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2) Patho 2 > 10) Multiple Sclerosis > Flashcards

10) Multiple Sclerosis Flashcards

1
Q

MS

A

Immune-mediated inflammatory disease of the CNS characterized by relapses; Causes irreversible myelin & axonal damage

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2
Q

Explain the pathophysiology of MS

A

1) Abn immune response to a virus/environmental trigger in genetically susceptible individuals
2) T-cells get activated, cross the BBB, & release inflammatory mediators, which damage oligodendrocytes

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3
Q

What population is MS typically dx’ed in?

A

Women age 20-50

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4
Q

What is MS associated w/?

A

Brain & spinal cord lesions

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5
Q

When should MS tx start?

A

ASAP

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6
Q

Sx’s of MS

A
  • Fatigue
  • Pain
  • Weakness
  • Spasticity
  • Tremor
  • Impaired amb
  • B&B dysfxn
  • Visual disturbances
  • Cognitive impairment
  • Emotional changes
  • Imbalance
  • Incoordination
  • Sensory changes
  • Dysarthria
  • Dysphagia
  • Sexual dysfxn
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7
Q

What is the 1st sx of MS?

A

Fatigue w/no other indications that MS is occuring

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8
Q

Neuromyelitis Optica (Devic Disease)

A

Mimic’s MS bc of eye issues, but its really an optic nerve pathology

*MD realizes he was wrong bc MS tx doesn’t work for this

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9
Q

Relapsing Remitting MS (RRMS)

A

Acute attacks w/full recovery or partial residual deficit; Disease does not progress

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10
Q

Secondary Progressive MS (SPMS)

A

Starts w/RRMS followed by progression at a variable rate that may include occasional relapses & remissions

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11
Q

Primary Progressive MS (PPMS)

A

Disease progressively worsens w/out plateaus or remissions

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12
Q

What pt pop has the worst prognosis w/PPMS?

A

Males

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13
Q

Progressive Relapsing MS (PRMS)

A

Disease is progressive but w/clear acute relapses

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14
Q

Malignant MS

A

Very rare; Death usually occurs w/in 1yr from dx

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15
Q

Relapse

A

Sx’s lasting >1 or 2 days

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16
Q

Will an MRI show inflammation even if a pt has no sx’s?

A

Yes

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17
Q

What causes the axonal damage?

A

Continuous inflammation

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18
Q

When is there the most inflammatory activity?

A

Early

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19
Q

Why is MS one of the most difficult neuro pathologies to dx?

A

Bc there’s no standard set of clinical sx’s & there’s no single test that can always confirm the dx

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20
Q

What is clinical dx’s of MS based on?

A

MHx & sx’s

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21
Q

Expanded Disability Status Scale (EDSS)

A

Quantifies disability in 8 fxnl sx’s

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22
Q

EDSS Score of 1.0-4.5

A

Pt has MS, but they’re fully ambulatory

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23
Q

EDSS score of 5.0-9.5

A

Defined by the impairment to amb

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24
Q

EDSS score of 9.5

A

Pt is totally helpless & bedridden; Can’t communicate effectively, eat, or swallow

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25
Q

EDSS score of 10

A

Pt is dead

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26
Q

Prognosis of MS

A

1/3 has very mild course
1/3 have moderate course
1/3 become disabled

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27
Q

Factors for favorable prognosis

A
  • Female
  • Onset before age 35
  • Monoregional vs polyregional lesions
  • Sensory vs motor sx’s
  • Complete recovery after exacerbation
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28
Q

What will an MS pt in rehab require?

A

Frequent reassessments

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29
Q

True or False: MS drugs don’t cure the disease, but they do alleviate sx’s.

A

True

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30
Q

What is used to tx relapses?

A

Steroids

31
Q

True or false: Once the dx has been made, the damage has already started to occur.

A

True

32
Q

When is tx most & least affective?

A

Most–>Early inflammatory phase

Least–>Later neurodegenerative phase

33
Q

Sequelae of inactivity associated w/MS

A
  • Impairment of neuromuscular fxn
  • Psychosomatic disturbances
  • URTI
  • Thrombophlebitis
  • Pressure ulcers
  • Negative Ca2+ & N balance
  • Other nutritional deficiencies
34
Q

What should be done at regular intervals?

A

Rehab

35
Q

PT implications

A
  • PT’s w/MS have less muscle endurance & incr muscle fatigue
  • 30% aerobic capacity deficit
  • Pt’s don’t always recognized relapses
  • PT’s need to be aware of everything that can be effecting the pt
  • Respect the fatigue, but don’t give in to it
  • Focus on improving & maintaining fxn
36
Q

Why do MS pt’s have an aerobic capacity deficit?

A

As a result of marked deconditioning 2° to disuse, immobility, CV dysfxn. & sympathetic dysfxn

37
Q

What worsens fatigue?

A
  • Hot/humid weather
  • Hot bath/shower
  • Having another MS attack
  • Stress
  • Sleep problems
  • Fever
  • Incr in daily activities
  • Exercise
  • Age
  • Gender
  • Educational level
  • Marital status
  • # of kids
  • Occupation
  • Duration of illness
38
Q

Primary Fatigue

A

Caused by factors related to the disease process such as demyelinization, inflammation, axonal loss, immune factors, pyramidal involvement, etc

39
Q

Secondary Fatigue

A

Caused by pathological consequences of the disease such as meds, psychological effects, disuse, deconditioning, sleep disturbances, & heat sensitivity

40
Q

Central Fatigue

A

Subjective sense of fatigue present in disorders of the NS

41
Q

Peripheral fatigue

A

Disorders of the muscle & NMJ

42
Q

Can central & peripheral fatigue co-exist?

A

Yes

43
Q

Do women or men have more fatigue?

A

Women

44
Q

What should be used to tx central fatigue?

A

Disease modifying drugs

45
Q

What should be used to tx peripheral fatigue?

A

Exercise

46
Q

Oxidative problems are the result of what?

A

Deconditioning

47
Q

Why us improving oxidative capacity of muscle important?

A

Bc muscles want to produce energy anaerobicially

48
Q

What causes autonomic dysfxn?

A

MS plaques

49
Q

What will autonomic dysfxn do to exercise tol?

A

Decr it

50
Q

Who is more significant AD found in?

A

Pt’s w/more severe disease

51
Q

What systems does AD involve?

A

Sympathetic & parasympathetic

52
Q

What pt pop has a very high incidence of AD?

A

MS w/CV pathologies

53
Q

True or False: Pt’s w/autonomic dysfxn will have a blunt HR & BP response to aerobic exercise.

A

True

54
Q

Benefits of exercise for pt’s w/MS

A
  • Neuronal survival & plasticity
  • Promotes neuronal health, survival, & resistance to injury
  • Stims neurogenesis
  • Preserves cognitive fxn
  • Modulates dysregulation of immune fxn
  • Disease-modifying anti-inflammatory effect–>Slows the disease process
55
Q

Exercise Implications

A
  • Educate
  • Devo effective HEP
  • Promote safe independence
  • Provide resources for AD’s & community programs
  • Tx for one problem can aggravate another
  • Pt status should dictate intensity & frequency
  • Don’t always need a mobility
  • Goals should be adaptable & realistic
  • Anticipate pt’s future
  • Maintenance
  • Don’t tx fatigue w/exercise
56
Q

How often should pt’s w/MS amb for health?

A

Daily

57
Q

Implications for aerobic exercise

A
  • 2-3x/wk
  • Start w/20 min including rest, then progress to 30-60min
  • 65-75% of MHR; Progress THR by 5% monthly
58
Q

Implications for anaerobic exercise

A
  • 2-3x/wk
  • 1-3 sets of 8-15reps for each major muscle group
  • Alternate upper & lower body
  • Based on pt’s status
  • Progress by 2-5% when pt can consistently do 15 reps
59
Q

Implications for flexibility training

A
  • Do all major muscle groups
  • 10-15min w/30sec holds
  • Do after exercise sessions
60
Q

How often should a pt do breathing exercises?

A

2x a day for 30min

61
Q

What is the best exercise for machine for MS & why?

A

Air dune bc it distributes work over a greater muscle mass causing the VT to occur at a higher VO2 level

62
Q

How long should it take for core temp to normalize after exercise?

A

30 min

63
Q

Uhthoff’s Phenomenon

A

Reduction of visual acuity & incr fatigue associated w/hyperthermia

64
Q

What happens to MS pt’s fx risk?

A

It increases 2x bc of sarcopenia & steroids

65
Q

What positioning should weight training be done in?

A

Sitting

66
Q

Yoga can be good for what?

A

Anxiety, pain, & spasticity

67
Q

What drugs are used for acute relapses?

A
  • Solumedrol
  • Plsamapheresis
  • Dexamethasone
68
Q

What is tysbari for?

A

Relapsing MS or when injectables don’t work

69
Q

Oral drugs

A

Gilenya & aubagio

70
Q

Gilenya

A

1st oral drug for RRMS

71
Q

Aubagio

A

Oral anti-inflammatory

72
Q

Tecfidera

A

Anti-inflammatory that prevents T-cells from leaving the lymph nodes

73
Q

Cytoxan & Mitoxantrone

A

For aggressive MS

74
Q

What do disease-modifying drugs do?

A
  • Decr frequency & severity of attacks
  • Decr scaring
  • Slow disease progression

2) Patho 2 (20 decks)

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