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Semester 5 PMNM Exam 7 > CNS Demyelinating Disorders > Flashcards

CNS Demyelinating Disorders Flashcards

1
Q

Article

A

READ it! There will be a question from it!

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2
Q

MS is a ___ ____ ___ disease of the ___

A

Chronic, autoimmune, inflammatory disease of the CNS

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3
Q

MS is often initially episodes of what, followed by what

A

Episodes of reversible neurological deficits followed by progressive neurological deterioration over time

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4
Q

MS - rates are higher in what geographic area

A

Farther from the equator

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5
Q

MS - cause

A

True cause is unknown

Involves combination of genetic and non genetic triggers

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6
Q

Pathophysiology MS

A

Genetic susceptibility plus viral trigger and then leads to a higher immune response

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7
Q

Pathophysiology MS - genetic susceptibility plus viral trigger and then heightened immune response leads to what

A

T cell antibodies attack oligodendrocytes

The T cells are attacking the myelin in the CNS “friendly fire”

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8
Q

Can oligodendrocytes survive the insult from T cell attack?

A

Initially they can remyelinate but over time they can’t repair themselves and will end up with demyelination

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9
Q

What happens to the areas of the axon that are demyelinated

A

Gliosis! accumulation of the astrocytes and microglia

This gliosis forms glial scars (plaques) and the axon will degenerate

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10
Q

What can gliosis do to synaptic transmission

A

Slow it down at first and then block it completely

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11
Q

What is the primary cause of permanent clinical disability

A

Axonal damage!!!

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12
Q

What areas are most vulnerable to demyelination

A 
Optic nerves 
Periventricular white matter
CST tracts
Posterior (dorsal) columns
Cerebellar peduncles
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13
Q

Pro Inflammatory and Anti Inflammatory Cytokines

A

Thought to be that people with MS have heightened response of these T cells but it has been shown that exercise might help tilt the balance more towards the anti-inflammatory T2 cytokines

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14
Q

Why is there a higher incidence of MS in regions with less sunlight

A

Vit D is important for down regulating immune response - so being in a place without sunlight already puts them at risk for having a heightened immune response

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15
Q

What is one of the independent risk factors for MS

A

Vitamin D insufficiency

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16
Q

Forms of MS

A

Relapsing Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Primary Progressive MS (PPMS)
Progressive Relapsing MS (PRMS)

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17
Q

Relapsing Remitting MS (RRMS)

A

Periods of attacks (flare-ups) separated by periods of recovery (partial or full)
With each relapse there are new s/s and old ones worsen

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18
Q

Relapsing Remitting MS - how common

A

Most common

85%

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19
Q

Secondary Progressive MS

A

Begins as relapsing remitting but then at some point turns progressive and steady decline over time, with or without acute attacks

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20
Q

Primary Progressive MS

A

Worsens continuously from onset - usually without distinct attacks
Flare up 100% of the time and just keeps adding s/s

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21
Q

Primary Progressive MS - how common is it

A

15%

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22
Q

Progressive Relapsing MS

A

Primary progressive (so continues to get worse) plus periods of more severe acute attacks and no remission

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23
Q

How common is progressive relapsing MS

A

less than 5% - rare

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24
Q

Diagnosis of MS is based on the presence of

A

CNS lesions that are disseminated in time and space with no better explanation for the disease process
So they occur in at least 2 different parts of the CNS at least 1 month apart

25
Q

Confirmatory studies

A

1 CNS Imaging - MRI is particularly useful as the demyelinated area apepars white
2 Evoke Potentials - visual, auditory, brainstem, somatosensory
3 CSF analysis - when myelin breaks down there is a protein that is released and it can be found in CSF
Blood tests - to eliminate other diseases

26
Q

What usually gets someone a diagnosis of MS

A

One of the confirmatory studies showing it and the definition of 2 CNS areas impacted 1 month apart

27
Q

Drug therapy - what do they start with

A

Immunomodulatory therapy as soon as possible to prevent disability

28
Q

Drug therapy - examples of disease modifying drugs

A

Interferon
Mitoxantrone (chemotherapy)
Glatiramer Acetate

29
Q

What do they use for flare up?

A

High dose of corticosteroids - usually intravenously so will be in hospital a few days

30
Q

Why do we need to be careful with repeated corticosteroid use

A

HTN
DM
Osteopenia

31
Q

Other drugs also used to treat secondary complications such as

A 
Spasticity
Fatigue
Depression
Erectile dysfunction
Bowel function
UTIs
Bladder spasms
32
Q

Common s/s of MS

A

Early vision changes, paresthesias
CST involvement - UMN lesion symptoms - weakness first followed by spasticity
CBM involvement - ataxia, tremors

33
Q

FATIGUE with MS

A

Central/Primary Fatigue - overwhelming tiredness, exhaustion

34
Q

Fatigue with MS - how common

A

75 - 95% experience it

50% say it is their most troubling sx

35
Q

Fatigue with MS - worse with and better with what

A

Not related to disease severity
Worsen throughout the day, worse with heat/humidity
Better with cooling

36
Q

What does heat do?

Examples

A 
Worsens the symptoms for the patient 
Core temp inc by 1/4 to 1/2 a degree!!!
Hot baths
Hot, humid weather
Fever
Exercise!
37
Q

Does heat permanently or temporarily worsen their symptoms

A

Temporarily - reversed with cooling

38
Q

Pain experienced by what percent

A

80%

39
Q

Pain with MS is described how

A

Paroxysmal pain - intense, sharp, shooting
Can be trigeminal neuralgia can happen from demyelination of sensory division of trigeminal
Chronic neuropathic pain too from demyelination of spinothalamic tracts

40
Q

Medications for pain

A

Cimbalta, antidepressants, wearing compression garments

41
Q

MM weakness

A

Decreased strength
Neurologic effects that decrease recruitment and firing rates
MM effects like atrophy

42
Q

Spasticity is experienced by what percent

A

75%

43
Q

Spasticity - where more common

A

LEs more than UEs
Adductors and foot
Increased DTRs, clonus
Can fluctuate on a daily basis

44
Q

Spasticity is exacerbated by what

A

Fatigue, stress, overheating

45
Q

Does spasticity abate with during remission

A

NO! Not typically because they have axons that are degenerated - there is permanent axonal damage

46
Q

Meds for spasticity

A

Baclofen

Stretching, HEP, Orthotics

47
Q

Balance/Falls - Inc risk with MS why

A

Neuronal effects can impact vision, proprioception, vestibular function
Dec mm strength leads to dec ability to recover from perturbations
Spasticity may also contribute to gait impairments

48
Q

Risk of fracture from a fall is ____ than controls

A

Higher!

49
Q

Respiratory effects

A

Decreased strength of respiratory mm

Dec effectiveness of coughs which leads to inc risk of pulm disease

50
Q

Most common associated cause of death with MS

A

Pneumonias

51
Q

Bone health

A

Inc risk of OP - dec physical activity, steroid use long term

52
Q

Bone health - what can they do to monitor

A

DEXA scans - at least annually if not more

53
Q

Autonomic effects

A

Bladder/Bowel
Sexual Dysfunction
Decreased sweating

54
Q

Bladder function

A

80%
Small spastic bladder, failure to store
Flaccid, big bladder, failure to empty, UTI, kidney damage

55
Q

Bowel function

A

Bowel dysfunction in 60%

Constipation is most common

56
Q

Rehab - Aerobic exercise benefits

A

Dec constipation
Improve fatigue
Inc VO2 max and functional capacity
Maybe neuroprotection and maybe immunomodulation

57
Q

Rehab - Aerobic exercise - need to monitor

A 
Blunted HR response to exercise
Blunted BP response to exercise 
RPE should stay between 11 and 14
Monitor heart stress!!!
Aquatics can be beneficial! Just be careful of water temp!
58
Q

Rehab - Resistance exercise

A

Inc mm strength/power
Inc mm mass
Bone benefits
ACSM resistance training guidelines are appropriate - but err on side of caution with progression

Semester 5 PMNM Exam 7 (7 decks)

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