MS Flashcards
MC early S&S of MS
Blurred/double vision
Red-green color distortion
Blindness in one eye
Progressed S&S of MS
M weakness in extremities Difficulty with coordination/balance Impaired walking & standing Paresthesia Speech impediments, tremors, dizziness Hearing loss
Approximately ____% of people with MS have cognitive impairment including difficulty concentrating, attention/memory, poor judgement, and depression.
50
What are the 4 patterns of MS progression?
- Single incident with complete recovery
- Relapsing remitting
- Secondary progressive (what relapsing remitting usually turns into after a period of time)
- Primary progressive
Pathophysiology of MS
Immune system attacks myelin coating around nerves in CNS, causing development of plaques at multple sites in CNS
Which population is MC diagnosed with MS?
Females 20-40yo
People livign in developed areas, especially at increased latitude
True or false: individuals who move to more northern latitude at any age increase the risk of developing MS
False - only if you move before age 15
Individuals over 15 yoa moving to a
more northern latitude will have the
same risk for MS as the people in
their country of origin
Name 4 modifiable risk factors of MS
Smoking
Obesity in adolescence
Low vitD
Exposure to epstein-barr virus
MC symptoms of MS
Fatigue (90%) Depression (50%) Cognitive and emotional changes (40%) Peripheral visual symptoms ED (40%)
When conducting a systems review of a patient suspected of having MS, what are 6 body functions which should be focused on?
Cognition Vision Sensory Motor Sphincter dysfunction Energy levels
Name the specific questionnaire which is used for assessing MS
Expanded Disability Status Scale
What are 5 components of a bed-side neurological exam for someone suspected of having MS?
CNs (DAN)
CASE
Gait & Balance (mBESS, tandem gait stance, observation)
Rapid alternating movements & point-to-point movements
Peripheral neuro exam (DTR, motor, sensory)
What are some changes you would anticipate in the gait of an individual with MS?
Decreased speed Shorter strides Increased double-support time Lack of cross-crawl coordination Parachuting arm motion
Which muscle is the quickest to atrophy in the leg in association with MS?
VMO
The expanded disability status scale (EDSS) measures impairment in which 8 functional systems?
Pyramidal (muscle weaness/difficulty moving limbs)
Cerebellar (ataxia, loss of balance, coordination, tremor)
Brainstem (problems with speech, swallowing, nystagmus)
Sensory (numbness/loss of sensation)
Bowel/bladder function
Visual function
Cerebral function (difficulty with thinking and memory)
Other (chewing, swallowing, self-care, driving, GI function, resp function, energy levels_
What is the criteria for using the first section (1.0-4.5) of the EDSS?
Individual with MS who is able to walk without any aid
If an individual has impaired walking, how should you use the EDSS?
Use the second section (5.0-9.5)
What is the swinging light test?
Tests for relative afferent pupillary defects
Shine light in unaffected eye and note normal constriction BL
Quickly swing light to shine in affected eye and note weaker pupillary response
A lesion in the MLF associated with MS can lead to which symptom?
Internuclear opthalmoplegia (affected eye fails to adduct with lateral gaze)
Name of the type of pain experienced by individuals with MS characterized by burning and gnawing pains in the extremities
Neuropathic
What are paroxysmal symptoms (seen in association with MS)?
Temproary recurring episodes of slurred speech, incoordination, muscle spasms, painful/stabbing sensations
Caused by abnormal electrical impulses in acutely demyelinating lesions
What kind of tremor is seen in associated with MS?
Intention tremor
What are the MC bowel and bladder dysfunctions seen in associated with MS?
Urinary retention and frequency
Faecal incontinence is rare
What is Uhthoff’s phenomenon? Why does this happen?
Increase in core body temperature (caused by hot bath, fever, vigorous exercise) resulting in exacerbation of MS symptoms - can unmask “silent” lesions
Pathophysiology: prolongs inaxtivation of voltage-gated sodium channels causing poor conduction
What 3 tests can be done to diagnose MS?
- MRI: ID sclerotic lesions, swelling, atrophy of brain tissue
- Evoked potentials: measures speed of nerve impulse conduction in pathways of CNS (will be reduced in MS due to myelin damage)
- Lumbar puncture: test CSF for myelin breakdown and antibody proteins associated with CNS inflammation
What is the name of the antibody proteins found in the CSF of individuals with MS which are known to be present with inflammation in the CNS?
Oligoclonal bands
What does the term “dissemination in time and space” mean? What is it used for?
Dissemination in space: evidence of scarring in at least 2 separate areas of CNS
Dissemination in time: evidence that plaques occured at different points in time
Used for identifying MS pattern of progression
What are the 7 lag times that contribute to delayed diagnosis of MS?
Symptom: subclinical, incubation, injury to symptom delay
Physician: onset-to-medical visit
Imaging: Time to takes to book, complete assessment, receive report
Referral: Time to takes to book, complete assessment, receive report
Laboratory: Time to takes to book, complete assessment, receive report
Management: Communication, appointments, fax, file work
Diagnostic lag time: onset-to-diagnosis
True or false: chiropractors are able to make a diagnosis of MS as it is an MSK condition
False - can have as differential but clinical guidelines, lab testing, and imaging is required
What is the MS prodrome?
Early set of S&S that indicate onset of a disease; precedes more obvious/typical symptoms that enable dx
Still controversial if one exists
Name 4 ddxs of MS
SLE
Lyme disease
HIV
Subacute combined degeneration
When is treatment of MS most effective?
Early, inflammatory phase (not later, neurodegenerative phase)
Which progression pattern of MS is MC treated with disease-modifying agents?
Relapsing forms
Which of the following CAM therapies has sufficient evidence for treatment of MS: A) Biofeedback B) Cannabinoids C) Reflexology D) Music therapy E) Low-fat diet with omega-3 supplementation F) Hypnosis G) Yoga H) Reflexology I) Bee venom
Cannabinoids
Reflexology
Bee venom
Low-fat diet with omega-3
What is the natural history of MS?
Very unpredictable! (Hallmark of MS is its unpredictability)
1/3 have a very mild course
1/3 have moderate course
1/3 become more disabled
Positive prognostic factors of MS
Female Onset before age 35 Mainly sensory symptoms Monofocal (not multifocal) episodes Complete recovery following relapse
What are 6 serious complications of MS?
Urosepsis (Untreated UTI) Pulmonary dysfunction Skin breakdown Untreated depression Osteoporosis
Individuals with MS tend to have a hypokinetic lifestyle. What are 3 serious complications of a hypokinetic lifestyle?
- Sarcopenia
- Dysmotility syndrome (>=3 of: osteoporosis, falls in preceding year, low lean mass, slow gait speed, low grip strength, obsesity/high fat mass)
- Frailty syndrome (>=3 of: weakness, slowness, low level of physical activity, self-reported exhaustion, unintentional weight loss)
What are the 4 components of core strength?
- Diaphragm strength
- Abdominal muscle strength
- Back extensor muscle strength
- Pelvic floor muscle strength
What exercise can be used to assess core strength?
Double-leg hip lift (assesses muscle strength, flexion/extension capacity, and neuromuscular control of core stability in a single plane)
