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Neuroconditions 2022 > MS > Flashcards

MS Flashcards

1
Q

What are the exercise nd physical activity recommendations for people with MS

A

>150 min /week of exercise and or >150 min/week of lifestyle physical activity

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2
Q

What can exercise and PA improve based on moderate evidence?

A

improve strength, mobility, fatigue, and QOL(participation)

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3
Q

What are the guidelines for exercise 2-3xweek to improve aerovic capacity and muscular strength that effects gait and monbility?

A

aerobic/endurance: 60-80% max HR, 30-60 minutes
resistance exercise: 2-3 sets at 8-15 RM for major muscle groups

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4
Q

what is relapse with MS and how to treat

A

treated acutely with steroids
more conservative with exercise and therapy

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5
Q

What is pseudo relapse

A

periods of where patients feels decline in function but no new brain activity or lesions: most often due to other factors like UTIs or other sickness
more common than actual relapse

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6
Q

How do you educate with tone management

A

spasticity – stretching may improve gait temporarily
PF and knee extensors/hip flexors 3x60 sec

educate
stretching ater sitting/driving for longer periods
avoid being sednetary longer periods
exercise in intervals

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7
Q

What medicine helps with spasticity

A

baclofen

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8
Q

What is the dosing for MS resistance training

A

2-3 sers at 8-15 RM (form fatigue)

higher intensity 80% of IRM (3x7-10 reps) 
max intensity (4 sets of 4 reps at 85-95% of I RM 
lower intensity 1 set 30 , 3 sets of 15 at 20-30% of I RM`
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9
Q

What can aerobic exercise do for people with MS

A

increase VO2 max

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10
Q

What are the dosing for aerobic training for MS

A

at least 30 min/day 3 days/wk; 60-80% HR max
consider intervals for fatigue
monitor effort level (modifed Borg or HR monitor)

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11
Q

What is intermittent walking program?

A

intermittent rest can manage pperformanace fatuge
resting every 2 minutes during 6mwt compared to continuous walking
bout of exercise throughout day

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12
Q

What is mS>

A

chronic often ddisabiling disease that attacks the central nervous syste. Thought to be an autoimmune disease

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13
Q

What is the prevalence/ incidnec of MS

A

global prevalence >2.5 million, US adults ~750,000

most common neurological condirion in young adults (late teens to 35)

women 2.5-2.8 x great than men

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14
Q

How do you diagnose MS

A

multiple facetos are needed to diagnose MS capturing dissemination in space and time

clinical exam: neurological exam for sings of UMN involvement

Medical hx: hx of past events consistent with MS

MRI images: start with brain, then spinal cord

lab tests: ex: CSF

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15
Q

What dose the 2017 McDonald critera allow for?

A

MS diagnosis with the first MRI

dissemination in space: lesions in 2 of 4 areas

oerventricular

brainstem

juxtacortical

spinal cord

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16
Q

What are the 4 areas lesions can take place in for MS

A

perventricular

brainstem

spinal cord

juctacortical

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17
Q

What type of MRI is used in MS

A

T2 weighting

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18
Q

What are the typical findings with t2 weighting MRI

A

multiple T2/flair whie matter lesions

lesions >3mm

often periventricular of juxatcortical

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19
Q

What do FLAIR lesions result from

A

gliosis (sclerosis), inflammation, demyelination, edema (rare)

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20
Q

Can T2 lesions correlate disability?

A

no, T2 lesions correlate poorly with disability

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21
Q

What are the typical findings with T1 MRI?

A

T1 weighting highlights myelin

dark= loss of acson

T1 hypointense lesions= black holes

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22
Q

What finding in a MRI correlates with disability?

A

black hole burden correlates with diability found with T1

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23
Q

What can an MRI of brain show for people with MS?

A

Depending on the type of MRI utilized can show black holes, lesions, and atropthy

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24
Q

What can an MRI of the spinal cord show for people with MS

A

short (<3 segment) spinal cord lesions. acutely show cord swelling and later atrophy of cord if damage is permanent

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25
Q

What can cerbrospinal fluid show in MS

A

elevated level of protein in CSF indicates abnormal immune response

oilgoclonal IgG bands in CSF

increased IgG index (>.68)

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26
Q

What are the four types of diagnoses for MS

A

relaspins remitting

primary progressive

secondary progressive

progressive-relapsing

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27
Q

What do osymtpoms of MS depend upon

A

location of the lesion

28
Q

What are the initial symptoms of MS?

A

limb weakness-40%

decreased vision/optic neuritis- 22%

tingling and unusal sensations such as electrical , itching or sunburned/ paresthesias -21%

double vision/ diploplia -12%

dizziness/vertigo- 5%

urinary bladder urgency, frep, hesitancy- 5%

pyramidal signs, (hyperreflexia, clonus, spasticity posterior column sensory deficits (vibration > proprioception), cerebellar (intention tremor, dysmetria)

29
Q

What is optic neuritis?

A

demyelination of optic nerve

painful vision loss – usually peaks in days/weeks, recovers usually in first month-6 motnths

other signs and symptoms– decreased color vision (red desaturation), field loss, central scotoma, relative afferent pupil defect

30
Q

What are the prognosis for MS?

A

50% will require aid to walk within 10 years

50% will develop cognitive deficits

50-80% wont be working in 10 years

loss of lifetime earning

loss of productivity

31
Q

What are good prognositic factors for MS?

A

optic neuritis at onset

sensory onset

little disability at 5 years

replasping/remitting

ful recovery from attacks

few OCB at diagnosis

32
Q

What are bad prognositic factors for MS

A

cerebellar dysfunction

motor symptoms at onset

high attack rate

progressive course

African Americans

baseline MRI with multiple lesions

33
Q

What are the causes of MS?

A

MS is a multifactorial disease caused by the interplay of environmental, genetic, and immune factors

34
Q

Where is the highest risk of MS in the worls

A

northern europe, northern US, canda, southern australia, new zealan

35
Q

Where in the world is the lowest risk of MS

A

asia, south american, uncahrted regions

(<5 per 100,000)

36
Q

What is the main environmental risk of MS

A

Vitamin D

sun expposure decreases with higher latitudes,

by increasing Vitamin D intake, higher the dose the fewer relapses

37
Q

What is the genetic susceptibility for MS

A

MHC association: HLA-DR2 for those of northern european descent

1: 1000 iin general population
1: 100 with first degree relative

67% with an identical twin

38
Q

What kind of disease is MS

A

T cell mediated disease

39
Q

What classifies a T cell mediated disease

A

overproduction of inflammatory cytokines

t cells (thymus gland)– cross BBB, and attack myeline

B cells (humoral– can present antigen to T cell

40
Q

What do new drug therapies try to target?

A

T and B cells, MS responds well to drugs that act on the immune system

41
Q

What are the acture pharmacolocgical management of MS

A

corticosteroids, plampheresis, cyclophosphamide

42
Q

What are maintenance disease modifying pharmacological managmant of MS

A

interferons

anti-neoplastic agents

glatiramer acetate

monoclonal antibodies

43
Q

What is an acute relapse in MS

A

a flare, (relapse, attack, bout, episode, exacerbation): >= 1 symtpom form MS with objective neurological deterioration lasting over 24 hours in the absence of fever and flollowing a neurologically stable perior of >30 days.

44
Q

What do steroids do for symptoms of MS

A

decrease inflammation

side effect: anxiety, trouble sleeping, high SBG, worsen stomach ulcers

45
Q

What does plasmaphereis do for MS

A

similar to dialysis

side effects: hypotension, blood clots, and infection

46
Q

What medicine is used for sever relapses

A

cyclophosphamide (cehmotherapy)

47
Q

What is the difference between the escalation approach and the risk appropriate appproach

A

esccaltion approach= may undertreat early, over treat later

risk appropriate= may match disease activity better

48
Q

What happend if there is a relapse during pregnancy?

A

corticosteroid use is probably safe to use to treat relapses in the second and third trimestes, but disease modyfing medication stop

49
Q

What is used to mangment the symtom of fatigue

A

alpha adrenergic receptio agonissts (Amantidine and Modafinil)

50
Q

What is used to maagment spasticity for MS?

A

bacloffen (oral and intrathecal)

51
Q

What is the most improant function fo people with MS?

A

walking

52
Q
A
53
Q

What types of things should you screen for for people with MS

A

memory/cognition - difficulties w/ dual taksing are associated with falls and gait issues

bladderl/ bowel – mod-servere bladder dysfunction associated with increased falls

cardiovascular– autonomic dsfunction can impair CV

autonomic function – Gi, sexual, sudomotor

intergumentary – AFOs, WCs, etc.

54
Q

What should you include in an exam for MSk and neurologic?

A

strength and motor function

somatosensation

ocular motor function

coordination

tone (spasticity)

55
Q
A
56
Q

What is the gold standard scale?

A

EDSS– Kurtzke expanded disability statuse scale

57
Q

What is the MS edge

A

overall review of 63 outcome measures that cover a range of body structure and function, activity, and participation and the utility of those outcome measures for patients with MS.

58
Q

What participation outsomes would you use for MS

A

MS-Walking scale 12

dizziness handicap inventory

modified fatigue impact scale

steps/physical activty

59
Q

What is a good way to measure physical activity for people with MS

A

Accelerometers and pedometers

,easures the total activity and sednrary time

validity: cut off of 3,279 stpes.day= fully ambulatory

less stpes may predict fall risk

60
Q

What is the MS walking scale

A

12-item questionarrie measure of walking related limitation, the higher the score the more imparied

0-24= independent

25-49= gait disability

50-74 une mployment

61
Q

What are the cutoff and discriminates for the 6MWT and the DGI

A

6MWT

mild 603 m

moderated 507 m

sever 389 m

DGI

<19 for falls

62
Q

What is an outcome measure for gait speed in MS?

A

timed 25 foot walk

measure of gait speed– 2 trials are averaged

norm= <4 sec

>6 sec= occupational changes

>8 sec= Medicare diability, dependence with ADLs, gait assistance

63
Q

What outcome measure discriminates between people with MS and healthy controls

A

TUG

MS 10 (1.7 sec)

control 8.71 (1.04)

64
Q

What is the computerized dynmaic posturography sensory organization test

A

measure of central sensory integration of balance that has 6 conditions

reliable in people with MS across 7–10 days

responsive to change affter vestibular rehab

65
Q

What s the modifited fatigue impact scale for participation for MS

A

measure of fatigue perception,

21 items

higher scores= more limitations due to fatigue

cut off indicating moderate or greater fatigue impact= 38

Neuroconditions 2022 (14 decks)

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