The Impact of Multiple Sclerosis in the. James Bowen, MD Multiple Sclerosis Center
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1 The Impact of Multiple Sclerosis in the Pacific Northwest James Bowen, MD Multiple Sclerosis Center Swedish Neuroscience Institute
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8 Motor Symptoms of MS Weakness Spasticity - stiffness, brisk reflexes Ataxia Tremor
9 Sensory Symptoms of MS Numbness Paresthesia (sensory signals misinterpreted) Pain Ti Trigeminal i lneuralgia Lhermitte s phenomenon (electrical buzzing on bending the neck)
10 Visual Symptoms of MS Loss of vision (optic neuritis) Diplopia (double vision) Nystagmus (eye movements jerking) Internuclear ophthalmoplegia h l (misalignment of eyes in a particular manner)
11 Paroxysmal Symptoms Symptoms Pain/Paresthesias Spasticity/Dystonia i i Trigeminal Neuralgia Lhermitte s phenomenon
12 Autonomic Symptoms of MS Bladder Urgency Hesitancy Frequency Bowel Constipation Urgency Sexual ldysfunction
13 Other Symptoms of MS Fatigue Heat sensitivity Restless leg syndrome Cognitive impairment
14 Relapsing/remitting Primary yprogressive Secondary progressive Progressive/relapsing g
15 Diagnosis
16 McDonald 2010 Dissemination in Space: Any 2 Lesions in 2 locations Periventricular Juxtacortical Posterior fossa* Spinal cord* * Symptomatic lesions in these sites do not count Swanton J. JNNP 2006;77: Polman C. Ann Neurol 2011;69:292
17 MAGNIMS Modification Dissemination in Time: Any time New T2 lesion on scan at any time Enhancing + non-enhancing lesions on same scan Swanton J. JNNP 2006;77: Polman C. Ann Neurol 2011;69:292
18 Juxtacortical lesions
19 Intratentorial Lesions
20 MRI Findings FLAIR
21 MRI findings
22 Epidemiology
23 Genetics of MS 20% of patients have another affected family member Risks to siblings = 4% Risks to parents = 3% Risk to child = 2.5% (mostly female) Monozygotic twins = 26% Dizygotic twins = 2.3%
24 Genomewide Study Of 110 SNPs, 3 significant HLA-DRA accounts for 4% of risk IL-7R accounts for 0.2% of risk IL-2RA accounts for 0.2% of risk N Engl J Med 2007;357:851
25 Kurtzke J. Phy Med Rehab Clin NA 2005;16:327
26 75 = 30 cases/100,000 Wallin MT. Ann Neuro 2004;55:65
27 North South Ratios Male White Black Other Female White Black WWII/KC Vietnam Total
28 Changing Gender Rates MS Death rate/100, Males predominated in US and Europe in early 20 th century Switch to female predominance in s In graph, death rate for white women higher in young, males in older. i.e. demographics are changing Now 70% female Kurtzke J. Phy Med Rehab Clin NA 2005;16:327
29 Mean Sex Ratio by Year of Birth % women increases by 0.85%/yr Orton S. Lancet Neuro 2006;5:932
30 Changes in Racial Distribution Male White Black Other Total Female White Black Oh Other Total WWII/KC Vietnam Era Kurtzke J. Phy Med Rehab Clin NA 2005;16:327
31 Treatment
32 Treatment of Attacks Methylprednisolone 3-5 days Plasma Exchange 5 cycles
33 Disease Modifying Therapies Interferons Avonex Interferon -1a IM Betaseron Interferon -1b Extavia Interferon -1b Rbif Rebif It Interferon -1a 1 SQ Glatiramer acetate: Copaxone Mitoxantrone: Novantrone Natalizumab: Tysabri Fingolimod: Gilenya
34 MS in the Pacific Northwest
35 MS and the Northwest 1:500 in WA state Twice national average 3 rd most expensive disease of young adults years of age Building family Peak earning years Expensive disease
36 Needs in our Region 8,500 patients in Western WA 12,000 in WAMI region 750 pts/ms neurologist 12 Neurologists 4 Rehabilitation
37 Costs 2003: $47,215/patient/yr $16,050 - DMTs $13,685 - Retirement, $18,436 - lost productivity : Medicare non-medication costs $23,630 Progressive disease $5,887 Relapsing disease DMTs now: $42-48K/yr
38 Multiple Sclerosis Current Research Studies
39 Resources One of largest MS Centers in US Comprehensive MS Services Diagnosis Neurology Rehabilitation Social/vocational l Extensive research infrastructure
40 Wellness Physical Wellness: exercise program Emotional Wellness Rehabilitation Psychology: Toshima Counseling: Wittenberg Social Wellness Case management/social Work: Wittenberg Vocational Rehab Counseling: Virani
41 Wellness Education Lecture series Podcasts Website Newsletter Support groups (4) Yoga Music/movement
42 Completing the Vision Consolidate space Improve access Allow for growth PT/Wellness: equipment Meeting room/yoga/music&movement /M Education facility Therapy garden Added Services: education, neuro-psychology, recreation therapy
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