MS Flashcards
MS is a _________ disease that primarily affect the _____
immune-mediated
CNS
True or False?
Research suggests that MS may be the result of an abnormal autoimmune response to some infection or environmental trigger in a genetically susceptible individual
true
MS is an inflammatory disease that destroys?
areas of myelin in the CNS, primarily white matter
what is the most common area in the CNS that MS attacks?
optic nerve
in MS, ________ become rreversibly damaged as a result of the inflammation, even early in the disease
axons
damage areas become
slclerotic
90% of pts are diagnosed between ____ and _____
16-60
true or false
men have a more aggressive version and it more prevalent compared to women
False
women to men 2-3:1
However male form appears to be more aggressive
MS is prevalent in ______ zones
temperates zones
True or False
First degree relative with MS = greater risk of developing MS
True
most common S/S of MS?
Fatigue (88%) Difficulty walking (87%) Bowel & bladder problems (65%) Pain and other sensory changes (60%) Visual disturbances (58%) Cognitive problems (44%) Tremors (41%)
what are examples of cognitive problems that MS pts have trouble with?
dual to multi-tasking
difficulty following detailed instructions
decreased ST memory
what are other common symptoms?
nystagmus speech difficulty incoordination weakness spasticity muscle spasms sexual dysfunction emotional instability
Initials attacks of MS are often _______, ___ and _______
transient
mild
self-limited
How to Diagnosis MS?
Clinical attacks
MRI
CSF (elevated gamma globulin levels and possibly WBC)
+ Evoked Potentials ( Central N. conduction testing )
what are some factors that seem to predict a more favorable MS course?
Female
onset before 35
monoregional vs polyregional attacks
complete recover after an exacerbation, leaving little or no residual impairment
what are some factors that seem to predict a poor prognosis of MS?
Male gender
Onset after age 35
Brainstem symptoms such as nystagmus, tremor, ataxia, and dysarthria
Poor recovery following exacerbations
Frequent attacks
African-Americans (less likely to have MS, but more likely to have a more progressive form of the disease)
what are some covert symptoms of MS?
fatigue pain vision bowel and bladder paresthesias
what are the 4 categories of MS established by the National Multiple Sclerosis Society?
Relapsing-remitting
Primary-progressive
Secondary-progressive
Progressive-relapsing
what is the most common form of MS at the time of initial diagnosis?
Relapsing-Remitting MS
Relapsing-Remitting MS makes up ______ % of MS
85
Relapsing-Remitting MS has clearly define ______ with periods of ______
flare-ups
remissions
_____ % of relapsing-remitting MS develop Secondary-Progressive MS within ______ years
50
10
Explain the course of Secondary-Progressive MS
Initial Relapsing-Remitting course followed by progression with or without occasional relapses, minor remissions with some recovery and plateau
_________ MS is relatively rare only making up 10% of MS
Primary-Progressive MS
true or false
Primary-Progressive MS has a disease progression without plateaus or with occasional plateau and temporary minor improvements possible
true
true or false
with Primary-Progressive MS, a person has to have an attack to have an increase in disabilityTr
False
Steady increase in disability without “attacks”
Progressive-Relapsing MS is the rarest of on ___% of pts getting it?
5%
True or False
Progressive-Relapsing MS is progressive from onset
true
Progressive-Relapsing MS has clear acute relapses, ____ or _____ full recovery
with or without
what are the 5 categories of treatment for MS?
Treatment of acute exacerbations Symptom management Disease modification Rehabilitation Psychosocial support
what are factors triggering a relapse of MS?
often unpredictable infections physical and emotional stress heat can transiently increase symptoms Last trimester of pregnancy offers a natural protection against a relapse
true or false
vaccine are not safe for MS patients?
Influenza vaccines are safe; no vaccines have been found to increase relapse incidence
pool recommended temp for MS pts is ______ degrees
<85
____-____% increased risk for relapse after a delivery of baby
20-40
with acute relapse management, natural improvement occurs over _____-____ weeks
4-12
corticosteroids help by?
attempts to end the attack sooner and leave fewer permanent lesions
true or false
corticosteroids have evidence that is decreases the extent of overall disability
False
Little evidence that these medications alter the extent of disability or overall course of the MS.
what are the goals of managing MS?
Reduce frequency of relapses
Reduce progression of disability
Reduce number and volume of brain lesions
what is Avonex?
For treatment of all relapsing forms of MS and for a single clinical episode if MRI is consistent with MS
Weekly IM injection
what is adverse reactions of Avonex?
Flulike symptoms after injection
Depression, mild anemia, elevated liver enzymes, allergic reactions, heart problems
what is Rebif?
For all relapsing forms of MS
3x/week IM injection
what are the adverse reactions of Rebif?
Flulike symptoms
Injection site reactions, liver abnormalities, depression, allergic reactions, low red or white blood cell counts
what is Betaseron & Extavia?
For the treatment of all relapsing forms of MS
Every other day subcutaneous injection
what are the adverse reactions of Betaseron & Extavia?
Flulike symptoms after injection
Injection site reactions
Allergic reactions, depression, elevated liver enzyme levels, low white blood cell counts
what is a precaution of Betaseron & Extavia?
Should not be given to patients with severe and untreated depression due to increased risk of suicide associated with this treatment
what is copaxone?
For the treatment of relapsing/remitting MS
Daily subcutaneous injection
what are the adverse reactions of Copaxone?
njection site reactions
Vasodilation, chest pain, anxiety, palpitations, shortness of breath, flushing (5-10 min after injection; no known long-term effects)
what is Novantrone (Serono)?
For worsening relapsing/remitting MS and for progressive relapsing or secondary progressive
MS 4x/year IV infusion
_______ is generally recommended for individuals with an inadequate response to, or are unable to tolerate other MS drugs
Tysabri (Natalizumab)
Tysabri (Natalizumab) is taken every _____ weeks by ____ ______
4 weeks
IV infusion
adverse reactions of Tysabri (Natalizumab) include?
increased risk of progressive multifocal leukoencephalopathy (PML), infusion reactions, headache, fatigue, joint and limb pain, abdominal discomfort, diarrhea, and rash
what do PTs need to do/know about MS pts?
General knowledge pertaining to medication side effects
Coordination of treatment and medication schedules
Make note of changes in patient’s performance
PT treatment for MS pts compose of?
Support coordinated care & patient empowerment Wellness and health promotion Fatigue Weakness Spasticity Balance/Vestibular Coordination Sensory Problems Ambulation and Mobility Activities of Daily Living
what are reasons MS pts may have fatigue that can be addressed?
decrease sleep poor diet deconditioning movement limitations depression neuromuscular conditions body core temp emotional stress
true or false
Rising of core body temp increases conduction velocity
False
slows it
true or false
while heat might aggravate common symptoms, there is no link to causing an exacerbation of the disease
true
what is something a person with MS can use to help against heat sensitivity?
cooling garments
