Question

Leah realizes that she cannot wait until her appointment to receive medical care; she quickly goes to the emergency room. After a mountain of questions about Leah’s symptoms and medical history, the doctors decide to admit her for further testing. She is transferred to the neurology unit and the doctors request she undergo a series of laboratory tests, including an MRI and a spinal tap. In the meantime, the doctors prescribe high dosages of steroids to help alleviate the symptoms.

Upon reviewing Leah’s medical history and the results of the various laboratory tests, the neurologists diagnose her with Multiple Sclerosis (MS). They explain to her that MS is an autoimmune disease and that her own immune system has been attacking the myelin sheath that surrounds the nerves of her central nervous system. She remains in the hospital for a week until sensation is fully recovered in her lower body and strength is restored in her legs. She is discharged from the hospital and schedules a follow up appointment with the neurologist.
When she returns to the neurologist, they discuss Leah’s diferent options for treatment. Because there is no cure for the disease, options in medication vary greatly. She decides to try daily injections of Copaxone, a medication that is similar in structure to a protein found in myelin.
Leah continues to see the neurologist on a regular basis and gives herself an injection every evening. Over the course of seven months of therapy, she only experiences one occurrence of numbness, which subsides after a couple of days. She tries to stay positive and tries to minimize the disease’s impact on her life.
Questions

1. What is myelin and how does it affect the transmission of nerve impulses? Identify the cells responsible for the formation of myelin.

2. Why did Leah experience the altered sensation in her lower body? Was there something wrong with her skin?Why couldn’t she stand? Was there something wrong with the muscles of her right leg?

3. What are the “scleroses” in Multiple Sclerosis and where do they occur? How does this influence nerve transmission?

4. How does an MRI and spinal tap help confirm the diagnosis of Multiple Sclerosis?

5. Why did steroids help alleviate Kathy’s symptoms?

6. Did Leah’s hearing loss have anything to do with the Multiple Sclerosis? Why/Why not?

Answer 1

1. Myelin a mixture of proteins and phospholipids forming a whitish insulating sheath around many nerve fibres,Nerve impulses can travel faster in a neuron containing myelin as compared to a neuron which does not contain a myelin. Two types of cells are identified with the formation of myelin sheath, Oligodendrites responsible for formation of myelin sheath in the central nervous system, while the schwann cells are responsible for the formation of myelin sheath in the peripheral nervous system.

2. There was nothing wrong with her skin. The altered sensation was due to damage caused by multiple sclorosis to the nerves in the brain and spinal cord. This damage interferes with the normal transmission of messages to the brain. The brain cannot interept the signals in the normal way, resulting in the altered sensation. multiple sclerosis damage to nerve pathways may hamper coordination and/or cause weakness, poor balance, numbness, or abnormal increase in muscle tone which will make it difficult for her to stand. There is nothing wrong with her leg muscles.

3.Scleroses means scar tissue, these scars can occur in multiple areas, scar tissue prevents nerve cells from reforming their connections.in multiple scelorosis myelin is damaged and stripped away from the axon. This process is called demyelination. Messages that pass along a demyelinated nerve become delayed or blocked, causing the symptoms associated with multiple sclerosis.

4.  They can use an MRI test to check for lesions, or scarring. A spinal tap can tell you if the amount of protein, white blood cells, or myelin in your spinal fluid is too high. It can also reveal if the fluid in your spine contains an abnormal level of antibodies, which all can help in diagnosing multiple sclerosis.

5. Steroids can act by supressing the inflamatory response which can decrease the severity and duration of exacerbations in multiple sclerosis, steroids can reduce the rate of relapses and slow the progression of MS, it cannot reverse or cure the disease.

6. If there is scars in the auditory nerve or any associated areas, than it can damage to the nerve pathway of hearing, which can lead to hearing loss,  however this is seen only in minority of individuals suffering from MS.