Month: February 2016

Create a responsive website

This link shows how the new responsive design can be used to make your website adapt to the device that the website is viewed on.

These screenshots show how a webpage adapts when viewed on different devices. The images start with a traditional desktop view and goes through how the webpage would look on a tablet and eventually down to a phone layout. The website uses breakpoints to respond to the change in pixel width. These breakpoints are added when the layout that is being used is broken when squashed. This allows the website to keep a consistent look across a number of devices without appearing broken on some screen resolutions. Breakpoints are also used when the text becomes illegible due to the size of the screen that the site is being viewed on. As you can see from the screenshots below the functionality of the website doesn’t change, only the layout of the webpage changes.

• Early Treatment
  • We now know that early treatment improves long-term health and wellbeing by slowing down the build up of irreversible damage and reducing the number of relapses people experience. However, the evidence also doesn’t mean that starting treatment later will not have any benefits.
  • Experts used to think that when a person with MS had a ‘relapse’ it meant symptoms appeared and/or quickly got worse and then went away (or ‘remitted’).
    
    Thanks to wider use of MRI scanning, we now have evidence that when symptoms get better, the damage that MS causes often doesn’t stop. So even when someone with MS is not having a relapse, MS may carry on attacking their body. This could lead to nerve damage that can’t be put right.
    
    This new evidence has changed what we understand about MS and how to treat it. Rather than waiting to see whether more relapses occur, DMTs should be offered as close as possible to diagnosis, before damage to the body has built up.
• Disease modifying therapies (DMTs)
  • do not cure MS but reduce how many relapses someone has and how serious they are
  • Alemtuzumab (Lemtrada)
    • two courses of treatment spaced a year apart from each other
    • given through a drip
  • Avonex (interferon beta-1b)
    • injected into the muscle once a week
  • Betaferon (interferon beta-1b)
    • injected under the skin every other day
  • Dimethyl fumarate (Tecfidera)
    • take as a tablet twice a day
  • Extavia (beta interferon-1b)
    • injected under the skin every other day
  • Fingolimod (Gilenya)
    • take as a tablet once a day
  • Glatiramer acetate (Copaxone)
    • It’s injected under the skin using a pre-filled syringe once a day or three times a week.
  • Natalizumab (Tysabri)
    • natalizumab is given through a drip (known as an infusion), which takes about an hour. You need to go to hospital once every four weeks for the infusion, but you don’t need to stay overnight.
  • Plegridy (peginterferon beta 1a)
    • injected under the skin every two weeks
  • Rebif (beta interferon-1a)
    • It’s injected under the skin three times a week.
  • Teriflunomide (Aubagio)
    • It’s a tablet that you take once a day.

Exercise

• improves the overall health of people with milder ms
• help people with more severe ms to stay mobile
• help some people manage ms symptoms and decrease the risk of heart disease
• improve muscle strength and fitness, helping with mobility or weakness problems
• help manage weight control, especially when combined with a healthy, well balanced diet

Physiotherapy

• Physiotherapy is often recommended when there is a specific problem or ongoing symptoms that affect day-to-day activities, mobility and independence. It can help whatever your level of disability, but can be a particularly valuable when physical symptoms progress or you are recovering from a relapse.
• Physiotherapy might involve the physiotherapist working ‘hands-on’ with you – for example they may hold and move your limbs for passive stretching and range-of-motion.

Diet

• Certain diets are promoted as effective therapies for MS.Some people may find they help, though this hasn’t been proven conclusively for people with MS.However, a healthy diet is good for everyone, and many people with MS find it a good way to manage their health

• MS is not easy to diagnose as it can cause a number of different symptoms
• its hard to pin point when MS begins
• the early signs and symptoms are different for everyone
• diagnosis can take several months
• a number of different causes need to be explored and many different tests need to be carried out
• The tests for MS
  • Neurological examination
    • Your neurologist will ask you lots of questions about past symptoms and problems – this is known as ‘history taking’. It helps the neurologist get a better picture of you and can help identify any other problems that may explain current symptoms.
    • A physical examination checks for changes or weaknesses in your eye movements, leg or hand coordination, balance, sensation, speech or reflexes. Whilst a neurologist may strongly suspect MS at this stage, a diagnosis won’t be given until other test results confirm MS.
  • Magnetic resonance imaging (MRI)
    • Confirm a diagnosis in over 90% of people with MS
    • An MRI scanner uses a strong magnetic field to create a detailed image of your brain and spinal cord. It is very accurate and can pinpoint the exact location and size of any damage or scarring (lesions).
    • To get the image of a person’s brain and spinal cord they must lie down and enter a small tunnel in the centre of the MRI scanner. The process can take between 10 and 60 minutes and is painless, though some people can feel a little claustrophobic in the scanner. The Newcastle Upon Tyne Hospitals NHS Foundation Trust has produced a video which explains what to expect when you have an MRI
  • Evoked Potentials
    • This involves testing the time it takes for your brain to receive messages
    • This is carried out by placing small electrodes on your head to monitor your brainwaves responding to what you see or hear.
    • If myelin damage has occurred, messages to and from your brain will be slower.
  • Lumbar Puncture
    • This is sometimes called a spinal tap.
    • It involves a needle being inserted into the space around your spinal cord, under local anaesthetic.
    • A small sample of the fluid that flows around the brain and spinal cord, called cerebrospinal fluid, is then taken and tested for abnormalities.
    • People with MS often have antibodies in this fluid.
    • People commonly report headaches following a lumbar puncture. The medical staff should advise you on how to manage this. Newer, smaller needles cause less discomfort, although they’re not yet being widely used.

Types of MS

• Relapsing remitting MS (RRMS)
  • 85% of people with MS are diagnosed with this type
  • distinct attacks of symptoms which then fade away either partially or completely
• Secondary progressive MS (SPMS)
  • sustained build up of disability. Completely independent of any relapses
  • Many people with RRMS go on to have SPMS
• Primary progressive MS (PPMS)
  • Affects 10-15% of people diagnosed with MS
  • Symptoms gradually get worse over time, rather than appearing as sudden attacks (relapses)

MS in children

• MS in children is rare. Around five to ten per cent of young people with MS will experience MS symptoms before the age of 16.

Benign MS

• If you have a small number of relapses followed by a complete recovery, you may be described as having benign MS.
• Benign MS can only be diagnosed retrospectively, after a period of at least 10 to 15 years.

Signs and Symptoms

• Early signs
  • Optic neuritis
    • one of the more obvious early symptoms, but this is often because this is a more ‘concrete’ symptom as opposed to ‘vague’ neurological symptoms like numbness or tingling.
• Balance
  • affect people differently
  • vary from day to day
• Bladder
  • two main types – storage and emptying
  • Doctors don’t know why some people get one or the other and other people get a bit of both
• Bowel
  • bowel incontinence
  • constipation
  • the two can be linked but not always
• Eyes and sight
  • Optic neuritis
    • inflation of the optic nerve
    • varies from blurred vision to complete loss of sight
    • this is the nerve that carries messages from the eye to the brain
  • Eye movement
    • the nerve pathways that control the movement of their eyes can be affected
    • eyes may not move smoothly
    • the two eyes may be out of alignment
• Fatigue
  • an overwhelming sense of tiredness that occurs after very little activity
  • affects people in different ways
  • may change daily or hourly
• Memory and thinking
  • cognitive problems
    • most people will be affected mildly
    • difficulty concentrating
    • being unable to find the right word
    • short term memory problems
• Mental health
  • depression
  • stress
  • anxiety
• Pain
  • invisible symptom
  • pain might feel like squeezing, crushing, cold, hot, stabbing or burning
  • MS hug – a tightness in the chest
• Sexual problems
  • around 50-80% of women will experience some form of sexual dysfunction
  • Men may have problems with erections and ejaculation
• Spasms and stiffness
  • common symptom
  • affect at least 20% of people with MS
  • affect people differently and vary over time
• Speech
  • 40-50% are affected by speech difficulties
  • MS damage in different parts of the brain affects the way speech is produced. This can cause problems that may come and go including slurred speech, low volume or a weak voice.
• Swallowing
  • damage to any part of the brain that controls swallowing
  • damage between the brain and the spinal cord
  • Temporary changes in swallowing can happen during a relapse and improve, or disappear completely, over time.
  • can become more difficult in the long term
• Tremor
  • trembling or shaking movement
  • cannot control voluntarily
  • for some people the tremor is so mild that they’re the only one aware of it
  • two kinds of tremor
    • intention tremor
      • comes when you want to reach for something
    • postural tremor
      • when you have a tremor as you sit or stand
  • MS tremors are usually caused by damage to myelin in an area of the brain known as the ‘cerebellum’, and the nerves leading to and from it.
  • For a small percentage of people, it is more severe, causing limbs to shake so that you need help with everyday tasks like eating and drinking.
  • Specialists like physiotherapists and occupational therapists can assess the problems that tremor and other movement difficulties are causing you.
• Pseudobulbar Affect
  • a neurologic effect that occurs in 10 percent of people with MS, although some research suggests a much larger percentage. It is characterized by sudden, uncontrollable expressions of laughter or crying without an apparent trigger.

• No one knows the exact cause of MS, but it is likely a mixture of genetic and environmental factors
• Genes and family history
  • MS is not directly inherited as there is no single gene that causes it – unlike cystic fibrosis
  • it is likely a combination of genes that make some people more susceptible to developing MS, but not everyone with this gene combination will develop MS. Genes are only a part of the story.
  • while MS can occur more than once in a family it is only a 2% chance of a child developing MS when a parent is affected.
• Environmental factors
  • MS is more common in places further away from the equator
  • It is virtually unheard of in Malaysia or Ecuador, but relatively common in Britain, North America, Canada, Scandinavia, southern Australia and New Zealand.
  • Viruses
    • It is not clear why people further away from the equator are more likely to develop MS. Perhaps a bacteria or virus plays a role
    • No single virus has been identified as definitely contributing to MS, but there is growing evidence that a common childhood virus, such as Epstein Barr virus (which can cause glandular fever), may act as a trigger.
    • This theory is still unproven and many people who do not have MS would have also been exposed to these viruses, so just like genes, they are unlikely to be the whole story.
  • Vitamin D

• There is a growing amount of research that suggests that a lack of vitamin D could be a factor in causing MS.
• Most of our Vitamin D is from exposure to sunlight.
• Low levels of vitamin D have been linked to higher numbers of people developing many different conditions, including MS.
• Smoking
  • smoking appears to increase the risk in developing MS
  • It is not clear why but one theory is that the chemicals in the cigarette smoke affect the immune system
  • There is still more we need to know about the link between smoking and MS. This includes whether the risk increases the more someone smokes, how smoking interacts with other risk factors for MS and whether smoking also affects progression in MS.