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Neuro 2 Midterm Exam > Lecture 11-12: Multiple Sclerosis > Flashcards

Lecture 11-12: Multiple Sclerosis Flashcards

1
Q

What is the pathophysiology of MS?

A

chronic, inflammatory demyelinating disease of the CNS, brain and spinal cord which leads to axonal and neuronal loss

damage accumulates as disease progresses

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2
Q

What is a result of the axonal damage of MS?

A

conduction delay and conduction block of electrical potential along CNS pathway

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3
Q

What is a similar disease to MS?

A

GB and CIDP, except those are LMNL and this results in more UMN sx

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4
Q

What is the epidemiology of MS?

A

common in 20-40 y/o, peak onset of 30, 2:1 ratio female to male, predominantly caucasian

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5
Q

What is etiology of MS?

A

believed to be an autoimmune disease induced by viral or other infectious agent such as herpes, measles, epstein barr, chlamydia

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6
Q

What is the mechanism of pathophysiology of MS?

A

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

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7
Q

What is the gold standard for medical diagnosis of MS?

A

MRI- can see plaques in brain

also CSF- increased IgG bands from broken down myelin

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8
Q

What are common disease modifying drugs used for MS?

A

Interferon Beta 1a and B, copaxone (injection) and tysabri (infusion)

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9
Q

What are SE of these drugs for MS?

A

malaise, fatigue and pain at injection site ( remember this for HEP and TX)

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10
Q

What is a potentially fatal SE of these drugs for MS?

A

progressive multifocal leukoencephalopathy

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11
Q

What are some medications that can be used for sx management of MS?

A 
gabapentin- pain
ditropan- bowel/bladder
SSRI- mood
steroids- gold standard for acute inflammation to protect myelin
baclofen- spasticity
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12
Q

What supplement can potentially be beneficial for pts with MS?

A

vitamin D

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13
Q

What are the 4 major types of MS?

A
  1. relapsing remitting (RRMS)
  2. primary progressive (PPMS)
  3. Secondary progressive (SPMS)
  4. Progressive Relapsing (PRMS)
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14
Q

What are characteristics of RRMS?

A

acute attacks with full recovery or partial deficit, lack of disease progression between attacks

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15
Q

What is often the first sign of RRMS?

A

optic neuritis- such as eye pain, visual disturbances, black spots

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16
Q

What is another common first sx of RRMS?

A

severe acute vertigo due to inflammation of MLF which supplies CN 3,4,6, 8

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17
Q

What are characteristics of SPMS?

A

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

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18
Q

What are characteristics of PPMS?

A

progressive disability from onset with out remissions or significant improvements

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19
Q

What percentage of pts with MS have PPMS?

A

10% but its the most severe and usually occurs in pts that are older than 50

20
Q

What are characteristics of PRMS?

A

progressive from onset, clear acute relapses that may or may not resolve

rarest form

21
Q

What is the criteria for a pt to be experiencing a true relapse?

A

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

22
Q

What are common triggers for an exacerbation?

A

stress, infections, fatigue, trauma, childbirth, HEAT- fever, exercise, hot baths, weather

23
Q

What are most common PT specific sx of MS?

A

sensory, motor, visual, fatigue, pain, cerebellar sx, autonomic changes

24
Q

What are non PT specific sx with MS?

A

bladder/bowel dysfunction, speech/swallowing, cognitive, emotional, sexual

25
Q

What is the single most important thing to remember about catching new symptoms?

A

you must know a pts baseline so you know for sure if a symptom is new or not

26
Q

What is usually the first presenting sx of MS?

A

visual sx, 80% of pts experience these

27
Q

What is the cause of optic neuritis?

A

inflammation and demyelination of optic nerve

sx: eye pain, loss of vision, blind spots, burred vision, nystagmus

28
Q

What is most common sensory sx in pts with MS?

A

numbness and parathesia in extremities or trunk

29
Q

What are motor sx associated with MS?

A

weakness, balance deficits (falls even in young pts), coordination deficits (ataxia), hypertonia (spasticity high in extensors and adductors)

30
Q

What are two main types of fatigue in patients with MS?

A

primary and secondary

31
Q

What is primary fatigue?

A

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

32
Q

What is secondary fatigue?

A

from deconditioning, infections, sleep disturbances, poor nutrition, med SE, heat intolerance

33
Q

What types of pain are associated with MS?

A
  1. neuropathic- associated with damage to neural tissue
  2. Lhermitte’s sign
  3. paroxysmal limb pain
  4. HA
  5. optic neuritis
  6. trigeminal neuralgia
34
Q

What is trigeminal neuralgia pain?

A

intense pain in face likely due to pontine plaques in the nerve

35
Q

What types of cerebellar sx are most common?

A

ataxia, tremors, hypotonia, vestibular sx

36
Q

How may pts with MS have cognitive sx?

A

40-70%

memory, processing speed, executive functioning, attention, visual spatial learning

37
Q

What is a more common sx in MS than in any other chronic medical condition?

A

depression due to effect of frontal or subcortical white matter dz

38
Q

What are sx of cardiovascular dysautonomia?

A

involvement of ANS leads to difficulty regulating HR, temp, BP, digestion. with feeling of lightheadedness, malnutrition, inability to sweat

use RPE during tx

39
Q

What is prognosis for MS?

A

life expectancy not reduced but will have difficulty working and may require AD after 15 years and wheelchair use after 20 years

40
Q

What are predictors for a favorable outcome?

A

onset with only one sx, RRMS, young age at onset, neuro stability after 5 years, low axonal loss

41
Q

What is the gold standard outcome assessment measure for MS?

A

Expanded disability status scale (EDSS) which helps measure disease severity

0-10 scale with increments of 0.5

42
Q

What is the EDSS scale 0-10 in relation to function?

A 
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
43
Q

What outcome measure test is commonly used with RRMS?

A

Ms functional composite- measures walking speed, cognitive function and arm/hand dexterity

44
Q

What is the gold standard outcome assessment for MS and QOL?

A

MS quality of life inventory (MSQLI) this measures one participation levels

45
Q

What outcome measure can be used at home for MS pts?

A

VAS for fatigue, can keep a journal to measure at what points of day are they more fatigued versus what makes them feel worse

46
Q

What is Utoff’s sign?

A

pseudo exacerbation of neuritis brought on my extreme exertion

Neuro 2 Midterm Exam (11 decks)

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