MS

Question 1

Multiple Sclerosis is

Answer 1

chronic inflammatory, autoimmune, demyelinating disease of CNS

An abnormality in the immune response thatresults in an attack on the individuals own neural tissue

Question 2

Most common theory for MS

Answer 2

environmental trigger, probably a virus induces a delayed autoimmune attack on a genetically susceptible individual.

Question 3

Relapsing –remitting (RRMS)

Answer 3

relapses with full recovery or some remaining neurological symptoms and residual deficits. Then New attack

Question 4

MS New Attack

Answer 4

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

Question 5

Primary-progressive (PPMS)

Answer 5

progression from the onset without remission

Question 6

Secondary-progressive ( SPMS)

Answer 6

initial relapsing-remitting course followed by progression at a variable rate.

Question 7

Progressive-relapsing (PRMS)

Answer 7

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.

Question 8

General clinical mainifestation of MS pt 1

Answer 8

Heat sensitivity
Fatigue
Gait disturbance
Weakness, mild paresis to total paralysis
Spasticity
Balance and coordination
Speech and swallowing dysfunction
BB dysfunctipon

Question 9

General clinical manifestations of MS pt 2

Answer 9

Pain
Parenthesis and other sensory changes
Visual disturbances
Cog problems
Tremors
Depression

Question 10

McDonald Criteria

Answer 10

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

Question 11

McDonald- person who has 1 year steady disease progression needs

Answer 11

At least 2 of following:
>/= MS typical T2 lesion
>/= 2 T2 SC lesion
CSF oligioclonal bands

Question 12

MS cure

Answer 12

None

Question 13

MS treatment focused on

Answer 13

Immune modulation - slowing activated immune system from getting to central fibers slows the processes of demyelination in MS

Question 14

Phase 1 MS treatment (acute)

Answer 14

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

Question 15

Plasma exchange most helpful

Answer 15

In MS pts who had mild disability before attack

No proven benefit beyond 3 mo from onset of neuro symptoms

Question 16

MS tx phase 2

Answer 16

Med used to modify the course of disease progression as well as ongoing management of symptoms of MS

Question 17

MS beta infernos - subacute

Answer 17

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

Question 18

MS - ABC drugs

Answer 18

A - interferon beta 1a (avonex)
B- interferon beta 1b (betaseron)
C - glatiramer acetate (copaxone)

Question 19

MS - corticosteroid plus ACTH

Answer 19

Shortened recovery period after acute attack

Question 20

MS - avonex and refib (interferon beta 1a)

Answer 20

Slow down immune response -> reduce inflammation, swelling, rapid proliferation of T and B cells, block activated T cells from crossing BBB and damaging myelin

Question 21

MS betaseron

Answer 21

Higher dose of interferon eliciting a movie potent reponse

Question 22

MS copaxone

Answer 22

Immunomodulator
Decoy to clot T cell receptors
Fools immune system to decrease attack on myelin

Question 23

MS Mitoxantrone

Answer 23

Immunosuppressant
Modify replacing and secondary progressive MS
Only drug approved for tx of secondary progressive MS

Question 24

Natalizumab

Answer 24

Monoclonal antibody that prevents immune cells from moving from blood into CNS

Question 25

MS Fingolimod

Answer 25

New oral immunomodulating agent under eval for tax of relapsing remitting MS

Question 26

MS depression

Answer 26

Meds and sleep aid

Clonazepam used at night to aid in sleep intation and decrease spasm

Question 27

Ms and botulism

Answer 27

Focal injections to decrease spastic uncles

Question 28

MS PT manage

Answer 28

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

Question 29

Average frequency of attacks of MS

Answer 29

1 a year

Question 30

MS attacks tend to be more frequent in

Answer 30

Early stages,

Become less frequent in later years

Question 31

MS strongest predictor of outcome

Answer 31

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

Question 32

MS onset at young age

Answer 32

May be more favorable than onset after 40 which is associated w/ PRMS

Question 33

MS one f the most important prognostic factors

Answer 33

Neuro findings at 5 years
Sig pyramidal and cerebellar signs w/ involvement of multiple sites associated w/ poorer prognosis and a more severe disability

Question 34

MS and life expectancy

Answer 34

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

Question 35

MS Death rate in persons who are unable to walk or stand

Answer 35

More than 4x that in person same age w/out MS