Bloch: MS Flashcards
MS is an immune-mediated disease of the (blank). It is a disease of the (blank) and axons
CNS; myelin
The balance b/w the protective and (blank) response determines the net effect of the inflammatory response
destructive
It has been shown that active inflammation results in both (blank) and (blank)
demyelination; axonal transection
Who gets MS?
Age?
Gender?
Location?
women in their 20’s-50’s;
most common in Northern European ancestry and in more Northern and Southern latitudes
T/F: The risk of MS is greater if there is a first-degree relative with MS
True
How do you ultimately diagnose MS?
clinically!
You can use MRI and CSF to provide support
What are the diagnostic criteria for MS?
dissemination in time and space; evidence that damage has occurred in at least two separate areas of the CNS at different points in time
List some symptoms that may be associated with MS… the list is long…
numbness loss of vision pain fatigue trouble walking bowel or bladder dysfunction sexual dysfunction depression
What things in your work-up would increase your suspicion of MS?
female
age 25-40
clinically isolated syndrome (like optic neuritis or transverse myelitis)
A first neurologic event suggestive of demyelination
clinically isolated syndrome (CIS)
Individuals with a clinically isolated syndrome suggestive of demyelination are at increased risk for developing MS if this occurs
multiple, clinically silent lesions on MRI
These are the two most common clinically isolated syndromes
optic neuritis
transverse myelitis
In general, patterns of MS can be progressive or (blank)
relapsing-remitting
**55% of cases are relapsing-remitting
What factors come into play when choosing a DMARD?
patient's disease course and prognostic indicators benefits vs risks of each medication co-morbidities cost vs. benefits for each patient patient's lifestyle and preferences patient readiness
What are some negative prognostic indicators of MS?
frequent, multifocal attacks heavy MRI burden on initial scans pyramidal involvement ataxia cognitive difficulties 5 year accumulation of disability spinal progression
new symptom or sudden worsening of old symptom lasting at least 24 hours, and usu accompanied by an objective change in neurologic finding
relapse
Treatment with (blank) recommended if relapse significantly interferes with everyday functioning
corticosteroids
**3-5 day course of high-dose intravenous methylprednisolone
high dose oral steroids may also be used
What symptoms of MS are readily visible?
spasticity gait, balance, coordination problems speech/swallowing problems tremor weakness
What can be used in patients with MS to promote function, comfort, independence, and conserve energy, safety and activity?
mobility aids, like a cane or crutches or a walker
This causes temporary worsening of MS symptoms
elevation in body temperature (heat sensitivity)
**cooling strategies are beneficial during hot, humid weather, exercise, cooking
What can happen to your bladder in MS?
fails to store pee; large bladder (fails to empty); dysynergic bladder; nocturia
How can you manage the burning, irritating neuropathic pain associated with MS?
newer anti-epileptic drugs
This is often under-diagnosed and undertreated in patients with MS
depression
T/F: Depression and suicide are both more common in patients with MS
True
T/F: Cognitive impairment is rare in MS, and only occurs in the late stages or severe MS
False!
T/F: MS is a white matter disease so it doesn’t really affect brain volume, gray matter, or the cerebral cortex
False!
T/F: If an MS patient can pass a brief mental status exam, they are good to go!
False
T/F: Memory problems reported by MS patients are usu caused by stress, anxiety or depression
False
The amount of (blank) correlates with lesion load and brain atrophy. It can occur at any time, but is more common later on. It is most likely progressive MS.
cognitive impairment
What drugs are used to treat MS?
DMARDS like IFNb-1b or IFNb-1a
