Guillain Barre Syndrome and MS

Question 1

what part of the CNS does GB syndrome affect?

Answer 1

nerve roots and peripheral nerves

Question 2

what is the prognosis for GB syndrome?

Answer 2

it is good, most pts return return to PLOF within 1-2 yrs

Question 3

what is the age risk factors for GB syndrome?

Answer 3

none, it can affect any age

Question 4

what gender risk factors are there for GB syndrome?

Answer 4

men are 2x more likely

Question 5

what is the significance of GB syndrome and infectious diseases?

Answer 5

2/3 of people who are diagnosed with GB had sxs of infectious disease 2 weeks prior to GB

Question 6

explain the pathology of GBS

Answer 6

an infection activates an immune cascade that breaks up the myelin.

Question 7

what are 2 medical tests that help with the dx of GBS?

Answer 7

Examination of CSF for increased protein.
Nerve conduction test

Question 8

what are some clinical signs that help the dx for GBS?

Answer 8

Progressive weakness of multiple nerve roots.
Symmetrical onset
Develops over a few days to weeks
Hyporeflexia or areflexia

Question 9

what is a very common clinical presentation of pts with GBS?

Answer 9

severe fatigue

Question 10

explain the 3 steps/progression of GBS using the correct terms

Answer 10

Nadir (peak) of motor impairments happens 2-8 weeks after onset.
Plateau occurs for 2-4 weeks
Improving occurs for 2 months to several years

Question 11

talk about ventilation and GBS? How often is it required, what causes it and what are the implications of it?

Answer 11

it is required in ~40%. It is needed because of weakness of the intercostals, abdominals, diaphragm.
It increases risk of pneumonia

Question 12

how often is cranial nerve involvement in pts with GBS and what CNs are involved?

Answer 12

around 50%. CN 7, the facial nerve

Question 13

how often do ANS sxs occur in pt with GBS and what are some ANS sxs that occur?

Answer 13

around 50%.
Orthostatic hypotension
cardiac dysrhythmias
BP fluctuations
ileus (lack of muscle contractions of intenstines)

Question 14

how would you educate a GBS pt if they asked whether they will be able to ambulate again or not?

Answer 14

I’d say it is highly likely, depending on their prognostic factors. 80% of GBS pts ambulate 6 months after onset.

Question 15

what is the most common residual affect from GBS?

Answer 15

weak anterior tibialis

Question 16

what percentage of GBS pts die?

Answer 16

5-10%

Question 17

what are some factors associated with increased risk of mortality? (GBS)

Answer 17

severe weakness
bulbar dysfunction
ANS sxs
rapid onset
Age >60 y/o
Need for ventilation
Pulmonary infections

Question 18

what is the sensation changes associated with GBS?

Answer 18

pain, hyperesthias

Question 19

what can be done during a GBS pts recovery that will increase their chances of having recurring episodes of temporary loss of fx?

Answer 19

strenuous exercise and fatigue

Question 20

what exercises are recommended during the nadir and plateau stages?

Answer 20

AAROM and AROM

Question 21

describe MS in one sentence

Answer 21

It is an autoimmune disease that causes demyelination in the brain and SC

Question 22

what age range is associated with MS?

Answer 22

20-50

Question 23

in one sentence, what is a major difference between MS and GBS?

Answer 23

MS is UMN disorder and GBS is LMN

Question 24

what gender, ethnicity, and regions are associated with increased risk of MS?

Answer 24

women
caucasian
colder countries/areas

Question 25

Does GBS, MS, or ALS have an increased risk if a family member has a hx?

Answer 25

MS and ALS

Question 26

explain the signifigance of oligodendrocytes and astrocytes in MS

Answer 26

oligodendrocytes get attacked and can remyelinate but eventually die off. These dead areas are filled with astrocytes and become hardened/plaques

Question 27

explain what the area of predilection is for MS

Answer 27

it is when MS prefers specific areas. It prefers optic nerve, white matter, and the cerebellar peducles

Question 28

what areas in the spinal cord does MS prefer?

Answer 28

corticospinal tract and posterior column

Question 29

Proteins found in CSF...explain how this is different between MS and GBS

Answer 29

They both protein in their CSF but there will be IgG present in MS but not in GBS

Question 30

in order for a MS dx what criteria is required?

Answer 30

other dx to be r/o and one of the following... an MRI showing lesions in 2 different areas OR any new lesion seen on an MRI after the original scan

Question 31

what are the 4 major subtypes of MS?

Answer 31

clinically isolated syndrome relapsing remitting MS primary-progressive MS secondary-progressive MS

Question 32

what if the subtype of MS, clinically isolated syndrome is active?

Answer 32

it will become relapsing-remitting MS

Question 33

what is the most common subtype of MS?

Answer 33

relapsing remitting

Question 34

explain the difference between remission and relapse

Answer 34

relapse: brief episodes where sxs worsen then get better remission: when the disease doesn't progress and the pt has a complete or almost complete return to normal fx

Question 35

explain the disease course of pts with primary-progressive MS

Answer 35

they progressively worsen without relapsing or remitting.

Question 36

explain the disease course associated with secondary progressive MS

Answer 36

it begins as relapsing remitting MS but then the pt gets to a point where they stop really having relapses or remissions and they just progressively get worse.

Question 37

explain what an exacerbation is and what qualifies as an exacerbation

Answer 37

an exacerbation has to last >24 hours. It is when new or recurrent sxs last >24 hrs and they aren't related to any other disease or injury

Question 38

what can cause exacerbations?

Answer 38

infections, diseases of organs, stress

Question 39

what is pseudo exacerbation?

Answer 39

an exacerbation but less than 24 hours

Question 40

explain what Uthoff's symptom is

Answer 40

an adverse reaction to heat that is immediate and dramatic impact on fx.

Question 41

what are some things you would educate a pt about if the suffer from Uthoff's symptom?

Answer 41

avoid enviroments or activities that increase body temp. If you feel these sxs come on then try to cool of and the sxs should resolve.

Question 42

what is Lhemitte's sign?

Answer 42

when you cervical flex it causes a sharp pain

Question 43

What occurs with Relative afferent pupillary defect (RAPD)?

Answer 43

shine a light into one eye and they both dilate

Question 44

what 5 vision changes can be present in MS pts?

Answer 44

diplopia, RAPD/Marcus Gunn, scotoma, nystagmus, optic neuritis

Question 45

what type of nystagmus would a pt with MS have?

Answer 45

vertical nystagmus

Question 46

what are some sensory changes in pts with MS?

Answer 46

parasthesia and numbness pain: headaches, Lhemitte's sign, hyperpathia Tic douloureux

Question 47

what tests can be used to test for cerebellar lesions?

Answer 47

heel to shin test dysdiadokinesia finger to nose gait

Question 48

explain the relationship between MS and spasticity

Answer 48

75% of MS pts have it. Greater in LE. Fluctuates daily

Question 49

what time of day should we schedule pts with MS, why?

Answer 49

In the morning, their fatigue worsens throughout the day

Question 50

What factors can increase an MS pts fatigue? (6)

Answer 50

depression spasticity some medication exertion heat decreased sleep

Question 51

what are 4 possible sxs of MS if the cerebellum is involved?

Answer 51

ataxia postural tremor intention tremor vestibular dysfunction

Question 52

what impairments might a pt with MS have that lead to gait ataxia?

Answer 52

dysmetria dyssynergia dysdiadochokinesia

Question 53

spasticity in what muscle may cause scissoring when walking?

Answer 53

abductors

Question 54

how often does sxs of speech and swallowing affect MS pts? What are some sxs that they may experience?

Answer 54

40% Dysarthria Dysphonia Dysphagia

Question 55

how often do patients with MS experience cognitive impairments?

Answer 55

50% of MS pts

Question 56

what are 4 predictors of better prognosis in MS pts?

Answer 56

onset w/ only 1 sx Benign and RRMS <40 y/o Few overall lesions on brain scan

Question 57

what affect can medications have on the relapses associated with MS?

Answer 57

can decrease relapse rate by 30% and reduce severity

Question 58

what are 2 preventative and restorative interventions for MS during the early stages?

Answer 58

exercise and community classes

Question 59

what are 2 preventative and restorative interventions for MS during the middle stages?

Answer 59

exercise and community classes

Question 60

what are the parameters for aerobic conditioning in patients with MS? frequency, intensity, length

Answer 60

3-5 days a week, alternate days 60-85% HRmax 30 minutes a day or 3 10-minute sessions

Question 61

what are some compensation ideas for gait ataxia?

Answer 61

light weights, weighted boots/jacket, weighted canes/walker/utensils

Question 62

what is the scoring for the fatigue scale for motor and cognitive functions?

Answer 62

<43 mild <53 moderate <63 severe

Question 63

explain the scoring for the 12-item MS walking scale?

Answer 63

it is 0-100 and the higher score indicates more disability

Question 64

explain the scoring for the MSQOL-54

Answer 64

it is 0-100 and the higher the score the higher the QOL