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Neuro Clinic > MS > Flashcards

MS Flashcards

1
Q

what is MS?

A

lesions (plaques) in primary white matter throughout the CNS- demyelinating

destruction of oligodendrocytes- cell bodies and axons tend to be spared

common sites

impairs neural transmission causing nerves to fatigue rapidly (not efficient when moving from node to node)

myelin sheath is replaced by fibrous scarring produced by glial cells (gliosis)

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2
Q

who gets MS? when?

A

onset of MS typically occurs between 15-50 years old.

peak age=30

2:1 more women

predominately white

geographical pattern with areas of high, medium and low frequencies. Best linked to vitamin D deficiency
High = temperate zones of northern US, scandinavian countries, northern Europe, southern Canada, New Zealand, and southern Australia.
Medium= closer to the equator
Low= tropical areas

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3
Q

what is the etiology of MS?

A

unknown

theory- autoimmune disease induced by a viral or other infectious agent (herpes and chlamydial pneumonia)

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4
Q

what is the clinical course of MS?

A

relapsing remitting (RRMS)

primary progressive (PPMS)

secondary progressive (SPMS)

progressive-relapsing (PRMS)

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5
Q

what is RRMS?

A

relapsing remitting MS

80%

usually early diagnosed, mostly women

clearly defined disease relapses, periods of acute worsening of neurological function, followed by remissions (periods without disease progression and partial or complete abatement not S&S)

~80% of RRMS cases go on to develop SPMS

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6
Q

what is SPMS?

A

begins with a relapsing remitting course followed by progression with or without occasional relapses, minor remissions and plateaus

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7
Q

what is PPMS?

A

rare form occurring in about 10& of cases.

Characterized by a nearly continuous worsening of the disease from the onset without distinct relapses.

some do have occasional plateaus or temporary minor improvements.

typically has a later onset, usually after 40.

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8
Q

what is PRMS?

A

progressive relapsing MS

characterized by progressive disease from onset but without clear acute relapses that may or may not have some recovery or remission

commonly seen in people who develop the disease after 40

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9
Q

what is benign MS?

A

characterized by mild disease in which patients remain fully functional in all neurological systems 15 years after onset.

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10
Q

what is malignant MS?

A

“Marburg’s variant”

characterized by rapid progression leading to significant disability or death within a relatively short time after onset

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11
Q

what are exacerbating factors?

A

defined by new and recurrent MS symptoms that last at least 24 hours and are unrelated to another etiology.

avoiding these aggravating factors is important in ensuring the patient’s optimal function

pseudoexacerbation= temporary worsening of MS symptoms. episode typically comes and god quickly, usually within 24 hours.

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12
Q

what is Uthoff’s symptom?

A

adverse reaction to heat

anything that raises the body temp can bring on a pseudo-attack

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13
Q

what are clinical S&S of MS?

A

1= fatigue

weakness

sensory disturbances

spasticity

dizziness/vertigo

sexual dysfunction

cerebellar disturbances:

  • poor balance
  • intention tremors
  • ataxia
  • dysmetria
  • dysdiodochokinesia
  • dyssynergia

visual disturbances:

  • diplopia
  • nystagmus
  • blurred vision
  • optic neuritis
  • scotoma (blind spot)

communication/swallowing:

  • dysarthria
  • dysphagia

bladder/bowel disturbances:

  • decrease frequency
  • urgency
  • incontinence
  • retention
  • hesitancy

cognitive/behavior disturbances:

  • memory
  • attention/concentration
  • learning
  • visuospatial skills
  • emotional changes
  • depression
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14
Q

what are tests and measures for body structure and function?

A

aerobic capacity and endurance

ataxia

cardiovascular/pulmonary status

dizziness/vestibular

fatigue

flexibility

muscle performance

pain

posture

sensory integrity

somatosensation

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15
Q

what are tests and measures for activity?

A

balance/falls

bed mobility

gait

reach and grasp

transfers

wheelchair skills

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16
Q

what are OM for participation?

A

health and wellness

home management

leisure

QOL

role function

shopping

social function

work

17
Q

outcome measurement rating scale:

A

4: highly recommend:
- excellent psychometric in MS population
- excellent clinical utility in an MS population (administration <20 min, requires equipment typically found in the clinic, no copyright payment required, easy to score)

3: recommend:
- good psychometrics in MS pop
- good clinical utility

2: unable to recommend at this time:
- insufficient info to support a recommendation for individuals w/ MS

1: do not recommend
- poor psychometrics, poor clinical utility , or both in an MS population (time, equipment, cost)

18
Q

what does an EDSS range of 0.0-3.5 on the expanded disability status scale mean?

A

low end of range= normal

upper end of range=

  • moderate disability in 1 FS or mild disability in 3-4 FS
  • fully ambulatory
19
Q

what does an EDSS range of 4.0-5.5 on the expanded disability status scale mean?

A

low end of range=

  • fully ambulatory w/o aid or rest at least 500m
  • self sufficient, but relatively severe disability

Upper end of range=

  • ambulatory w/o aid 100m
  • disability precludes full daily activities
20
Q

what does an EDSS range of 6.0-7.5 on the expanded disability status scale mean?

A

Low end of range=
-intermittent or unilateral assist for walking 100m

Upper end of range=

  • unable to take more than a few steps; restricted to w/c
  • may need assistance for transfers
21
Q

what does an EDSS range of 8.0-9.5 on the expanded disability status scale mean?

A

Low end of range:

  • restricted to bed/chair/w/c
  • retains self-care; effective UE use

Upper range:

  • restricted to bed
  • dependent
  • unable to communicate and swallow
22
Q

what are recommendations for practice setting?

A 
acute care
inpatient rehab
home health
skilled nursing
outpatient
23
Q

what are meds used for an acute attack?

A

1- corticosteroids

2- plasmapheresis

24
Q

what do corticosteroids do?

A

used for acute MS attacks

used to reduce the inflammation that spikes during a relapse.

ex:
- oral prednisone (Deltasone)
- intravenous methylprednisolone (Solu-medrol)

side effects may include mood swings, seizures, weight gain and increased risk of infections

25
Q

what is plamapheresis?

A

used for acute MS attacks

removes some blood and mechanically separates blood cells from plasma

mix blood cells with a replacement solution and return to the body

26
Q

what are disease modifying drugs for MS?

A

1- beta interferons

2- glatiramer acetate (copaxone)

3- natalizumab (tysabri)

4- novantrone (mitoxantrone)

5- fingolimod (gilenya)

6- teriflunomide (aubagio)

27
Q

what is beta interferons?

A

disease modifying drug for RRMS

(avonex, betaseron, extavia and rebif)

appears to slow the progress of MS, reduce the # of attacks and lessen the severity of attacks.

interferons can cause many side effects: including reactions in the injection area and liver damage

biggest complaint= injection site is sore

28
Q

what is glatiramer acetate?

A

(Copaxone)

may reduce the # of MS attacks

works by blocking your immune system’s attack on myelin

subcutaneously injection once daily

side effects may include flushing, chest pain or heart palpitations after injection and reactions at the injection sites

29
Q

what is Natalizumab ?

A

(Tysabri)

interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and SC

this med increases the risk of progressive multifocal leukoencephalopathy (PML)- a brain infection that is usually fatal.

30
Q

what is Novantrone ?

A

(Mitoxantrone)

immunosuppressant med can be harmful to the heart and is associated with development of blood cancers like leukemia

because of these risks, it is usually only used to treat active severe, advanced MS, based on both clinical assessment and MRI studies

31
Q

what is fingolimod?

A

(Gilenya)

an oral med given once daily, this works by trapping immune cells in lymph nodes

heart rate is monitored for 6 hours after the 1st dose bc is can result in bradycardia

must be immune to the chickenpox virus

other side effects include diarrhea, cough and headache

32
Q

what is teriflunomide?

A

(Aubagio)

oral med- reduces attacks and lesions

blood tests required to monitor liver function

can also cause serious fetal damage and it must not be taken during pregnancy

other side effects include diarrhea and nausea

this med stays in your system for months. if you have complications, additional meds can be administered in order to help your body rapidly eliminate the drug

33
Q

what drugs are used for spasticity in MS?

A

Lioresal (baclofen/intrathecal baclofen)

Valium (diazepan)

Dantrium (dantrolene)

Botox

Klonopin (clonazepam)

34
Q

what drugs are used for fatigue?

A

amantadine

provigil

prozac

35
Q

what drugs are used for gait?

A

dalfampridine (ampyra) - improve walking speed in some people

major side effect= seizures

36
Q

what are complementary/ alternative meds for MS?

A

diet

acupuncture

stress management

marijuana

exercise- tai chi, yoga

37
Q

what is the focus of tx? what are concerns?

A

increase sensory awareness; compensate for sensory loss; promote safety

pain management

exercise sessions should be scheduled on alternate (non endurance) days and during optimal times (morning when body temps are lowest and before fatigue)

submax exercise intensities (mod intensities 50-70% MVC)

circuit training (alternating UE and LE) may prove best for reducing likelihood of fatigue

adequate rest periods

slow progressions

manage core body temp

group exercise

Neuro Clinic (14 decks)

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