Exam 2: Multiple Sclerosis, Orthotics, Guillan Barre Flashcards
What is multiple sclerosis?
-A chronic progressive inflammatory disease involving damage to the myelin in the brain and spinal cord
-Autoimmune disease
-Can lead to physical dysfunction, depression, participation restrictions
What patient populations is MS most common in?
-Mean onset 30 years
-70% of onset is between 20-40 years old
-10-20% after 60
-Females > males
-Genetics (first degree relative 20x higher)
What can MS be triggered by?
Environmental factors such as sunshine, vitamin D deficiency, smoking, and Epstein-Barr virus
What is the proposed agent of oligodendrocyte dysfunction?
Pro-inflammatory agents released by microglial cells
What is the function of astrocytes?
Provide synaptic support, neuronal guidance, and maintain the blood brain barriers
What is the pathophysiology of MS?
-T cells are autoreactive in the periphery of the CNS
-T and B cells cross the weakened BBB
-T cells interact with B cells to create aberrant antibodies that target oligodendrocytes
-T cells and inflammatory microglia
-Antibodies lead to degeneration of myelin
What occurs during and after inflammatory demyelination?
-Damage to the transmission of nerve impulses occurs during the inflammatory phase
-When inflammation subsides, symptoms improve and oligodendrocytes can remyelinate axons
What does repeated inflammation cause? What does this equate to?
-Repeated inflammation causes reduced repair and axonal damage
-Axonal damage equates to irreversible disability
What is a hallmark sign of MS?
-Plaques that are caused by focal loss of myelin
-This leads to fibrous astrocytes and undergoes gliosis
-Associated with loss of axonal function
What are the relative percentages of axonal loss in the spinal cord, optic nerve, and brainstem/cerebellum?
-Spinal cord: 50%
-Optic nerve: 25%
-Brainstem/cerebellum: 25%
What does an MS lesion look like on an MRI?
Bright white plaque
What is gray matter dysfunction in MS?
-The extent and clinical relevance of grey matter pathology in MS is increasingly recognized
-Previous work has shown that GM pathology is more closely associated with some aspects of clinical disability than white matter injury, which has been suggested to arise independently
What is the epidemiology of MS?
-Over 947,000 affected in the US
-Women vs men 3:1
-Men have a worse prognosis/aggressive disease
-Western European ancestry
-Geographic prevalence: extreme northern and southern latitudes, northern climates in US, Canada, and Scandinavia
-Least common in warm climates such as Asia, Africa, South America
-People who migrate from high to low risk regions before puberty reduce their risk
What latitude is MS more common in?
Above 45 degrees
What are the classifications of MS?
-Relapsing-remitting MS (RRMS)
-Secondary progressive MS (SPMS)
-Primary progressive MS (PPMS)
-Progressive relapsing MS (PRMS)
-Benign MS
What is relapse remitting MS (RRMS)? What percentage of MS diagnoses are RRMS?
-Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
-85% of cases
What is secondary progressive MS (SPMS)? What percentage of MS diagnoses are SPMS?
-Initial relapsing-remitting MS that suddenly begins to have decline without periods of remission
-Occurs after RRMS
-75% of RRMS cases are diagnosed with SPMS within 15 years of diagnosis
What is primary progressive MS (PPMS)? What percentage of MS diagnoses are PPMS?
-Steady increase in disability without attack or periods of remission
-Gradual worsening of symptoms
-Does not respond to medical standard of care/drugs
-Progressive myelopathy
-15% of cases
-Usually in young males
What is benign MS?
One occurrence with no occurrence
What is progressive relapsing MS (PRMS)? What percentage of MS diagnoses are PRMS?
-Steady decline since onset with super-imposed attacks
-5% of cases
What is the preclinical phase of MS?
-May have mild or no symptoms
-Lab tests will be negative
-Can last many years before onset of symptoms
What is the relapsing remitting phase of MS? How long does it last?
-Onset of symptoms with periods of remission
-Can last 10-15 years
When does secondary progressive MS phase come on? How long does it last?
-After being in the RRMS phase for about 10-15 years
-Can last 20+ years
What is the expanded disability status scale?
-A scale that is used by physician’s to grade disability in patients with MS
-Ranges from no disability to confined to bed
-PT’s cannot use this scale