Sunday, May 28, 2017


Symptom management in MS

Heat management

1.  cool pool

2,  Avoid hot showers

3. Hydration

4.  cooling vests and packs

5.  Lightweight clothes

6.  Rest after exertion

Spasticity management

1.  Stretching ROM

2.  yoga

3.  orthotics

4. Air splints

5.  relaxation techniques

6.  botox

Fatigue management

1.  Exercise 30 minutes five days per week

2.  Spasticity management-- esp stretching

3.  Postural stability esp truncal and core exercises

4.  Energy conservation-- rest breaks, prioritizing

5.  Mobility devices as appropriate

6.  Sleep management

7.  Healthy lifestyle and diet- low carbs

8.  Heat management

MS clinical resources that are commonly used

Pearls on cognition in MS 2017 Consortium

1.  Ralph Benedict concluded that of all volume measurements the one that correlated best with cognitive deficits was third ventricle enlargement, and by inference thalamic atrophy.

BiCams is available for scoring in his website with normal

thalamic SHAPE also is important not just atrophy

Cognitive rehab works

CN atrophy corresponds with cognitive fatigue

Pearls on non MS demyelinating disease in kids

1.  CRION is rare in children is steroid dependent optic neuritis, relapse off steroids

2.  One presenter stated that ON + TM presentation "Devics presentation" has been MOG in "all cases she has seen"

3.  Pediatric NMO has more brain lesions

4.  4 MOG phenotypes in kids:  a.  Recurrent ADEM   b.  recurrent ON   c.  ADEM followed by ON   d.  NMOSD with MOG positive serology rather than Aquaphorin 4 positive

5.  No cases of simultaneous MOG positive and MS

6.  MOG has female predominance 1.5:1 and mean age of onset of 21

7.  MOG respods best to IVIG not Rituxan; has 20 % rate of relapses but they are bad relapses.

Source 2017 Consortium session on pediatric MS

Pediatric MS pearls

1.  PPMS is very rare before age 18

2. associations include lots EBV, early menarche, obesity, HLA DR1*15

3. Kids with MS look genetically like adults with MS

4.  Kids can have lesion disappearance between attacks that can be confusing

5. Teens have lots of cortical lesions, atrophy, that corresponds with IQ

6.  ADEM kids also have atrophy especially thalamus

7.  Need to be 11 to accurately use McDonald criteria

8.  Incidence is 1:100,000

9. Consider differential diagnosis in  kids including ADEM,NMO, MOG, CRION (see separate post).  Well trained radiologists can be very helpful. In a series of 110 kids with demyelinating disease, 56 had MS,  25 had NMOSD, 12 had ADEM and 5 had RION

10.  RR is 2-3 times higher and disability rate is higher

11.  Don't diagnose with a presentation of encephalopathy

source- lectures at Consortium meeting session on pediatric MS 2017

MS resources

SSD guide MS Society

how to guide
checklist of actions to take
legal information

Practical fitness online MS
range of motion
strength training workouts
designed for you
18.95 per month
20-30 minutes per day
new workouts every Monday
wheelchair and standup
sign up at


towel blizzard caps
tag along towels
great for MS patients going into sun
stay cool in 100 degree heat

cooling vests


MRI Funding Assistance
or 1-800-532-7667 ext 120


Dictus band- orthosis for drop foot
less expensive and simpler than AFO

please note there are other suppliers, this is just one of them

Merry walker

Mary Harroun
21350 South Sylvan Drive
Mendelein IL 60060
ph 847-837-9580
f     847-837-8582