MS Flashcards
What are the exercise nd physical activity recommendations for people with MS
>150 min /week of exercise and or >150 min/week of lifestyle physical activity
What can exercise and PA improve based on moderate evidence?
improve strength, mobility, fatigue, and QOL(participation)
What are the guidelines for exercise 2-3xweek to improve aerovic capacity and muscular strength that effects gait and monbility?
aerobic/endurance: 60-80% max HR, 30-60 minutes
resistance exercise: 2-3 sets at 8-15 RM for major muscle groups
what is relapse with MS and how to treat
treated acutely with steroids
more conservative with exercise and therapy
What is pseudo relapse
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
How do you educate with tone management
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
What medicine helps with spasticity
baclofen
What is the dosing for MS resistance training
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`
What can aerobic exercise do for people with MS
increase VO2 max
What are the dosing for aerobic training for MS
at least 30 min/day 3 days/wk; 60-80% HR max
consider intervals for fatigue
monitor effort level (modifed Borg or HR monitor)
What is intermittent walking program?
intermittent rest can manage pperformanace fatuge
resting every 2 minutes during 6mwt compared to continuous walking
bout of exercise throughout day
What is mS>
chronic often ddisabiling disease that attacks the central nervous syste. Thought to be an autoimmune disease
What is the prevalence/ incidnec of MS
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
How do you diagnose MS
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
What dose the 2017 McDonald critera allow for?
MS diagnosis with the first MRI
dissemination in space: lesions in 2 of 4 areas
oerventricular
brainstem
juxtacortical
spinal cord
What are the 4 areas lesions can take place in for MS
perventricular
brainstem
spinal cord
juctacortical
What type of MRI is used in MS
T2 weighting
What are the typical findings with t2 weighting MRI
multiple T2/flair whie matter lesions
lesions >3mm
often periventricular of juxatcortical
What do FLAIR lesions result from
gliosis (sclerosis), inflammation, demyelination, edema (rare)
Can T2 lesions correlate disability?
no, T2 lesions correlate poorly with disability
What are the typical findings with T1 MRI?
T1 weighting highlights myelin
dark= loss of acson
T1 hypointense lesions= black holes
What finding in a MRI correlates with disability?
black hole burden correlates with diability found with T1
What can an MRI of brain show for people with MS?
Depending on the type of MRI utilized can show black holes, lesions, and atropthy
What can an MRI of the spinal cord show for people with MS
short (<3 segment) spinal cord lesions. acutely show cord swelling and later atrophy of cord if damage is permanent
What can cerbrospinal fluid show in MS
elevated level of protein in CSF indicates abnormal immune response
oilgoclonal IgG bands in CSF
increased IgG index (>.68)
What are the four types of diagnoses for MS
relaspins remitting
primary progressive
secondary progressive
progressive-relapsing
What do osymtpoms of MS depend upon
location of the lesion
What are the initial symptoms of MS?
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)
What is optic neuritis?
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
What are the prognosis for MS?
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
What are good prognositic factors for MS?
optic neuritis at onset
sensory onset
little disability at 5 years
replasping/remitting
ful recovery from attacks
few OCB at diagnosis
What are bad prognositic factors for MS
cerebellar dysfunction
motor symptoms at onset
high attack rate
progressive course
African Americans
baseline MRI with multiple lesions
What are the causes of MS?
MS is a multifactorial disease caused by the interplay of environmental, genetic, and immune factors
Where is the highest risk of MS in the worls
northern europe, northern US, canda, southern australia, new zealan
Where in the world is the lowest risk of MS
asia, south american, uncahrted regions
(<5 per 100,000)
What is the main environmental risk of MS
Vitamin D
sun expposure decreases with higher latitudes,
by increasing Vitamin D intake, higher the dose the fewer relapses
What is the genetic susceptibility for MS
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
What kind of disease is MS
T cell mediated disease
What classifies a T cell mediated disease
overproduction of inflammatory cytokines
t cells (thymus gland)– cross BBB, and attack myeline
B cells (humoral– can present antigen to T cell
What do new drug therapies try to target?
T and B cells, MS responds well to drugs that act on the immune system
What are the acture pharmacolocgical management of MS
corticosteroids, plampheresis, cyclophosphamide
What are maintenance disease modifying pharmacological managmant of MS
interferons
anti-neoplastic agents
glatiramer acetate
monoclonal antibodies
What is an acute relapse in MS
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.
What do steroids do for symptoms of MS
decrease inflammation
side effect: anxiety, trouble sleeping, high SBG, worsen stomach ulcers
What does plasmaphereis do for MS
similar to dialysis
side effects: hypotension, blood clots, and infection
What medicine is used for sever relapses
cyclophosphamide (cehmotherapy)
What is the difference between the escalation approach and the risk appropriate appproach
esccaltion approach= may undertreat early, over treat later
risk appropriate= may match disease activity better
What happend if there is a relapse during pregnancy?
corticosteroid use is probably safe to use to treat relapses in the second and third trimestes, but disease modyfing medication stop
What is used to mangment the symtom of fatigue
alpha adrenergic receptio agonissts (Amantidine and Modafinil)
What is used to maagment spasticity for MS?
bacloffen (oral and intrathecal)
What is the most improant function fo people with MS?
walking
What types of things should you screen for for people with MS
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.
What should you include in an exam for MSk and neurologic?
strength and motor function
somatosensation
ocular motor function
coordination
tone (spasticity)
What is the gold standard scale?
EDSS– Kurtzke expanded disability statuse scale
What is the MS edge
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.
What participation outsomes would you use for MS
MS-Walking scale 12
dizziness handicap inventory
modified fatigue impact scale
steps/physical activty
What is a good way to measure physical activity for people with MS
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
What is the MS walking scale
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
What are the cutoff and discriminates for the 6MWT and the DGI
6MWT
mild 603 m
moderated 507 m
sever 389 m
DGI
<19 for falls
What is an outcome measure for gait speed in MS?
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
What outcome measure discriminates between people with MS and healthy controls
TUG
MS 10 (1.7 sec)
control 8.71 (1.04)
What is the computerized dynmaic posturography sensory organization test
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
What s the modifited fatigue impact scale for participation for MS
measure of fatigue perception,
21 items
higher scores= more limitations due to fatigue
cut off indicating moderate or greater fatigue impact= 38
