MS, Multiple Sclerosis

Clinic

• MS is a demyelinating autoimmune disease of the nervous system.
• Specific symptoms can include
  • Double vision / Blindness in one eye
  • Muscle weakness
  • Trouble with sensation
  • Incoordination
  • Cognitive disturbance.

Question:

Can I consider GBS as a miasmatic model for MS? NO I suggest Encephalomyelitis esp Acute disseminated encephalomyelitis type and Subacute sclerosing panencephalitis

MS Sub types

I think MS is an umbrella covering a list of demyelinating disease. I suggest a new classification Considering sign / Symptoms which equals the localization of demyelination.

• Autonomic
• Visual
• Motor
• Sensory
• Vestibular
• Cerebellar

In order to find appropriate miasm, I need to know series of miasms which could cause Encephalomyelitis. Then the localized involvement could specialized the miasm. ADEM could be a good choice.

	Pathology	Sign / Symptoms	Entities	Miasms
Vestibular MS	Intra-pontine 8th nerve fascicle involvement= Acute Vestibular Syndrome (AVS). Vestibular system dysfunction are observed in 49–59% MS	Vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs	ADEM Ataxia Vertigo or Dizziness	VZV for vertigo STLE for dizziness
Autonomic MS	Impairments in the autonomic control of cardiovascular and thermoregulatory function during exercise Note: Here we have Hypothalamus temperature regulation disorder.	Uhthoff's phenomenon: Agg from higher than usual temperatures Attenuated elevations in blood pressure during exercise can negatively impact blood flow to skeletal muscle. Diminished sweating during exercise may impair heat dissipation likely limiting the exercise intensity that can be performed before detrimental core temperatures are reached.	ADEM / SSPE Thermoregulation impaired	RBOL
Upper motor neuron MS	Corticospinal tract involvement		ADEM Spasticity Paralysis/Weakness: Hyper Reflexia Reflexes, Primitive	HTLV-1 HIV
Cerebellar MS			ADEM Tremor Cerebellar Ataxia Dysarthria	CXB VZV
Urge incontinence Bladder MS	Spastic (overactive) bladder/ Prevalence of Bladder MS is 8%	Incontinence : Unable to hold urine Frequency / Urgency Hesitancy / Difficulty in starting urination	ADEM / Brain-stem Incontinence Frequency / Urgency	HTLV-1 STLE
Overflow Bladder MS	Bladder does not empty properly (retains some urine in it)		ADEM Bladder/Atonia	HSV-1
Visual MS	Sudden visual loss		ADEM / SSPE Optic neuritis/Atrophy	EBV WNE HTLV-1 RBOL
Cognitive MS	40-65 % Cognition skills such as Cognitive miasms: VZV, EBV, HHV-6, CMV, HSV-2, RBOL, HSV-1 Aphasic Miasms: VZV	Memory Attention span Information processing (Decision making, Problem solving) Visual-Spatial Abilities Verbal Fluency: Word-Hunting or mixing words	ADEM / SSPE Cognition Concentration Memory Aphasia	VZV EBV INFL MMP

Its sign/ symptoms are

• Spastic and hyperactive bladder (repetition, urgency)
• Impaired urination
• Inability to hold urine
• Inability to completely empty urine
• Nocturia

Two types: It clearly refers to two types of Urge and Overflow

2.1 Urge incontinence Bladder MS

• Sign/ Symptoms
  • Spastic (overactive) bladder that is unable to hold the normal amount of urine,
  • Frequency / Urgency
  • Hesitancy / Difficulty in starting urination
  • Incontinence (the inability to hold in urine)
• Rubrics:
  • Incontinence
  • Urging
  • Myoclonus
  • Jerking
• Miasms: HTLV-1

2.2 Overflow

• Sign/ Symptoms
  • Bladder that does not empty properly (retains some urine in it)
  • Nocturia
  • Inability to empty the bladder completely
• Rubrics:
  • Transverse Myelitis,
  • Bladder, Enuresis
  • Bladder/Atonia
• Miasms: HSV-1 , HSV-2

2.5 Bowel MS

• Constipation due to Decreased or slowed Bowel motility.
• Bowel accidents can happen for a variety of reasons. Its most common cause of is constipation. When a hard plug of impacted stool builds up in the back passage, a loose, watery stoo can leak out. This is known as overflow incontinence.

• Bowel accidents can also be caused by reduced sensation in back passage, so he dose not recognize the urge to go to the toilet, and reduced control of the muscles at the bottom of his anus.

• Rubrics
  • Constipation:
  • Involuntary stool

• Miasms: HSV-1, HSV-2

2.6 Painful MS

There are two different form first Central sensitization and second Hyper Stasia. It seems that both of them havw same maiasmatic origin. Therefore Painful (Central sensitization) and sensory MS could be explained commonly.

• Rubrics
  • Hyper Stasia: HSV-1, HSV-2
  • Dysesthesia: HTLV-1

Plb

Related disease

RBD

• Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by brief recurrent episodes of loss of muscle atonia during rapid eye movement sleep, with enacted dreams that cause sleep disruption.
• MS patients have an increased risk compared with the general population to be affected by a sleep disturbance, including RBD. Patients affected, however, uncommonly can present RBD as the first clinical manifestation of MS without other neurologic deficits. These clinical presentations have usually been attributed to inflammatory lesions in the pedunculopontine nuclei, located in the dorsal pons. We present a case of RBD in a 38-year-old woman who was later diagnosed as having MS due to imaging findings and development of focal neurologic deficits. MS should be considered among the differential diagnoses in patients who present with symptoms of RBD, particularly if they are young and female.