2 MS Pathophysiology Flashcards
What is MS?
Immue-related response in which antibodies induce demyelination by antibody dependent cell mediated cytotoxicity
Cytokines attack myelin, macrophages to help uptake myeline = oligodendrocyte apoptosis leads in increase demylination, increased axonal injury and scerlosed
Inflammatory
Demyelinating
CNS - white matter damage in SC, brainstem, cerebral hemispheres
Plaques
What are the risk factors for MS?
Enviromental: Vitamin D defficiency, Smoking, Infection
Genetic: First degree relative risk
Female > Male
MS: Clinically Isolated Syndrome
First episode of neurlogic symptoms last at least 24 hours
usually no associated fever or infection and is followed by a complete or partial recovery
Monofocal episode
Multifocal episode
Multifocal episode?
More than one sign/symptom - lesions in more than one place
ex: attack of optic neuritis accomplanied by numbness or tingling in legs
Monofocal episode
Single neurologic sign or symotom
Single lesion
MS: Relapsing Remitting
Most common disease course
Clearly defined attacks of new or increasing neurologic symotoms
worsesning, not worsening, stable
MS: Primary Progressive
Worsening neurologic function from onset of symptoms without early relapses or remissions
MS: Secondary Progressive
Follows an initial relapsing remitting course
Most who are diagnose with RRMS will transition to secondary
- progressive worsening
Disease modifiers
Active/not active
Relapses or new increasing neurologic dysfunction, followed by full or patial recovery
Progressive/not progressive
steadily increasing neurologic dysfunction without recovery
How is MS diagnosed? (3 critieria)
- Evidence of damage in at least 2 areas of CNS
- Evidence that damange occured at 2 distinct points in time (at least one month apart)
- Other possible causes are ruled out
What other test is used to diagnose MS?
CSF specfic oligoclonal bands
Clinical features of MS
Optic neuritis
brainstem/cerebellar dysfunction
pyramidal symptoms
spinal cord invovlement
fatigue
Heat intolerance
Cognitive dysfunction
depression
sexual dysfunction
Optic neuritis
Visual loss
pain with eye movement
brainstem cerebellar dysfunction
Ataxia, dysarthria, intention treamor, nystagmus
balance dysfunction
Pyramidal symptoms
Paresthesia
Spasticity/Spams
Loss of dexterity
Spinal cord Involvement
Spasticity/flaccidity
Sensory loss
Motor loss
Loss of bowel and bladder control
What is considered good prognosis?
few attacks, good recovery from attacks
Relapsing remitting
early medical management
<35 years
women better prognosis men
longer duration between exacerbations
1 impairment during year
remission of initial impairments
What is considered poor prognosis?
multiple attacks
poor recovery
primary progressive
pyramidal
brainstem signs
cerebellar signs
Spincter impairments
What are the most common problems with MS?
- Fatigue
- Walking/balance
- Bowel/bladder
- Pain/abnormal sensation
- visual disurbance
- Cognitive dysfunction
- Ataxia
What is the difference between acute and chronic fatigue?
Acute: Fatigue that has been present on > 50% of days
- Significant development or increase in fatigue in the past 6 weeks
- Fatigue that limits ADLS and QoL
Chronic: last longer than 6 weeks
What questionnaire is used to measure fatigue?
- MFIS for fatigue in people with MS
21 items
- past 4 weeks
What questionaire for MS Gait?
- Expanded disability status scale (EDSS)
0 - .4 walk with out assistance
4 - 7.5 primarily walking distance and assistance levels
6 = cane
7.5 - 9.5 determinants are ability to transfer from WC to bed and self care
10 = Death
Balance objective measures for MS
Acitivities specific balance confidence scale
Berg balance
Functional Reach
MS pain findings
- headache
- neuropathic extremity pain
- LBP
- Lhermittes sign
- Trigeminal Neurlgia
From Dysesthesia (burning, tingling, aching, throbbing, banding)
Describe sensory loss in the spine and brain in MS
Spinal = dermatomal
Brain = homunculus distribution
What is weakness in MS?
Axonal damange
Reduced force production
peripheral fiber changes
Disuse atrophy
TEST: MMT, Dynamometry
How would you test for MS spasticity?
- Modified Ashworth, Tardieu
- ROM: Flexibility
- goniometry
What are signs of Cerebellar involvement?
- Ataxia
- Dysdiadokinesia - timing of agonist/antagoninst
- Rebound - delayed response
- Dysmetria - amplitude
- Dyssenerggia - sequencing
- Intention tremor
- Hypotonia
- Vestibular inputs to cerebellum
How do you test for disdiadokinesia?
Rapid alternating pronation/supination
walk fast (makes gait impairment more pronounced)
What is testing for rebound?
Resist flexion of joint and let go
Test for dysmetria?
Figer to nose, heel to shin
Peg test
circle trace
Dyssnergia testing
touch heel to opposite knee, hand to opposite elbow in supine
Duela task
What is testing for intention tremor?
pt moves finger forward or foot toward finger or target
Test for hypotonia
passive lumb mobement
muscle palpation
DTRs
Hold object while conversing
What are the 3 predictors of participation limitations?
Fatigue
Physical function
Psycholigical variables
What are the goals of PT?
functional independance
Safety
Qol
Provide resources: equipment needs, community support, programs education
What is the goal of PT after a relapse attack?
Return to baseline function
may wait after a couple weeks onset to resume therapy
What is the PT goal after progressive disease?
- Avoid deconditioning
- maximize independent function
- assesing for mobility aids
What is the goal of PT with advanced disease?
Seated trunk postioning/control
transfers
upper limb and function
respiratory function
Equipment needs
What is the general guideline for exercising with MS?
mild to mod disability
30 min moderate intensity aerobic activity
2 x week
