MS 2

Question 1

Prognosis MS

Answer 1

• 74% of patients survive 25 years after onset
• Few are still working 10 years after onset
• 50% will require an assistive device for gait 15 years after onset
• 50% will require a wheelchair for mobility 20 years after onset

Question 2

Predictors of favorable prognosis

Answer 2

-Onset with only 1 primary symptom
-Benign and RRMS have more favorable prognosis
-Age of onset under 40
Over 40 is associated with PPMS
-Neurologic imaging at 5 years-makes sense right?
Poor prognosis associated with multiple lesions a pyramidal and cerebellar sites
Few overall lesions associated with better prognosis

Question 3

Medications

Answer 3

• Is not 100% preventative of relapses
• Only partially successful
• Can decrease rate of relapse by up to 30%
• Reduces severity of relapses
• Decreased number and smaller total area damaged on MRI studies
• No medications can reverse existing deficits

Question 4

medication

Answer 4

—Synthetic Interferon-blocks T cells from crossing the blood brain barrier Immunomodulator
Decreases B and T cells
—Copaxone (Glatiramer acetate)
Immunomodulatory
Acts as a decoy and binds T cell receptors
—Novantrone
Immunomodulator
Has a limited life-time dose as it can damage the heart

Question 5

relapse management

Answer 5

-Corticosteriod therapy-decreased inflammation

Must be given acutely
Generally IV for 5 days followed by an oral taper of up to 6 weeks

-Side effects

Agitation
Nervousness
GI distress
Increased appetite
Increased susceptibility for infection

–Benefits

Decreased swelling in the CNS
Possible decrease in circulating toxins and immune

Question 6

intervention types

Answer 6

Aim is to minimize potential complications, impairments, functional limitations and disability
3 kinds

-Primary Prevention-prevention of disease in a susceptible population-example preventing MS itself

Secondary Prevention-decreasing the duration and severity of symptoms or delaying the emergence of disease sequelae through early detection and intervention – preventing balance issues

Tertiary Prevention-minimizing the degree of disability- may need a cane for gait but not a walker

Question 7

Compensatory intervention type

Answer 7

Aimed a modifying the task, activity, or environment in order to allow the patient to remain fully functional within the scope of existing impairments

Example: instead of bowling with only a ball, a ramp or a ball with handle is used

Question 8

Maintenance Intervention type

Answer 8

Occasional, clinical, educational, and administrative services designed to maintain the patients current level of function
Generally in utilized during later stages of disease
Not well funded by insurance

Question 9

Outcome Measures

Answer 9

MSQOL-54
Modification of the Health Status Questionaire (SF-36)
11 subscales related to MS
Problems-must contact author for permission to use, but it is free online…

Multiple Sclerosis Impact Scale (MSIS-29)-total 145 the higher the score the greater the perceived disability
Measures the physical and psychological impact
Can be used for community based individuals and inpatient

Expanded Disability Status Scale (EDSS) for Patients with MS
Widely adopted 
Used to standardize MS research
Based on 7 functional systems
Pts are graded on presenting symptoms 
Flaws
Heavily relies on mobility
History of problems with interrater reliability with less impaired individuals