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Sub Acute Final Prep Sean > MS > Flashcards

MS Flashcards

1
Q

Facts and Aetiology of MS

A

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

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2
Q

Risk factors for MS

A

Genetic predisposition (dysfunction in Human Leukocyte Antigen gene)
Latitude (sunlight/vitamin D exposure)
Viral exposure
Smoking
Obesity

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3
Q

What are the types of MS

A

Relapsing-Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Primary Progressive MS (PPMS)
Clinically Isolated Syndrome (CIS)

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4
Q

What is Relapsing Remitting MS (RRMS)

A

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

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5
Q

What is Secondary Progressive MS (SPMS)

A

Follows an initial RRMS course, then progressively worsens over time with fewer remissions

Progressive worsening of neurological function over time

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6
Q

What is Primary Progressive MS (PPMS)

A

progressive from onset
worsening neurological function from onset of symptoms without early relapses or remission

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7
Q

What is Clinically Isolated Syndrome (CIS)

A

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

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8
Q

Patients with CIS are more likely to develop MS if what changes?

A

MRI changes

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9
Q

Patients with CIS are less likely to develop MS if what doesn’t change?

A

MRI doesn’t change

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10
Q

Pathophysiology of MS

A

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.

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11
Q

Difficulty with defining prognosis in people with MS

A

Prognosis varies due to different MS types, unpredictable disease progression and individual responses to treatment

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12
Q

Signs and symptoms of MS

A

Vision problems
numbness/tingling
fatigue
muscle weakness/spasms
Mobility issues
cognitive impairment
Balance difficulties
Bladder or bowel dysfunction
pain
depression

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13
Q

What is the EDSS for MS? What do scores indicate

A

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

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14
Q

Management of MS

A

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

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15
Q

Impairments for MS

A

Muscle strength
muscle coordination
Spasticity
vision
sensation
proprioception
speech/language

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16
Q

Is fatigue a primary or secondary impairment in MS? How does fatigue affect physio?

A

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

17
Q

What is fatigue aggravated by in MS?

A

heat, pain, depression and excessive exertion

18
Q

How to manage fatigue in MS patients?

A

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

19
Q

Cochrane evidence for using physiotherapy/exercise interventions for fatigue

A

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

20
Q

Fatigue measurement scales for MS

A

Fatigue severity scale

Use of Fatigue Diary

21
Q

Define ataxia

A

Loss of dexterity/coordination

Reduction in spatial and temporal movement accuracy

22
Q

Someone who is ataxic has deficits in what?

A

Movement
- speed/timing
- direction
- amplitude
- force

23
Q

what is the role of the cerebellum

A

regulated movement coordination, balance and fine motor control

24
Q

What are some adaptive motor behaviours that people with ataxia present with?

A

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)

25
Q

What are the treatment strategies to manage and treat ataxia

A

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

26
Q

Closed tasks for ataxia require

A

Rhythm

27
Q

Open tasks for ataxia require

A

prediction

28
Q

Evidence for physiotherapy for ataxia in MS

A

poor documentation and no recommendations can be made to guide prescribing

29
Q

Exercise therapy for MS

A

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

30
Q

What drugs are used to treat MS attacks

A

Corticosteroids to reduce nerve inflammation

Plasma exchange to remove proteins that are ‘attacking’ the body

31
Q

What are beta interferons used for in MS

A

Most commonly prescribed to treat RRMS
Reduces frequency and severity of relapses

Side effects: flu like symptoms and injection site reactions

32
Q

What is Ocrelizumab used for in MS

A

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

33
Q

What are antispastic medication used for in MS

A

for spasticity/dystonia and reduces muscle activity

Side effects: tiredness, falls, feelings of weakness

Sub Acute Final Prep Sean (10 decks)

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