MS Flashcards
Facts and Aetiology of MS
Autoimmune disease with no cure, more common in females. Affects younger individuals
progressive and affects several body systems
Cause unclear
QoL reduced
Prevalence: 104 per 100,000
Risk factors for MS
Genetic predisposition (dysfunction in Human Leukocyte Antigen gene)
Latitude (sunlight/vitamin D exposure)
Viral exposure
Smoking
Obesity
What are the types of MS
Relapsing-Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Primary Progressive MS (PPMS)
Clinically Isolated Syndrome (CIS)
What is Relapsing Remitting MS (RRMS)
episodes of relapse where immune cells attack the brain followed by periods of remission, where symptoms may partially or fully resolve (85% have this kind at diagnosis)
Relapse can occur within days to years between
What is Secondary Progressive MS (SPMS)
Follows an initial RRMS course, then progressively worsens over time with fewer remissions
Progressive worsening of neurological function over time
What is Primary Progressive MS (PPMS)
progressive from onset
worsening neurological function from onset of symptoms without early relapses or remission
What is Clinically Isolated Syndrome (CIS)
The first episode of neurological symptoms caused by inflammation and demyelination but does not yet meet the criteria for MS
Patients may or may not go on to develop MS
Patients with CIS are more likely to develop MS if what changes?
MRI changes
Patients with CIS are less likely to develop MS if what doesn’t change?
MRI doesn’t change
Pathophysiology of MS
immune cells attack myelin and oligodendrocytes which leads to demyelination. This results in neuroinflammation and, over time, can lead to axonal loss, forming plaques in the CNS
Ultimately results in delayed transmission of information in the nervous system as demyelination occurs.
Difficulty with defining prognosis in people with MS
Prognosis varies due to different MS types, unpredictable disease progression and individual responses to treatment
Signs and symptoms of MS
Vision problems
numbness/tingling
fatigue
muscle weakness/spasms
Mobility issues
cognitive impairment
Balance difficulties
Bladder or bowel dysfunction
pain
depression
What is the EDSS for MS? What do scores indicate
Expanded Disability Status Scale
Ranges from 0-10 measuring disability and assesses functional systems
Scores from 1-4.5 indicate minimal to moderate disability where patients can walk independently
Scores from 5.0-9.5 reflect increasing severity, focusing on walking ability
Management of MS
Similar to that of Stroke
Impairments/activity limitations are similar to stroke so treat the same
Going to involve task-specific training, general exercise and falls prevention
Vary depending on Type of MS, stage of MS (remitting or stable), location of plaques/lesions
Impairments for MS
Muscle strength
muscle coordination
Spasticity
vision
sensation
proprioception
speech/language
Is fatigue a primary or secondary impairment in MS? How does fatigue affect physio?
Both
Fatigue can be a primary impairment due to neurological dysfunction
Fatigue can be a secondary impairment from conditions like depression or deconditioning
More common in patients with progressive disease and affects daily functioning
Most disabling symptom
Must consider fatigue when doing physio to consider energy levels to avoid fatigue exacerbation
What is fatigue aggravated by in MS?
heat, pain, depression and excessive exertion
How to manage fatigue in MS patients?
Monitor fatigue and explain to patients that symptoms may be exacerbated
Medication for fatigue
Emotional support
Energy conservation courses
Address secondary causes of fatigue (deconditioning and depression)
Address heat sensitivity
Appropriate exercise can reduce fatigue
Support offered by MS society
Cochrane evidence for using physiotherapy/exercise interventions for fatigue
Supports exercise interventions for managing fatigue. Physiotherapy showing benefits in improving endurance and reducing fatigue severity
Exercise therapy, particularly endurance, mixed or other training, may reduce self reported fatigue
Exercise not associated with risk of MS relapse
Fatigue measurement scales for MS
Fatigue severity scale
Use of Fatigue Diary
Define ataxia
Loss of dexterity/coordination
Reduction in spatial and temporal movement accuracy
Someone who is ataxic has deficits in what?
Movement
- speed/timing
- direction
- amplitude
- force
what is the role of the cerebellum
regulated movement coordination, balance and fine motor control
What are some adaptive motor behaviours that people with ataxia present with?
Excessive preshaping
Arms on tables (reduced degrees of freedom)
Restriction of movement amplitude (to control degrees of freem)
Wide base of support
Using arms excessively (with aids)
Excessive stepping
Walk faster (and difficulty slowing)
What are the treatment strategies to manage and treat ataxia
Use of external cues (visual, auditory and proprioceptive/tactile)
Balance training +/- ocular exercises and strengthening exercises
use of equipment (wheelchairs, parallel bars, standing frames, walkers, weights, special equipment)
use of constraints
Timing tasks - closed task and open task
Whole task training: must challenge movement, people won’t improve coordination by moving a single joint
Closed tasks for ataxia require
Rhythm
Open tasks for ataxia require
prediction
Evidence for physiotherapy for ataxia in MS
poor documentation and no recommendations can be made to guide prescribing
Exercise therapy for MS
Exercise therapy can be beneficial for patients with MS not experiencing an exacerbation
Evidence in favour of exercise therapy compared to no exercise therapy in terms of muscle power function, exercise tolerance functions and mobility related activities.
Improvements in mood
What drugs are used to treat MS attacks
Corticosteroids to reduce nerve inflammation
Plasma exchange to remove proteins that are ‘attacking’ the body
What are beta interferons used for in MS
Most commonly prescribed to treat RRMS
Reduces frequency and severity of relapses
Side effects: flu like symptoms and injection site reactions
What is Ocrelizumab used for in MS
Only approved treatment for PPMS
Slows worsening of disability in people with PPMS (and RRMS)
Reduces relapse rate in RRMS
Side effects: low BP, fever, nausea
What are antispastic medication used for in MS
for spasticity/dystonia and reduces muscle activity
Side effects: tiredness, falls, feelings of weakness
