Lecture 11-12: Multiple Sclerosis Flashcards
What is the pathophysiology of MS?
chronic, inflammatory demyelinating disease of the CNS, brain and spinal cord which leads to axonal and neuronal loss
damage accumulates as disease progresses
What is a result of the axonal damage of MS?
conduction delay and conduction block of electrical potential along CNS pathway
What is a similar disease to MS?
GB and CIDP, except those are LMNL and this results in more UMN sx
What is the epidemiology of MS?
common in 20-40 y/o, peak onset of 30, 2:1 ratio female to male, predominantly caucasian
What is etiology of MS?
believed to be an autoimmune disease induced by viral or other infectious agent such as herpes, measles, epstein barr, chlamydia
What is the mechanism of pathophysiology of MS?
immune respsone attacks myelin in CNS as BBB fails to protect it, the myelin in CNS can’t repair itself so it turns into glial plaques blocking conduction of the nerve
What is the gold standard for medical diagnosis of MS?
MRI- can see plaques in brain
also CSF- increased IgG bands from broken down myelin
What are common disease modifying drugs used for MS?
Interferon Beta 1a and B, copaxone (injection) and tysabri (infusion)
What are SE of these drugs for MS?
malaise, fatigue and pain at injection site ( remember this for HEP and TX)
What is a potentially fatal SE of these drugs for MS?
progressive multifocal leukoencephalopathy
What are some medications that can be used for sx management of MS?
gabapentin- pain ditropan- bowel/bladder SSRI- mood steroids- gold standard for acute inflammation to protect myelin baclofen- spasticity
What supplement can potentially be beneficial for pts with MS?
vitamin D
What are the 4 major types of MS?
- relapsing remitting (RRMS)
- primary progressive (PPMS)
- Secondary progressive (SPMS)
- Progressive Relapsing (PRMS)
What are characteristics of RRMS?
acute attacks with full recovery or partial deficit, lack of disease progression between attacks
What is often the first sign of RRMS?
optic neuritis- such as eye pain, visual disturbances, black spots
What is another common first sx of RRMS?
severe acute vertigo due to inflammation of MLF which supplies CN 3,4,6, 8
What are characteristics of SPMS?
relapsing remitting course followed by progression at a variable rate
may include occasional relapses, remissions and plateaus
out of 85% diagnosed with RRMS- 50% will develop SPMS
What are characteristics of PPMS?
progressive disability from onset with out remissions or significant improvements
What percentage of pts with MS have PPMS?
10% but its the most severe and usually occurs in pts that are older than 50
What are characteristics of PRMS?
progressive from onset, clear acute relapses that may or may not resolve
rarest form
What is the criteria for a pt to be experiencing a true relapse?
must be a new or recurrent symptom lasting more than 24 hours, must be separated from previous attack by 30 days
pseudo exacerbation if less than 24 hours
What are common triggers for an exacerbation?
stress, infections, fatigue, trauma, childbirth, HEAT- fever, exercise, hot baths, weather
What are most common PT specific sx of MS?
sensory, motor, visual, fatigue, pain, cerebellar sx, autonomic changes
What are non PT specific sx with MS?
bladder/bowel dysfunction, speech/swallowing, cognitive, emotional, sexual
What is the single most important thing to remember about catching new symptoms?
you must know a pts baseline so you know for sure if a symptom is new or not
What is usually the first presenting sx of MS?
visual sx, 80% of pts experience these
What is the cause of optic neuritis?
inflammation and demyelination of optic nerve
sx: eye pain, loss of vision, blind spots, burred vision, nystagmus
What is most common sensory sx in pts with MS?
numbness and parathesia in extremities or trunk
What are motor sx associated with MS?
weakness, balance deficits (falls even in young pts), coordination deficits (ataxia), hypertonia (spasticity high in extensors and adductors)
What are two main types of fatigue in patients with MS?
primary and secondary
What is primary fatigue?
most frequent and severe with PPMS and SPMS, what level of exertion you think you are doing versus what level your neural workload actually is, is different
What is secondary fatigue?
from deconditioning, infections, sleep disturbances, poor nutrition, med SE, heat intolerance
What types of pain are associated with MS?
- neuropathic- associated with damage to neural tissue
- Lhermitte’s sign
- paroxysmal limb pain
- HA
- optic neuritis
- trigeminal neuralgia
What is trigeminal neuralgia pain?
intense pain in face likely due to pontine plaques in the nerve
What types of cerebellar sx are most common?
ataxia, tremors, hypotonia, vestibular sx
How may pts with MS have cognitive sx?
40-70%
memory, processing speed, executive functioning, attention, visual spatial learning
What is a more common sx in MS than in any other chronic medical condition?
depression due to effect of frontal or subcortical white matter dz
What are sx of cardiovascular dysautonomia?
involvement of ANS leads to difficulty regulating HR, temp, BP, digestion. with feeling of lightheadedness, malnutrition, inability to sweat
use RPE during tx
What is prognosis for MS?
life expectancy not reduced but will have difficulty working and may require AD after 15 years and wheelchair use after 20 years
What are predictors for a favorable outcome?
onset with only one sx, RRMS, young age at onset, neuro stability after 5 years, low axonal loss
What is the gold standard outcome assessment measure for MS?
Expanded disability status scale (EDSS) which helps measure disease severity
0-10 scale with increments of 0.5
What is the EDSS scale 0-10 in relation to function?
0- normal 1-no disability 2- minimal disability 3- mod disability 4- severe disability 5- disability affects daily activities 6- assistance required to walk 7- restricted to WC 8- restricted to bed or chair 9- confined to bed 10- death
What outcome measure test is commonly used with RRMS?
Ms functional composite- measures walking speed, cognitive function and arm/hand dexterity
What is the gold standard outcome assessment for MS and QOL?
MS quality of life inventory (MSQLI) this measures one participation levels
What outcome measure can be used at home for MS pts?
VAS for fatigue, can keep a journal to measure at what points of day are they more fatigued versus what makes them feel worse
What is Utoff’s sign?
pseudo exacerbation of neuritis brought on my extreme exertion
