Fundamentals of Multiple Sclerosis Flashcards
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a chronic disease affecting the central nervous system (the brain and spinal cord).
MS occurs when the immune system attacks nerve fibers and myelin sheathing (a fatty substance which surrounds/insulates healthy nerve fibers) in the brain and spinal cord. This attack causes inflammation, which destroys nerve cell processes and myelin – altering electrical messages in the brain.
What four factors do scientists believe may contribute to triggering MS?
Immunological factors
Environmental factors
Infectious factors (certain viruses and bacteria)
Genetic factors
Epidemiology: What age group is primarily affected by MS diagnoses?
People are diagnosed between the age of 20-50, but it can also occur in young children and older adults.
Epidemiology: Approximately how many people in the US are living with MS currently?
There are nearly 1 million people living with MS in the USA
Epidemiology: MS is more common in what geographic areas?
MS is more common in areas farthest from the equator.
MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
Epidemiology: MS is three times more common in what gender?
Women
MS is three times more common in women than in men, suggesting that hormones may also play a significant role in determining susceptibility to MS.
Epidemiology: What ethnic background makes up the majority of those diagnosed with MS?
Caucasians
MS occurs among African Americans, Asians, Hispanics, but is most common among Caucasians and those of northern European ancestry.
How is MS diagnosed?
A combination of neurological exams, MRIs, spinal fluid analysis, and blood tests to rule out other conditions.
What are the most common initial clinical symptoms that MS patients experience?
- numbness or weakness in limbs
- electric-shock sensations
- tremors; lack of coordination
- vision problems, including complete or partial loss of vision, often with pain during eye movement
What forms of diagnostic testing are commonly used to evaluate disease progression?
Neurological examination: neurologists will look for abnormalities, changes or weakness in your vision, eye movements, hand or leg strength, balance and coordination, speech and reflexes.
MRI Scan: shows whether there’s any damage or scarring of the myelin sheath (lesions) (the layer surrounding your nerves) in your brain and spinal cord.
Evoked potential test: tests measure the electrical activity in parts of the brain caused by light, sound, and touch.
Lumbar puncture: a procedure to remove a sample of your spinal fluid by inserting a needle into the lower back. The sample is then tested for immune cells and antibodies, which is a sign that your immune system has been fighting a disease in your brain and spinal cord.
What is the most common MS disease course?
Relapsing Remitting (RRMS)
What percentage of MS patients are initially diagnosed with relapsing remitting MS?
85%
Which form of MS is characterized by clearly defined attacks of new or increasing neurologic symptoms?
Relapsing Remitting (RRMS)
In relapsing remitting MS, attacks (__________) are followed by recovery (__________) periods where symptoms may disappear or some may continue or become permanent. Disease does not progress during (__________) periods.
relapses, remission, remission
People with (__________) tend to develop new brain lesions, whereas individuals with (__________) have spinal cord lesions.
relapsing remitting (RRMS), primary progressive (PPMS)
What may happen to new symptoms after a relapse?
Following a relapse, the new symptoms may disappear without causing any increase in level of disability, or the new symptoms may only partially disappear, resulting in an increase in disability.
What form of MS follows an initial relapsing-remitting course, but is characterized by progressive worsening of neurological function overtime?
Secondary progressive (SPMS)
True / False: In secondary progressive MS, disability gradually increases over time, with or without evidence of disease activity (relapses or changes on MRI).
True
Which form of MS is characterized by worsening neurologic function from the onset of symptoms, without early relapses or remissions?
Primary progressive (PPMS)
What does it mean for the disease course to be active?
Having an occasional relapse and/or evidence of new MRI activity over a specified period of time.
What is progression?
Evidence of disability accrual over time, with or without relapse or new MRI activity
What term describes patients without symptoms of MS whose magnetic resonance imaging (MRI) findings suggest they might be at risk of future demyelinating events.
Radiologically isolated syndrome
What term refers to a first episode of neurologic symptoms that lasts at least 24 hours and is caused by inflammation or demyelination (loss of the myelin that covers the nerve cells) in the central nervous system (CNS).
Clinically Isolated Syndrome (CIS)
As MS progresses, what complex symptoms may a patient experience that interfere with their health, safety, and quality of life?
Untreated bladder problems can lead to repeated infections, urosepsis, permanent kidney damage and death.
Reduced mobility and bladder/bowel incontinence can lead to pressure ulcers.
Dysphagia (difficulty swallowing) can result in aspiration of bacteria, saliva, food particles and liquids and can lead to airway obstruction, dehydration and malnutrition.
Impaired balance and ambulation increase the risk of falls and injuries and near-fallers and fallers perform similarly on timed walking tests, highlighting the need for continual assessment.
Uncontrolled spasticity can result in contractures that impact mobility, comfort, skin integrity and personal care.
Depression can interfere with self-care, reduce adherence to treatment and wellness promoting behavior such as healthy eating and exercise , and increase suicide risk.
Cognition problems involving attention, memory, problem-solving, verbal fluency and social cognition can impact safety, self-care, relationships, driving and money management.
