MS Flashcards
1
Q
What is MS
A
- CNS demyelination (initially) with development of plagues in CNS resulting in functional loss
- may be autoimmune
- immune mediated: T-cells, free radicals, glia (astropcytes/oligodendrocytes)
2
Q
Demographics of those diagnosed with MS
A
- age: ~35-45
- race: caucasian
- gender: women
- heredity: component/variant
- environmental exposure: northern climates, toxins
3
Q
Types of MS
clinically isolated syndrome
A
- symptoms appear but then never reappear
4
Q
types of MS
relapsing-remitting
A
- most common
- exacerbation
- long periods before next exacerbation
- gradual loss of function
- w/ full recovery from relpases or w. sequealae or residual deficits
5
Q
types of MS
primary progressive
A
- have 1st exacerbation but dont return to baseline
- just start to lose function
- accumulation of disability from onset with or without temporary plateaustin, minor remissions and improvements
6
Q
types of MS
secondary progressive
A
- relapsing remitting
- but does not get back to baseline
- accumulation of disability after initial relapsing course wiht or without occasional relapses and minor remissions
7
Q
MRI signs of MS
A
- perventricular white matter plaquestion- dawson’s fingers (small, finger-like lesions that appear on magnetic resonance imaging (MRI) scans of the brain) around corpus collosum
8
Q
How is MS diagnoses
A
- MRI: gold standard
- CSF testing: looking for proteins but not commonly used
- visual evoked potential: 1st sign is optic nerve involvement and this tests optic nerve
- (+) lhermittes sign: tingling or electrical sensation down the back with neck flexion
- optic coherence tomography: specialized CT scan to look at thinning or inflammation in retina
9
Q
Common sites for lesions to occur in CNS white matter with MS
A
- motor tracts
- posterior column (dorsal column)
- optic nerve
- brain stem
- cerebellar penuncles
10
Q
common clinical signs
A
- fatigue (most common)
- weakness
- sensory loss
- spasticity/hyperreflexia
- visual disturbance
- thermoregulation dysfunction (heat intolerance/hard to cool down)
- cerebellar signs
depend on where CNS is affects
11
Q
common clinical features: sensory
A
- paresthesia/numbness: mostly in feets and hands
- sensory ataxia
- dyscoordination
- sensory impairments with deep pressure, vibration, light touch
12
Q
common clinical features:
visual
A
- optic neuritis: acute loss of vision with possible long term deficits
- internuclear opthelamoplegia: paresis of medial recuts on attmpeted lateral gaze/with head turns
- blurred vision
- abnormal visla fields
- blind spots
- diplopia
13
Q
INO
A
- not only in MS patients but most commonly
- damage to middle part of brain
- allows coordination of medial rectus and lateral recuts between eyes especially with head turns
14
Q
common clinical features:
motor
A
- spasticity
- asymmetrical weakness
15
Q
common clinical features:
cerebellar signs
A
- nystagmus: pure horizontal
- cerebellar ataxia
- intention tremor
- balance disturbances
- dsyarthria
16
Q
common clinical features:
bladder dysfunction
A
- frequency: need to use bathroom more often
- dyssynergic bladder/hesitancy: can coordination sphincter to open with bladder contraction
- urgency: detrusor contracts strongly and sphincter cannot stay closed
- stress: waekness of pelvic floor+ stress muscles (cough, sneeze etc)
17
Q
disease modifying drugs
A
- interferon beta 1-a: avonex, rebif
- interferon beta 1b: betaseron, extavia
- glatirmer acetate: copazone
- monoclonal antibody: tysabri, PML (progressive multifocal leukoencephalopathy)
- antineoplastic: novatrone
- aubagio (ORAL)
- gilenya (oral)
18
Q
What can other MS drugs be used for
A
- exacerbations: steriods (minimize damage)
- fatigue: amantadine (antiviral)
- spasticity/gait impairment: ampyra/baclfen
- pain: klonopin, neurotin, elvail
- depression: prozac, cymbalata
- bladder dysfunction: oxybutinin, detrol, botox (first two are anticholinergics which may be detremental)
- ED: viagra
19
Q
common function problems with MS
and how can PT help
A
- motor control
- endurance/fatigue: energy conservation + monitor between sessions
- gait and functional mobility: loss of eccentric control
- incontinence: bladder/bowl (PNF can be beneficial and engage Pelvic floor)
- falls
- pain
- congition: affects brain/ can do dual task
- vision: aware of how their vision affects their balance
20
Q
Rehab considerations with MS
A
- heat/cold: thermoregulation issues
- humidity: hot humid environments may exacerbate symptoms
- fatigue
equipment needs (decline over time) - aquatics can be good but cannot be warmer than 94 and avoid humidity
21
Q
outcome measure for patients with MS
-
A
- expanded disability status scale
- MS quality of life inventory
- MS functional composite: timed 25 foot walk, PASAT (cognition), 9 hole peg test (UE function)
- SF-36: quality of life
recommended:
- standing balance; FICSIT-4
- functional reach test
- timed 25 foot walk
- 12 item MS walking scale
- dizziness handicap inventory
- rivermead mobility index
22
Q
complementary and alternative medicine for MS
A
- cannabis: should know what they are taking/interactions
- reflexology, massage, body work
- acupuncture
- yoga, t’ai Chi, aquatics
- low dose naltrexone: used for addiction but in lose doses can be beneficial for reducing symptoms especially spasiticiy
- chiropractic
