MS Flashcards
What is MS?
- The most common primary demyelinating disease (primary – idiopathic, presumably autoimmune) of CNS
- Lesions in the white matter
- Central: oligodendrocytes
Where do demyelinating lesions of MS occur?
- anywhere in the brain and spinal cord
- constellation of SxS of almost unlimited variety
Optic Nerve
- optic neuritis (pain)
- progressive loss of visual acuity (painless)
Brainstem
- Diplopia (III, IV, VI)
- Trigeminal neuralgia (V)
- Hemifacial spasm (VII)
- Vertigo, vomiting, nystagmus (VIII)
Cerebellum and spinocerebellar path
- Dysarthria, ataxia, abnormal stance and gait
Spinal Cord
- UMN weakness, spasticity, clonus, Babinski, sensory loss (dorsal columns and anterior lateral system), bowel and bladder dysfunction
Cerebral Cortex
- intellectual impairment, memory loss, emotional changes, depression
Temporal patterns of MS
- Relapsing/remitting (most common)
- Primary progressive
- Progressive-relapsing
Relapsing/remitting MS
- Most frequent exacerbations followed by less complete recovery than in benign form
- Stable: long periods of quiescence
- Secondary Progressive: fewer remissions with disease progression (more cumulative
disability)
Primary progressive MS
- Insidious relatively late onset and steady progression of symptoms and disability.
- More lesions in SC than brain. Different inflammatory cells.
Progressive- relapsing
often diagnosed as primary first, until a relapse occurs
5 major clinical subtypes of MS
- relapsing remitting
- primary progressive
- secondary progressive
- progressive relapsing
- clinically isolated syndrome
Relapsing remitting MS characteristics
characterized by specific attack
of deficits (relapse stage) with either full or partial recovery
(remitting stage); periods between relapses characterized by lack of disease progression
Primary Progressive MS characteristics
characterized by disease
progression and a deterioration of function from onset; may have slight fluctuations but specific attacks do not occur
Secondary progressive MS characteristics
characterized by an initial
relapsing remitting stage followed by a change to a
progressive course with steady decline in function and
impairments increase with or without specific attacks
Progressive relapsing MS characteristics
characterized by steady
deterioration in disease from onset with occasional attacks-
but time between attacks has continuing progression
Clinically isolated syndrome MS characteristics
first episode of
inflammatory demyelination in the CNS that could become MS
if additional activity occurs/progression to RRM
Risk factors of MS
- female for likely for RRMS
- equal for PPMS
- Age 20-30 for RRMS
- Age 40-50 for PPMS
Etiology of MS
unknown, likely viral or autoimmune
- May have a precipitating/exacerbating factors- infection,
trauma, pregnancy, stress
characteristics of MS overall
Demyelinating lesions (plagues) impair neural
transmission, causing nerves to fatigue rapidly
Where are lesions common?
pyramidal tract, dorsal columns, optic nerve, periventricular areas of cerebrum, cerebellar peduncles
Falls in MS
- Progressive MS classification is a significant risk factor
- use of mobility aid is a significant risk factor
- consider spasticity, gait disturbances, continence, and fear
Fatigue in MS
- Common but a separate entity –> physiologic basis unknown, different fro fatigue experienced by healthy individuals
- no correlation between severity of fatigue and involvement or severity of fatigue and depression
heat sensitivity
- internal sources or external sources
Uhthoff Symptom/ Phenomenon
- Increase or presence of neurological symptoms (vision, reflexes, sense) in response to a heating condition.
- Range of body temperature that could bring on neurological symptoms (.18 F –
4.14 F)
Expanded Disability Status Scale
0: normal neurologic function
1: no disability with only minimal signs
2: minimal disability
3: moderate disability
4: relatively severe disability
5: disability affects full daily activities
6: assistance required to walk and work
7: essentially restricted to WC
8: restricted to bed or WC
9: bedridden and unable to communicate effectively eat/swallow
10: death
MSQoL-54
structured, self-report questionnaire that the patient can generally complete with little or no assistance.
* It may also be administered by an interviewer. However, patients with visual or upper extremity impairments may need to have the MSQOL-54 administered as an interview.
Interventions
Guides by an understanding of the type of MS, location of the
plagues, general stages of the disease process, impairments,
and functional limitations present
View on exercise
- regular exercise is essential to preservation of function in this population by minimizing effects of immobility.
- Regarding influence on fatigue and relapse: Exercise therapy can be prescribed in
people with MS without harm. Exercise may reduce self-reported fatigue and does
not seem to be associated with a significant risk of MS relapse
Aerobic Training
- Autonomic regulation issues –> Usually a function of advancing disease
- Cardiorespiratory response
- It is likely that maximal aerobic capacity in persons with MS is partially
influenced by the level of neurological impairment –> Those with greater impairment sustain exercise for a shorter period of time, achieve a lower maximal exercise intensity and a lower oxygen uptake.
Precautions
- Strengthening and aerobic training can be safely performed in MS population
- Those with minimal impairments have best exercise tolerance and
get best benefit - Probably submaximal exercise for stable persons with MS
- Many unanswered questions
- Prevent over-fatigue and overheating
Preventing over-fatigue and overheating
- Aquatic therapy?
- Cooling suits
- Core body temperature changes throughout the day
- Try exercising in the morning * No information on exercise during exacerbations
- Don’t want to see increases in neurological signs/ symptoms
- Complaints of exercise – related fatigue or Uhthoff symptoms should resolve within an hour following cessation of activity or exposure.
Medical Management
- Immunosuppressant drugs- treat acute attacks and shorten episode
- Steroids
- Interferon drugs- slow disease progression
- Symptomatic management- tone reducing, bladder
Physical Therapy Goals
- Monitor changes in disease progression, attacks/change in
status - Rehab Goals- Focused on restoring function
- May receive intense therapy- RRMS- restore function
- Ongoing therapy needs- as disease progression occurs may need bouts of therapy to address new problems in function, maintain current level of function, address equipment needs
Energy Conservation
- Need to have an idea on level of fatigue and impact of fatigue throughout day
- Pacing, optimal scheduling, consideration of weather, use of devices
- Psychological support
