L2 MS Flashcards
what is multiple sclerosis
- An autoimmune disorder which causes attacks of demyelination, leading to permanent damage of the myelin sheath.
- The myelin sheath is a protective coating of the axons in the nerve fibres of the CNS.
- Attacks on the myelin sheath lead to an inability of the nerve fibres to communicate.
- The body can repair myelin, but not perfectly, and the damage leads to lesions or scars (which gives the disorder its name).
- Over time, degredation of the myelin can become permanent, leading to an increase in disability
- As the disease progresses it attacks the cell bodies, and leads to cortical atrophy (the shrinking of the cerebral cortex).
where does MS get its name
multiple sclerosis means many scars, referring to the many lesions or scars caused by demylination attacks
how many people in ireland live with MS
around 9000
what is the age of onset of MS
20-40
what is the mean age of onset for MS
28
influencing factors in the development of MS
- geographical location - more northern areas are more likely to develop MS (possible due to less vitamin D exposure)
- race - white people are more likely to develop MS than other races
- possible viral triggers - including herpes, severe flu and epstein-barr virus
- family history
- history of smoking
prevalence of MS
- 100 –140 per 100,000 in England and Wales
- 170 per 100,000 un Northern Ireland.
symptoms of MS
- Fatigue, cognitive changes (seen as a slowing down of mental faculties).
- Visual loss, sensory disturbance, limb weakness, balance and coordination issues.
- Bladder problems, pain, speech, and swallowing difficulties.
- Generally very specific to begin with → visual acuity or weakness in limbs symptoms; more lateral difficulties such as speech and swallowing tend to come later.
characteristic features
- Optic neuritis: Painful visual loss.
- Internuclear ophthalmoplegia: Double vision.
- Fatigue.
- Lhermitte’s phenomenon: Sudden brief pain or electrical buzzing sensation.
- Uhthoff’s phenomenon: Worsening symptoms with heat - due to less protection of the nerves.
5 subtypes of MS
- clinically isolated syndome
- relapsing-remitting MS
- secondary progressive MS
- progressive relapsing MS
- primary progressive MS
clinically isolated syndrome
one or two episodes followed by stabilisation
relapsing-remitting MS
unpredicatable attacks which may or may not leave permanent deficits followed by periods of remission
secondary progressive MS
initial relapsing-remitting MS which suddenly begins to have decline without periods of remission
progressive-relapsing MS
steady decline since onset with super-imposed attacks
primary-progressive MS
steady increase in disability without attacks
diagnostic criteria for MS
- McDonald Criteria
- Objective evidence of ≥2 attacks disseminated in space and time.
- Diagnostic tools include MRI and lumbar puncture - used to confirm or in cases of less objective clinical evidence.
three types of investigations for MS
- MRI
- lumbar puncture
- visual evoked potential
MRI - test for MS
- damage appears as white, healthy tissue appears as black
- over the course of years MRIs can reveal distributed plaques across the brain affecting movement and cognition
lumbar puncture - test for MS
- looks for oligoclonal bands in cerebro-spinal fluid
- presense of these is indicative of MS
- representative of the immune system attacks
visual evoked potential - test for MS
- Assesses the speed of passive information processing.
- Electrodes are placed on the individual’s scalp.
- They are presented with a flashing checkerboard.
- Delayed signal due to optic path damage leading to sluggishness identifying changes in the visual field.
prognosis of MS
- the subtype of MS tends to predict its prognosis (as well as the degree of disability across the lifespan)
- there is usually a shortened life expectance
- 50% of sufferers cannot walk unaided after 16 years of symptoms
- a younger age at onset correlates with a slower disease progression
what are the aims of treamtent for MS
- Reduce relapse rate and disability progression.
- Slower MRI lesion accumulation.
- Most active treatments are aimed at RRMS.
- Symptomatic treatments available for all types.
three examples of disease-modifying treatments
- injections
- IV infusions
- chemotherapeutic agent
name two MS treatments that come in the form of injections
- interferon beta
- glatiramer acetate
what is interferon beta
treament in the form of an injection which was once the most commonly used treatment for MS
side effects of interferon beta
flu-like symptoms (usually fade with continued therapy), depression, elevation of liver enzymes
what is glatiramer acetate
MS treatment which comes in the form on an injection; often used for RRMS, can reduce relapse rate by 1/3
what is the brand name for natalizumab
tysabri
how does natalizumab (tysabri) work
prevents immune systems cells from entering the CNS
why use natalizumab (tysabri)
it’s very effective and possibly leads to a larger reduction in relapse rate than other treatments
one danger of using natalizumab (tysabri)
it’s associated with an increased risk of a very serious viral brain infection called progressive multifocal leukoencephalopathy (PML). Regular blood tests for antibodies to this virus can help address this risk
what is mitoxantrone
- a potent chemotherapeutic agent
- used for agressive progressive MS
what risks are associated with mitoxantrone
cardiotoxicity & leukemia
treatment for relapses
high-dose steriods for recovery
treatment for spasticity
- baclofen
- tizanidine
- stretching and exercising affected muscles
tremour treatment
- assistive devices
- medications
- deep brain stimulation
ataxia treatments
- assistive walking devices
- physiotherapy
- occupational therapy
bladder issue treatments
- medications
- hydration changes
- self-cathterisation
fatigue treatments
- physiotherapy
- occupational therapy
pain treatments
medications and alternative therapies
eye/vision difficulty treatments
- vision therapy exercises
- special eyeglasses
- resting the eyes
depression treatments
- CBT
- SSRI
what does SSRI stand for
selective serotonin reuptake inhibitor
why use SSRIs over other anti-depressant medication
less likely to cause fatigue
members of the MS MDT
- neurologist
- neurorehabilitation specialist
- MS specialist nurses
- physiotherapist
- speech and language therapist
- occupational therapist
- social services
- palliative care
impact of MS
- affects young people’s work, family and finances
- significant psychological and cognitive effects such as depression, anxiety and potential dementia
- cognitive impairment affects up to 75% of individuals with MS
what is cognitive impairment
decline in ability to think, learn and remember
what role does an SLT have in MS management
assessment and intervention in the areas of:
- Speech: Spastic-ataxic dysarthria.
- Language: Anomia, aphasia.
- Swallowing
what is the prevalence of dysarthria in people with MS
45%
in which type of MS is the dysarthria typically mild
RR-MS
in which types of MS is the dysarthria typically moderate to severe
- Sp-MS
- PP-MS
symptoms of dysarthria in MS
- Articulation: Slow rate, imprecise consonants
- Phonation: Pitch and loudness instability
- Respiration: Reduced phonatory time, expiratory pressure
- Prosody: Variable intonation, pitch, and volume
impact of dysarthria on quality of life in MS
Negatively affects employment status, social participation, and overall quality of life
key interventions for dysarthria in MS
- Respiration techniques.
- Energy conservation and loudness regulation.
- Prosody.
- Paced speech with visual feedback.
- Adaptive compensation strategies.
- Education.
- AAC support, accounting for hand function and vision.
- Lee Silverman Voice Treatment (LSVT).
prevalence of dysphagia in MS
up to 40%
how does the relapse/remission cycles present in MS affect swallowing issues
means the difficulties may wax and wane
examples of contributing factors to swallowing difficulties in MS
- fatigue
- heat sensitivity
- physical disability (hand tremors)
two assessment tools
- Multiple Scelerosis Swallowing Performance Scale
- DYMUS
what is the Multiple Scelerosis Swallowing Performance Scale
7 point scale rating swallow from normal to NPO
what is DYMUS
10 question questionnaire for the assessment of dysphagia in MS.
key strategies for the management of dysphagia in MS
- Remove distractions during meals
- Sensory stimulation and proper posture
- Maintain hydration, avoid warm environments
- “Little and often” approach
- Compensatory techniques (e.g., head postures)
- Rehabilitation strategies (e.g., Expiratory Muscle Strength Training - EMST)
- Diet modifications and alternative feeding options
