MS Flashcards
MS patho phys
Abnormal immuno-mediated response attacks myelin, oligodendrocytes, and the axons
Activation of immune cells that cross BBB, enter CNS
Acute inflammatory attack gradually subsides (REMISSION), remyelination occurs
Remyelination often incomplete
With time, anti-inflammatory responses/remyelination cannot keep up
Demyelinated areas undergo gliosis
White matter > gray matter
avg age of onset MS
15-50 yrs
predisposing factors MS
wome>men
caucasion
exposure to epstien barr virus
diagnosis
2 criteria
MRI gold standard
dissemination in space
dissemination in time
dissemination in space areas
preventricular
juxtacortical
infratentorial
spinal cord
early detection in MS has been shown to
significantly decline number of attacks lesion sites and disability
CIS what is it
First clinical episode of a disease that shows characteristics of inflammatory demyelination that could be MS but has yet to fulfill criteria of dissemination in time
most commonly affected areas in CIS
brainstem spinal cord optic nerve
risk factors for conversion to clinically definite MS
Polysymptomatic presentation
>2 T2 MRI lesions
Oligoclonal bands present in CSF, not in serum
CIS + MRI
CIS w/o MRI
60-80 to develop
20 to develop
CIS optic neuritis s/s
Unilateral reduced visual acuity
Orbital pain particularly with eye movement
Reduced color vision
Afferent pupillary defect
Retrobulbar or mild disc swelling
cis brainstem s/s
BL opthalmoplegia
Ataxia and gaze evoked nystagmus
6th nerve palsy
Multi-focal symptoms
Facial sensory loss
Vertigo
Ataxia
Dysarthria
spinal cord s/s cis
Spinal cord
Incomplete transverse myelitis
Positive Lhermitte’s sign
Sharp nerve pain (often described as an electric shock) that passes down posterior neck and into spine & extremities when patient flexes neck
Sphincter symptoms
Asymmetric limb weakness
Symptom progression between 4 hours and 21 days.
MS clinical s/s
motor
sensory
visual
cog
poor tolerance for temp
fatigue
pain
sleep disorders
B/b dysfx
sexual dys fx
ms cog hallmark
Hallmark: slowed information processing speed
pain ms s/s
Trigeminal Neuralgia
Paroxysmal limb pain
Headache
Chronic neuropathic pain
heat insensitivity MS
Uhthoff symptom
Increase in presence of neurological symptoms in response to heating condition
Pseudo-exacerbation
Neuroblockade hypothesis: de-myelinated neurons ability to conduct APs decreases as temperature increases
ms and fatigue
Tends to worsen as day progresses
Exacerbated by heat, exercises
ms and fatigue can often lead to
to fear of fatigue decreased physical activity disuse worsening disability
exacerbations ms
MS Exacerbation: new and recurrent MS symptoms lasting >24 hours
Idiopathic vs Exacerbating factors:
Viral or bacterial infections
Disease
Major or minor stressors
psudoexacerbations ms
Transient worsening of symptoms
Occurs due to stress, infection, overheating, or overexertion
RRMS
Clearly defined episodes of acute worsening of neurologic function (relapses), followed by partial or complete recovery (remissions) with periods of time between that patients are clinical free of disease progression
Relapses with either full recovery or some remaining neurological signs/symptoms
SPMS
Initially presents as RR period followed by a steady worsening of neurologic function, with or without relapses
Remissions are minor, or can have plateau
PPMS
Continuous worsening from initial onset without distinct relapses or remissions
May have occasional plateaus and temporary minor improvements
acute exacerbation tx
Immunosuppressant drugs: treat acute flare ups and shorten duration of episode
Prednisone
Methylprednisolone
Adrenocorticotropic hormone (ACTH)
disease modifying drugs
interferon
copaxone
interferon
IM or SC injections
daily 3xwk or weekly
slow prog of disease/s/s
AE - flu like leukopenia
copaxone
Daily subcutaneous injection
Synthetic protein designed to mimic effects of myelin protein
Side effects: flu-like symptoms, nausea, visual disturbances, edema in hands and feet
pain ms management meds
neurotin
urinary dysfunciton meds
anticholinergic
EDSS 8 systems
pyramidal - plegia
cerebellar
brainstem
sensory
b/b
visual
cerebral
other
disability categorization EDSS
0-3.5 norm to mild
4-5.5 mild to mod
6-7.5 mod to severe
8-9.5 severe disability bed or wheelchair bound
disease steps scale can only be used for ms until
they are in a wheelchair and then no further
12 item MS walking scale
EDSS level
cut off
0-7.5
>=75 fall risk
mean time before use of unilat AD ms
15-20yrs
life expectancy in ms
10 yr less
average yrs spent at each level
about 3
disease prognosis if they have white matter lesions on MRI
88 percent of developing MS
appearance of ____ = poor prog ms
new lesions on T2 weighted MRI in < 2mo
good prognosis MRI ms
low total lesion burden, low active lesion formation, and negligible myelin or axon loss
disease prognosis clinical
RRMS vs PPMS
# of CNS systems involved
age
neuro findings at 5yrs
Tx EDSS 0-2.5
min mob def
standard test might not be sensitive enough
assessment of pt when symptomatic is extremely helpful
focus on edu and max fit levels
EDSS 3-6 tx
impairments more apparent
may begin to impact activity
secondary impairments develop
Treatment considerations:
Intermittent versus continuous activity
Can improve tolerance by increasing rest periods
6.5-9.5 EDSS tx
Significant mobility and functional limitations
More pronounced comorbidities
Longer remission periods
Treatment considerations
Despite focus being largely compensatory and preventative, it can still be very meaningful!
Major goal is to improve safety and efficiency with mobility
