MS Flashcards
1
Q
Frequency
A
- more than 2.3 million worldwide
- females > males (women are 2-3X more likely)
- mostly Caucasian population
- high frequency: Northern US, Scandinavian countries, and northern Europe
2
Q
Age
A
- Most people are diagnosed between the ages of 20 and 50
- Although MS can occur in young children and significantly older adults
3
Q
Genetic Factors
A
- more common in Caucasians of northern European ancestry.
- More common in areas farthest from the equator.
- United States - about one chance in 750 of developing MS
- For first-degree relatives of a person with MS, such as children, siblings or non-identical twins, the risk rises to approximately 1/40
- The identical twin of someone with MS has a 1/4 chance of developing the disease
4
Q
CNS
A
- Demyelinating lesions and plaques are found throughout the CNS especially in the periventricular areas of cortex, cerebellum, brainstem and spinal cord
- Does not involve the PNS
5
Q
What is MS?
A
- Autoimmune disease in which the oligodendrocytes (myelin) is attacked by the person’s own antibodies
- Immunological mediated pathogenesis
- De-myelination leads to NCV abnormalities: slowing of transmission or conduction blocks cross-talk (neurons “talk” to each other since myelin no longer insulates)
- Produce patches of demyelination = plagues in the white matter
6
Q
Immunological mediated pathogenesis
A
- Slow virus theory - acquire virus during puberty lies dormant (mean approximately 12 years) before MS begins
- Autoimmune reaction theory - CNS reaction against itself resulting in demyelination
7
Q
Diagnosis
A
- Hard to diagnose.
- No single test for MS, the diagnosis can be missed, delayed or even incorrect.
- MS is not a “reportable” disease, which means that the government does not require physicians to inform any central database when they make the diagnosis. Without this kind of centralized reporting system, there is no easy way to count people with MS.
-Multiple courses - relapses and remissions, relentless progression, very slow progression
8
Q
Multiple symptoms
A
- dependent upon where the plaques, inflammation and demyelination are located
- Sensory disturbances
- Paresis of one or multiple limbs
- Cerebellar movement disorders (intention tremor, ataxia, dysmetria, loss of balance, poor coordination, ataxic gait)
- Fatigue – major problem is persistent fatigue, loss of energy, decreased tolerance to exercise
- Visual disturbances
- Bowel, bladder, and/or sexual disturbances
- Heat cam increase symptoms
9
Q
Relapsing-Remitting MS (RRMS)
A
- Most common disease course
- Clearly defined attacks of worsening neurologic function
- attacks=relapses, flare-ups, or exacerbations –>followed by partial or complete recovery periods
- symptoms will improve partially or completly with no progression of the disease in these stages
- 85% of cases are initially diagnosed with RRMS
10
Q
Secondary-Progressive MS (SPMS)
A
- follows after the RRMS
- Most pts diagnosed with RRMS –> SPMS
- Disease will begin to progress more steadily with or without relapse
- Doesn’t necessarily progress quickly
11
Q
Primary-Progressive MS (PPMS)
A
- Steadily worsening neurologic function from the beginning
- Rate of progression may vary over time with occasional plateaus and temporary, minor improvements
- No distinct relpases or remissions
- About 10% of pts are diagnosed with PPMS
12
Q
Progressive-Relapsing MS (PRMS)
A
- Least common
- Steadly progressing disease from the begnning and occasional exacerbations along the way
- Pts with this form of MS, may or may not experience some recovery following these attacks
- The disease continues to progress without remissions
13
Q
PTs need to KNOW
A
Adverse reaction to heat (internal and external) - may exacerbate symptoms:
- Hot packs
- Immersion in water
- Hot weather
- Illness with fever
14
Q
Intervention
A
Vitamin D
Sunlight
