Multiple Sclerosis Disease - Research Paper Example

Multiple Sclerosis Aim of the Project This paper is out to examine the impact of Multiple Sclerosis on gait pattern. The research has a lot of significance associated with it following the fact that locomotion has proved to be not only basic but an essential part of human transportation. Multiple Sclerosis is considered as being a demyelization disorder that affects the spinal cord and the nervous system resulting in plaque patches in the spinal cord and brain regions. It is also considered as an inflammatory disease that is characterized by damage of the myelin sheaths of the axons located in the brain and spinal cord. This condition commonly progresses to stages of significant disability and reduced quality of life for the patient. Prevalence of Multiple sclerosis (MS) in UN is around 58 to 95 per 100 000 and it is estimated that in US there about 400 000 patients with MS (Noseworthy et al., 2000, p. 950). There is a substantial research that is explaining the pathogenic mechanisms of the disease; however the etiology of MS is still an object of debate. Many theories have been proposed as the causative agent for this condition. By some extent MS is considered to be an inherited condition because the incidence of MS is found to be higher in families with a case of MS and this is especially true for the siblings and children on patients with MS. Also genetic testing has already identified some genes of the major histocompatibility complex that are associated with MS, especially DR-15 and DQ-6 genes (Compston and Coles, 2008, p.1550). Other theories calculate with environmental factors like lack of sun exposure, vitamin D deficiency, stress, smocking and other factors (Ascherio and Munger, 2007, p. 290). Infective theory tries to connect MS with increased hygiene in the modern world and lack of nonspecific stimuli of the immune system or it connects it with some viral infective agents like human herpes virus, Epstein-Bar virus (Ascherio and Munger 2007). In order to investigate the effects of Multiple Sclerosis on gait pattern, MRI was used in the study of the nervous system and the spinal cord of MS patients. Being an idiopathic inflammatory disorder, MS mostly affects the central nervous system characterized by subsequent axon and demyelization degeneration. Now that the disease mostly affects the aged with symptoms such as weakness, numbness, loss of balance, visual impairment, fatigue, urinary bladder urgency and dizziness, it can be easily confused with other old aged disorders (Arnold and Mathews, 2002, p. 24). This situation calls for the need for proper diagnosis and study of its effects be conducted by experienced personnel. Magnetic resonance imaging (IMR) has proved to be a vital tool in diagnosing MS and will be the main tool in this project. IMR included with gadolinium contrast will be used during the first attack and will be based on in this research to provide lesions evidence in spinal cord and brain parts. This will be followed by a magnetic scan in a span of three months following the first MS attack and will be aimed at identifying new lesions as well as providing dissemination evidence over time. With the help of MRI, the paper is aimed at finding out how severe MS affects the functional ability of the human body. Justification Diagnosis of MS posses many challenges because it is a condition that can be presented to a wide range of different neurologic conditions. MS is diagnosed by using a combination clinical presentations and diagnostic imaging procedures, predominantly oriented at excluding eventual differential diagnosis. The hallmark of MS diagnosis is the so called dissemination of symptoms in space and time diagnosed using, clinical, laboratory, imaging or other method. The problem is that these criteria of diagnosis are constantly changing and evolving, in light of the new capabilities of the imaging procedures and new gained knowledge about the clinical presentation of the disease. Several researches have been conducted earlier on the effects of MS on gait patterns with most of them indicating severe and numerous effects. This poses a challenge to this paper to conduct a study in the same and even employ better study methods in order to come up with better and reliable findings. One of the studies was conducted in 1984 by Goldfarb & Simon for the purpose of determining the relationship between walking performance and MS Amyotrophic. The study involved 17 men and 7 women all within normal weight and height range. During the study, eight muscles were successfully identified for either stance phase or swing phase. The swing muscles in question included hamstrings, hip flexors, anterior tibilas and quadriceps while the stance muscles included the adductors, gluteus maximums, gastronomies and adductors. The findings of this study indicated that Amyotrophic MS patients took less time when it came to the swing phase and more time when it came to stance phase. The conclusion was that the walking velocity of Amyotrophic MS patients decreased. The findings also indicated that there existed no correlation between walking velocity and the pulmonary functions, diagnosis time and the neurology type (Hatzichristou, 2002, p. 44). Another research conducted earlier on MS focused on the impact of programs on aquatic exercise on gait parameters. The participants were subjected to a 10 week program on aquatic exercise that involved freestyle swimming and aqua-calisthenics. Exercise sessions lasting for sixty minutes were held every day with the intensity of the exercise put at 60% to 75% sub maximal. The findings of this study showed that MS patients experienced a reduction in stride length, higher cadence while walking and slower free walking speed rates. It was also evident from the study that MS patients had less vertical lift during the walking exercise. The conclusion of this study was that programs on aquatic fitness have less impact on impairing or improving gait parameters (Hatzichristou, 2002, p. 46). In 1999, a study was also conducted that examined the gait characteristics six months after and before the aerobic program. The study found out an increase in either external or internal rotation and also hip adduction or abduction meaning a specific motion range pattern was favorable as a result of exercise. The results also indicated that MS patients had more hip flexors tightness. The nature of the disease was a major limitation in this study thus the conclusion was that following the neurological reduction from MS experienced in 6 months time frame for various subjects, it become hard to differentiate the exercise intervened effects (Hatzichristou, 2002, p. 48). Another study on the same topic was carried out by Frzovic, Morris and Vowels in the year 2000 focusing on standing balance performance in relations to patients with MS. Measurements were taken on the standing balance of the subjects of the study in different positions such as the subjects having their feet together, their feet apart, single support stance, double support stance, perturbations that were self generated and stride stance. The findings showed that there existed no difference between the disease control group ability in maintaining different positions and the effects of the disease. The findings also illustrated that MS patients showed dismal performances when it came to both single and double leg stance and also how they responded to perturbation coming from outside (Hatzichristou, 2002, p. 49). Other researches were also used to determine the impact of drugs on the disorder as well as how drugs impact gait parameter. A study was carried out investigating baclofen effects on gait. The outcome of the study was that there was no striking difference between placebo treatment and baclofen in gait and postural instability. The conclusion was that baclofen had no effect on the treatment of gait (Hatzichristou, 2002, p. 50). MRI is a powerful tool for the diagnosis of MS however has some important drawbacks that should be potentiated. The lesions as detected by the MRI imaging are not specific to MS but can be caused by a range of different conditions. The conventional MRI scans are unable to differentiate between meny of these changes even with some specific new guidlines as defined by Barkhof et al (1997,p. 2064). Another important limitation of the classic T1-T2 weighted MRI images is that they are not very effective in quantification of the level of injury in the white mater. Also it is important that there are different types of abnormalities associated with MS that are also undetectable with the conventional MRI images. Another important point for the diagnosis of MS is the cortical signs of demyelinisation that is a common find on the biopsy specimens from MS patients but is very difficult to be identified using the classical MRI scanning. However in order to address some of these limitations of MRI scanning there are some new MRI sequences ad techniques that are able to introduce significant improvements in the accuracy of MRI diagnosis of MS. Objectives In order to me meet the aim of this paper, a sample subject will have to be selected after which it will be examined for MS as well as the effects the disease has on gait patterns. A sample of approximately 10, 000 people will be taken for this research. The female are most likely to be diagnosed with MS as compared to the men hence the disease is expected to impact gait patterns of the female more than the male. The non white individuals are also half likely to be diagnosed with the disease as compared to the white individuals hence the non white persons gait patterns are less likely to be affected by the disorder in if it happens that MS impacts gait patterns. Individuals coming from the high prone areas are also most likely to have the disease. Age is also a factor now that the aged are more prone to the disease thus it is expected they will be impacted more by the disorder (Rudick, 1996, p. 580). The diagnosis will be mostly conducted using MRI examination after the basic MS symptoms have been identified. The diagnosed will then be subjected to several activities and training with their progress being compared with normal individuals. By the end of the exercise, the study should be in a position to find out if gait patterns associated with MS patients are determined by training and exercise or by the disease progression. By studying the spinal cord and the brain using MRI, the paper will be in a position to determine if aquatic and aerobic training have any significance in maintaining gait patterns. In addition, the paper will find out if drug therapies and drugs affect the maintenance of gait patterns. For now the value of the MRI scan as a tool for diagnosis of MS is used only in association with the clinical, laboratory and other findings, however some new MRI procedures are showing potential for more specific diagnosis of MS. One of these new procedures is Magnetic transfer imaging (MTR). It is an MRI procedure that has a possibility for specific detection of the myelin content in the brain tissue (Schmierer et al. 2004, p. 407). For example one exciting possibility of MTR is that it can detect a low myelin content in patient even without any clinical or MRI changes that later develop MS symptoms. MTR can also be used for more subtitle monitoring of the progression of the disease by monitoring the myelin levels in the white matter etc. (Santos et al. 2002, p. 662). Another MRI sequence that has a potential for specific diagnosis of MS is Magnetic imaging spectroscopy (MRS). MRS is a MRI procedure that is capable of measuring the chemical composition of the organic tissues without the need for any invasive procedure. Method Data will be obtained from the selected individuals identified to be having MS using MRI activity as well as those individuals that were diagnosed not to be having MS with the use of NB distribution. All the sample individuals will be scanned monthly for not less than 6 months and will all be placed under several clinical trials that will be large scaled (Bhatia, 1999, p. 150). The statistical powers will then be calculated within the duration of the study and the findings used to examine the difference in activities, use of aquatic and aerobic training and the use of drug and drug therapy between individuals diagnosed with MS and those not diagnosed. The clinical trials that will be involved include; 1. A Second Or More Clinical Relapse Presentation This presentation will be the most straightforward situation involving patients aged between 20 and 30 years being presented with an additional typical neurological episode that will be supported by a MRI characteristic brain. At this stage, it is most likely that the patients will have MS. Further tests will be included in order to identify the number of individuals with MS who have borderline or negative MRI. Potentials evoked may recognize additional paraclinical lesions in such a situation as well as abnormalities of the brain and the CSF (Weiner and Cohen, 2002, p. 145) 2. At The Time Of The First Clinical Episode Presentation One clinical episode is not enough for the diagnosis of definite MS. The laboratory diagnosis in support of MS will include more than two lesions evidence and CSF OCBS monophasic presentations. More than 60 % of the sampled individuals who will be having MS typical type are expected to have many white matter lesions MRI. MRI abnormal brain presence is normally associated with a more than 80% risk of conducting definite MS in a span of 10 years (Filippi and Grossman, 2002, p. 1150). If the brain MRI is defined as not being normal in the case that there are definite numbers of lesion’s white matter, the investigation will appear as being more sensitive than potentials that have been evoked and CSF predictions that the individuals will develop the disorder at follow up. Hence in any setting, brain MRI can be used to show how likely an individual with one typical neurological episode will develop definite MS. A negative scan normally gives some reassurances as approximately 11% of such individuals will end up having MS in future. 3. A Progressive Picture Presentation The individual’s diagnosis presentation with progressive issues should be carried out after any other causes have been ruled out. The main causes in this question include; brain and spinal cord structural lesions and spinal cord compression. Following the possible delay from the beginning to the presentation to a MS primary progression, the progressive deterioration clinical picture is normally clear. Following the old age factor, a good number of the individuals will prefer having their presentation after 50 years. This may lead to MRI brain confirmatory appearances to be almost impossible to distinguish from vascular WMLs and age related symptoms. In such a situation, the spinal cord MRI comes in handy in the investigation of such individuals now that it eliminates differential diagnosis that are important and also lesions in the spinal cord are easily identified in MS. This means that individuals who will be investigated for MS primary progressive form will most likely need spinal cord MRI (Holland, 2007, p. 67) 4. Individuals Who Have Negative Initial Investigations Brain MRI is normally witnessed in less than 5% of the individuals with MS and this is made possible by the use of modern techniques. Half of this number of individuals in a single series consisted of individuals with the basic progressive disease with the majority of them being severely disabled. In an effort to replace remitting disease in the past, normal imaging was closely related to mild or early disease. All individuals with negative brain MRI had not less than one spinal cord lesion, 56% of such individuals had abnormal VEPs while 87% of them had OCBs (Kalb, 2008, p. 67). The above situation indicated increased investigation value. Complete normality regarding all the investigations conducted while applying optimum techniques would lead to an MS diagnosis that would leave many questions unanswered. Most of the individuals showing relapsing symptoms lack objective signs thus making the non-organic diagnosis to be the mostly settled on conclusion. However, most of the patients showing early relapsing remitting mostly monophasic symptoms who had showed negative signs in the initial investigation, go ahead to have more problems and develop abnormalities when the investigation is repeated. Equipment The main equipment used in this project is the CNS imaging. The brain MRI scan has been identified as the most appropriate test used to confirm MS diagnosis. The MRI will be used to detect lesions which are expected mostly to appear in areas with high signal and this will be predominant in the spinal cord and the white matter in the cerebral. The MRI scanning will also be used to detect structural pathology in areas that can prove impossible to image using computed tomography like the cervical cord, craniocervical junction and the posterior fossa. An MRI brain scan will also be used together with a magnet that will be high field having more than 1.5 tesla. TI weighted post contrast of fast spin echo (TR=400-700; TE=5-25) or in some situations, conventional Serial dual echo (TR=2000-3500, TE=20-50/60-100) brain images will be acquired in each month for not less than 6 occasions that have to be consecutive. TI weighted scans will also be needed. 0.1 mmol/kg injections of gadolinium-DTPA will also be needed before the TI weighted scans. Slices of about 3 or 5 mm thickness which have to be contiguous and axial will also be required (LaRocca and Kalb, 2006, p. 52) Bibliography Arnold, D & Mathews, P. 2002. “MRI in the diagnosis and management of multiple sclerosis.” Neurology, 4:23-31 Ascherio A & Munger L.,2007. “Environmental risk factors for multiple sclerosis. Part I: the role of infection” Ann. Neurol. 61 (4): 288–99. Barkhof F, et al. 1997. “Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis.” Brain. 120:2059–2069. Bhatia, K. 1999. “The paroxysmal dyskinesias.” J Neurol. 246:149-55 Compston, A & Coles, A. 2008. Multiple sclerosis. Lancet 372 (9648): 1502–17. Filippi, M & Grossman, R., 2002. MRI techniques to monitor MS evolution: the present and the future. Neurology. 58:1147-53 Hatzichristou, D., 2002. “Sildenafil citrate: lessons learned from 3 years of clinical experience. Int J Impot Res. 14:43-52 Holland, J., 2007. Controlling Spasticity in MS. National MS Society: Denver Kalb, R., 2008. Multiple Sclerosis: The Questions You Have the Answers You Need. Demos Medical Publishing: New York LaRocca, N & Kalb, R, 2006. Multiple Sclerosis: Understanding the Cognitive Challenges. Demos Medical Publishing: New York Noseworthy J. et al., 2000. Multiple sclerosis. N Engl J Med. 28;343(13):938-52. Rudick, R., et al.1996. “Multiple sclerosis: The problem of incorrect diuagnosis.” Arch Neurol, 43:578-83 Santos AC, et al. 2002. “Magnetization transfer can predict clinical evolution in patients with multiple sclerosis”. J Neurol. 249:662 Schmierer K, , et al. 2004. “Magnetization transfer ratio and myelin in postmortem multiple sclerosis brain.” Ann Neurol. 56:407 Weiner, H & Cohen, J. 2002. “Treatment of multiple sclerosis with cyclophosphamide” critical review of clinical and immunologic effects.” Multi Scler. 8:142-54 Read More