MS

Question 1

Treatment goals

Answer 1

1. Shortening acute exacerbations, decreasing frequency of exacerbations, and relieving symptoms
2. Maintaining the patient’s ability to walk

Question 2

Treatment for Spasticity

Answer 2

Baclofen or tizanidine (Zanaflex)

Question 3

Tx for pain

Answer 3

gabapentin (Neurontin) or amitriptyline (Elavil)

Question 4

Tx for fatigue

Answer 4

Good sleep hygeine

Question 5

Tx for weakness/ataxia

Answer 5

PT for strengthening & balance

Question 6

Tx for depression

Answer 6

SSRI, support group for patient and family

Question 7

Tx for bladder dysfunction

Answer 7

Self-catheterization, Dietary changes, Avoid caffeine, alcohol and OJ, Antispasmodics

Question 8

Corticosteroid Use in Tx

Answer 8

anti-inflammatory, treat exacerbations

Question 9

Immunosuppressant use in Tx

Answer 9

slow/stop progression

Question 10

Immunosuppressant list

Answer 10

• Avonex IM or Rebif SQ (interferon beta 1a)
• Copaxone SQ (glatiramer)
• Gilenya PO (fingolimod)
• Tysabri IV (natalizamub)
• Tecfidera PO (dimethyl fumarate)

Question 11

Pathophysiology

Answer 11

: Inflammatory autoimmune disorder mediated by autoreactive lymphocytes: Activation of T lymphocytes against myelin antigens, axons and oligodendrocytes triggers an immunologic cascade. Recruitment of inflammatory cells and local release of cytokines and lymphokines results in injury to myelin and underlying axon. Axon demyelination and nerve fiber loss occur in patches throughout the CNS. Damaged myelin sheath can’t conduct normally and Loss of action potential causes neurologic dysfunction.

Question 12

Alternative theories of pathophysiology

Answer 12

1. Possible immune, but not autoimmune disorder due to chronic viral infection.
2. Nonimmune, noninflammatory etiology due to a genetically determined neuroglial degenerative process. 3. Chronic cerebrospinal venous insufficiency.

Question 13

Sxs

Answer 13

Paresthesias: extremities, trunk or unilateral face. Weakness/clumsiness in legs or hands. Visual disturbances: optic neuritis, diplopia due to ocular palsy, scotomas, gait disturbances, difficulty with bladder control, vertigo, mild affective disturbance, mild cognitive impairment, apathy, poor judgement, inattention, depression, seizures

Question 14

Diagnostic Studies: documentation evidence

Answer 14

Documentation of 2 distinct episodes of symptoms and 2 or more signs evident on neuro exam, episodes must last at least 24 hours and be separated by one or more months. Signs must be due to involvement of two or more separate parts of the brain or spinal cord.

Question 15

Diagnostic tests

Answer 15

• MRI (gadolinium enhanced) most sensitive diagnostic study for confirming MS. Shows brain atrophy
• CSF studies: ~80% have persistently elevated CSF IgG bands on electrophoresis
• Evoked potential test: measure electrical activity in certain areas of the brain in response to stimulation of certain groups of nerves