MS Flashcards
Multiple Sclerosis is
chronic inflammatory, autoimmune, demyelinating disease of CNS
An abnormality in the immune response thatresults in an attack on the individuals own neural tissue
Most common theory for MS
environmental trigger, probably a virus induces a delayed autoimmune attack on a genetically susceptible individual.
Relapsing –remitting (RRMS)
relapses with full recovery or some remaining neurological symptoms and residual deficits. Then New attack
MS New Attack
New symptoms must last at least 24 hours and be separate from other symptoms by at least 30 days to qualify as a new attack
Primary-progressive (PPMS)
progression from the onset without remission
Secondary-progressive ( SPMS)
initial relapsing-remitting course followed by progression at a variable rate.
Progressive-relapsing (PRMS)
progressive disease from onset but with clear acute relapses that may or may not have some recovery or remission.
Common in people who develop the disease after 40.
General clinical mainifestation of MS pt 1
Heat sensitivity Fatigue Gait disturbance Weakness, mild paresis to total paralysis Spasticity Balance and coordination Speech and swallowing dysfunction BB dysfunctipon
General clinical manifestations of MS pt 2
Pain Parenthesis and other sensory changes Visual disturbances Cog problems Tremors Depression
McDonald Criteria
For dx of MS
> /= 2 attacks and >/= 2 clinical evidence of lesion = MS
> /= 2 attacks and 1 clinical evidence of lesion and clear evidence of prior attack involving lesion in different location = MS
Other criteria gets more complicated. Just know big idea
McDonald- person who has 1 year steady disease progression needs
At least 2 of following:
>/= MS typical T2 lesion
>/= 2 T2 SC lesion
CSF oligioclonal bands
MS cure
None
MS treatment focused on
Immune modulation - slowing activated immune system from getting to central fibers slows the processes of demyelination in MS
Phase 1 MS treatment (acute)
Corticosteroids - reduce inflammation and shorten duration of flare ups
Plasma exchange - effective for people who have sudden, severe attacks of MS related disability but don’t benefit from high dose corticosteroid
Plasma exchange most helpful
In MS pts who had mild disability before attack
No proven benefit beyond 3 mo from onset of neuro symptoms
MS tx phase 2
Med used to modify the course of disease progression as well as ongoing management of symptoms of MS
MS beta infernos - subacute
Approved only for people who have relapsing forms
Reduce frequency and severity of flare ups
Prevent disability
Recommended for people who have more than one MS attack/year and for those who dont recover well from flare ups
MS - ABC drugs
A - interferon beta 1a (avonex)
B- interferon beta 1b (betaseron)
C - glatiramer acetate (copaxone)
MS - corticosteroid plus ACTH
Shortened recovery period after acute attack
MS - avonex and refib (interferon beta 1a)
Slow down immune response -> reduce inflammation, swelling, rapid proliferation of T and B cells, block activated T cells from crossing BBB and damaging myelin
MS betaseron
Higher dose of interferon eliciting a movie potent reponse
MS copaxone
Immunomodulator
Decoy to clot T cell receptors
Fools immune system to decrease attack on myelin
MS Mitoxantrone
Immunosuppressant
Modify replacing and secondary progressive MS
Only drug approved for tx of secondary progressive MS
Natalizumab
Monoclonal antibody that prevents immune cells from moving from blood into CNS
MS Fingolimod
New oral immunomodulating agent under eval for tax of relapsing remitting MS
MS depression
Meds and sleep aid
Clonazepam used at night to aid in sleep intation and decrease spasm
Ms and botulism
Focal injections to decrease spastic uncles
MS PT manage
Intervention to manage - fatigue, weakness, spasticity, sensory loss Balance and coordination training Improve speech Transfer and gait terminating W/c training Equipment/orthotic eval Referral for psychological issues
Average frequency of attacks of MS
1 a year
MS attacks tend to be more frequent in
Early stages,
Become less frequent in later years
MS strongest predictor of outcome
MRI
Scans w/ > 10 lesions - predict individuals will need cane w/in same time frame
Change in lesion load w/in first year is also a negative predictor of outcome
MS onset at young age
May be more favorable than onset after 40 which is associated w/ PRMS
MS one f the most important prognostic factors
Neuro findings at 5 years
Sig pyramidal and cerebellar signs w/ involvement of multiple sites associated w/ poorer prognosis and a more severe disability
MS and life expectancy
Reduced by a modest amount
74% surviving after 25 yrs after onset
Only small percent able to work 10 years after dx
15 years, 50% need AD
20 yrs, 50% W/c
MS Death rate in persons who are unable to walk or stand
More than 4x that in person same age w/out MS
