MS

Question 1

Theories of cause of MS

Answer 1

1) Environmental factors (higher incidence of MS living north of equator; or vitamin D deficient)
2) Immunologic/Infectious factors (30-60% of new attacks occur after a cold, flu, or common viral illness)
3) Genetic factors (identical twins have 25% chance of developing MS, while average person has 0.1% chance; also more common in females and those with specific gene)

Question 2

Symptoms of MS

Answer 2

Symptoms relate to the area of the CNS affected. May include:
• Fatigue
• Numbness/weakness in one or more limbs or the legs/trunk
• Partial/complete loss of vision in one eye at a time w/painful eye movement
• Double/blurred vision
• Tingling/pain in parts of body
• Electric-shock sensations with certain neck movements, esp bending neck fwd
• Tremor/lack of coordination/spasticity/unsteady gait
• Slurred speech
• Dizziness
• Problems with bowel/bladder function
• Changes in cognition/mood

Question 3

Exacerbation of Symptoms

Answer 3

Exacerbation = unpredictable episode of increased or new symptoms (flare-ups). May be as minor as fatigue and sensory loss, or as extensive as total paralysis of all Es and loss of bladder control. Exacerbation can be caused by elevated body temp.

Question 4

Remission

Answer 4

When symptoms of the disease seem to resolve, or slight return of function occurs alongside symptoms, or a short plateau with no new symptoms.

Question 5

Predictors of poor MS prognosis

Answer 5

• Progressive course
• Age of onset >40
• Cerebellar involvement
• Polysymptomatic onset
• Male sex

Question 6

Predictors of favorable MS prognosis

Answer 6

• Minimal disability 5 yr after onset of disease
• Complete, rapid remission of initial symptoms
• Age of onset <40
• Only 1 symptom during 1st year
• Onset with sensory symptom or mild optic neuritis

Question 7

4 Patterns (Types) of MS

Answer 7

1) Relapsing and Remitting (RRMS): Most common (85%); bouts of attacks over months/years, like steps with plateaus. Increasing level of disability over time.
2) Secondary Progressive (SPMS): Begins with relapses/remissions but evolves into progressive form over time. RRMS can progress to SPMS without treatment.
3) Primary Progressive (PPMS): (10% of cases); downward course with episodes of exacerbations/remissions. Become nonambulatory/incontinent and have dysphagia/dysarthria and LE/UE dysfunction. Require more help with ADLs.
4) Progressive Relapsing (PRMS): Least common (5%); Steady worsening of symptoms with episodes of exacerbations.

Question 8

Progressive nature of MS

Answer 8

MS is progressive because more and more of the CNS gets damaged over time, as less remyelination can occur.

Question 9

Focus of Medical Management of MS

Answer 9

Symptom management with medications is primary focus. (Includes spasticity, bladder mgmt., prevention of bladder infection, and mgmt. of pain/fatigue.)

Question 10

Most Widely Accepted Tool to Measure Impairments from MS

Answer 10

Expanded Disability Status Scale (EDSS). Completed by physician because it includes a detailed neurologic exam, while measuring ambulatory and functional mobility status. Limitations: does not allow specific assessment of ADLs; not sensitive to potential cog and sexual deficits.

Question 11

Stats on most MS diagnoses

Answer 11

• Between ages 20-50

* 2-3x more women than men

Question 12

Location of most MS Lesions

Answer 12

• 50% spinal cord
• 25% optic nerves
• 20% brainstem/cerebellum
• periventricular white matter

Question 13

Prognosis for most MS

Answer 13

• Typically live 6 years less
• 50% live 30 years after onset
• 50% die of complications of MS
• Course can be determined after 5 yr of initial symptoms