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NCS Prep > 8 Multiple Sclerosis > Flashcards

8 Multiple Sclerosis Flashcards

1
Q

MS Etiology

A

2.3 million people worldwide
Women 2-3x more likely than men
Most commonly diagnosed 25-35 y/o
Strong correlation between MS prevalence and distance from equator- vit D may be a factor

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2
Q

Factors that may cause MS

A

Lower risk closer to equator
Smoking increases risk
Higher risk if parent or sibling has it
Human herpes virus-6, Epstein-Barr, chlamydia pneumoniae bacteria, canine distemper, measles

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3
Q

Pathology of MS

A

Acute demyelination of axons- recovery with axonal plasticity/re-myelination early on, but permanent axonal damage later on

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4
Q

McDonald criteria overview

A

Dissemination in time- 2 or more distinct attacks
Dissemination in space- 2 or more lesions in CNS
Exclusion of other diagnoses

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5
Q

McDonald criteria for diagnosis

A

2 attacks + 2 lesions = no additional info needed
2 attacks + 1 lesion = need diss in space
1 attack + 2 lesions = need diss in time
1 attack + 1 lesion = need both
Progressive course over 1 year- need diss in space by two of: MRI brain, MRI SC, CSF fluid oligoclonal bands

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6
Q

MRI types

A

T1- detects active inflammation
T2- detects old and new lesions
FLAIR (fluid attenuated inversion recovery)- subtle changes

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7
Q

Evoked potentials

A

Sensory- impulses to arm or leg
Brainstem auditory- listen for series of clicks in each ear
Visual- observe alternating checkerboard pattern, identifies pathologic transmission along optic nerve pathway, only type proven useful in MS diagnosis

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8
Q

CSF analysis

A

Obtained via lumbar puncture
Findings- IgG, oligoclonal bands, certain proteins common with myelin breakdown (immune-related markers)
Not specific to MS

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9
Q

Sensory and pain symptoms

A

Paresthesias (most commonly begin distally)
Loss of proprioception and vibratory sense
Dyesthetic pain (pain not provoked by stimulus)

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10
Q

Visual symptoms

A

Optic neuritis- blurred vision, change in color perception, visual field deficit = most common
Nystagmus
Oscillopsia
Intranuclear opthalmaplegia (disconjucate eye movements)
Optic disc pallor

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11
Q

Heat intolerance symptoms

A

Sensitivity to changes in core body temperature
Uhthoff phenomenon- increase in body temp causes increased in neurologic symptoms
Neuroblockade hypothesis- increased temp decreases nerve conduction in partially demyelinated fibers (greater demyelination –> greater conduction loss)

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12
Q

Primary MS fatigue

A

Central fatigue- demyelination leads to failure of motor pathways during rapid activity
Decreased efficiency of motor unit activation- dec oxidative capacity, slow muscle contractile properties, decrease number of slow-twitch fibers, lower tetanic and twitch tension in muscles

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13
Q

Cerebellar symptoms

A

Ataxia, incoordination, dizziness, imbalance

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14
Q

Urinary symptoms

A

Incontinence, incomplete emptying, increased frequency

Can get UTIs

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15
Q

Cognitive symptoms

A

Emotional lability, depression, anxiety, decreased executive functioning

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16
Q

Krutzke expanded disability status scale (EDSS)

A

0 (no disability) to 10 (death)
0-4.5 can walk independently
5.0-9.5 impairments in ambulation

Functional systems- pyramidal (motor function), cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral or mental, other
FS scored 0 (low level of problems) to 5 (high level)

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17
Q

EDSS cutoffs

A
  1. 0- minimal disability in one FS (one S grade 2, others 0 or 1)
  2. 0- ambulates without aid or rest 200 m, disability severe enough to impair ADLs
  3. 0- essentially restricted to bed or chair but may be out of bed much of day. Retains many self-care functions
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18
Q

Relapsing-remitting

A

Most common 80%

Temp relapses lasting 1-3 months, complete or partial recovery between

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19
Q

Secondary-progressive

A

Second phase of RRMS if not treated

Progressive worsening, may or may not have relapses and remissions

20
Q

Primary progressive

A

Steady worsening, no relapses or remissions

21
Q

Progressive-relapsing

A

Steady worsening with intermittent acute flare-ups

22
Q

Malignant MS

A

Rapid and progressive

23
Q

Prognostic factors

A

Positive- RRMS, one symptom at onset

Negative- PPMS, older age at onset, male, African-American, early cerebellar or pyramidal signs, smoking, low vit D

24
Q

Relapse/exacerbation management meds

A

Corticosteroids- IV or oral, high dose, short duration

25
Q

Function of disease-modifying meds

A

Reduce number and severity of relapses
Reduce development of new areas of inflammation
Delay disability progression
Most act as immune-system modulators

26
Q

Injectable disease-modifying meds

A

Avonex (interferon beta-1a)
Betaseron (interferon beta-1b)
Copaxone (glatiramer acetate)
Rebif (interferon beta-1a)

27
Q

Oral disease-modifying meds

A

Aubagio (teriflunomide)
Gilenya (finfolimod)
Tecfidera (dimethyl fumarate)

28
Q

Infused disease-modifying meds

A

Novantrone (mitoxantrone)
Tysabri (natalizumab)
Lemtrada (aletuzumab)

29
Q

Exercise effects for MS

A

No decrease in pro-inflammatory or anti-inflammatory markers
No increase in neurotrophic factors
Correlation high aerobic capacity and structure preservation
No worsening, possible improvement in fatigue
Significant improvement in depressive symptoms and QOL
Trend to improved cognition
Improved muscle strength
Improvement in aerobic capacity
Gait speed and endurance improvements
Self-perceived ability to do ADLs trend for improvement

30
Q

Gait training results

A

Increase in swing time, step length, stride length, foot angle
Decrease in time in stance and DL support and toe clearance
Improved isometric strength, disability score, 3-minute stepping

31
Q

Treadmill training results

A

30 min 3x/week at 55-85% max HR
Significant increase in gait speed
Trend to improved endurance and fatigue levels
Faster rate of detraining

32
Q

Results of aquatic therapy

A

Improved QOL/ decreased fatigue
Improved gait speed, BBS, TUG, grip strength
Decreased neuromuscular deficits

33
Q

Fatigue impact

A

No significant difference in EDSS scores between low and high fatigue groups
Higher levels of fatigue reported = greater impairments in functional mobility, depression, physical and mental QOL
Disability not related to level of fatigue

34
Q

Effects of exercise on fatigue

A

No significant change in fatigue after exercise
No significant change in functional ability after exercise
Increased symptoms may happen after exercise, but temporary and unlikely to have deleterious effects on fatigue and function

35
Q

Exercise parameters to reduce fatigue

A

Endurance, resistance, and combined training

2-3 days/week, 60-80% max HR, 30 minutes/day

36
Q

Acute care EDGE highly recommended measures

A 
12-item MS walking scale
9-hole peg test
BBS
MS impact scale (MSIS-29)
Timed 25-foot walk
TUG cognitive and manual
37
Q

12-item MS walking scale

A

Questionnaire to measure ability to ambulate
12-60 points (higher number = greater disability)
No cut-offs

38
Q

9-hole peg test

A

Measures finger dexterity- time to place all pegs in holes and return to container
No cut-offs, but norms for different populations

39
Q

MS impact scale (MSIS-29)

A

Questionnaire measuring physical and psychological impact of MS on daily life
1 (no impact)- to 5 (extreme impact)
No cut-offs

40
Q

Timed 25-foot walk

A

Quantitative measure of mobility and leg strength
Average 2 timed trials
No cut-offs

41
Q

TUG cognitive and manual

A

Cog- backwards by threes
Man- hold cup of water

Manual- 14.5 seconds or longer, difference of 4.5 seconds between manual and TUG
Cognitive- 15 seconds or longer

42
Q

Inpatient and outpatient rehab EDGE highly recommended

A 
12-item MS walking scale
6MWT
9-hole peg test
BBS
DHI
MS functional composite
MS impact scale
MS quality of life
Timed 25 foot walk
TUG cognitive and manual
43
Q

Dizziness handicap inventory

A

0-100 (higher score is greater handicap)

>59 risk for falls in MS

44
Q

MS functional composite

A

Evaluates cognition, gait, and UE function in individuals with MS
Includes timed 25-foot walk, 9-hole peg test, paced auditory serial addition test
Convert to z-score, averaged

45
Q

MS quality of life (MS QOL-54)

A

Focuses on physical health and mental health for MS
No overall score, but summary for physical and mental health weighted based on combo of scale scores
Each question is Likert scale

NCS Prep (19 decks)

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