- Relapse - appearance of a new or deterioration of already existing symptoms lasting more than 24 hours in absence of fever or other clinical conditions that may explain the symptoms, which has been precede by a period of clinically stable condition lasting at least 30 days.
- Remission - a period of improvement or clinically stable condition for at least 30 days