MS Flashcards
1
Q
what is multiple sclerosis or, MS?
A
- immune-mediated,…
- inflammatory,…
- neruodegenergitive disease of the CNS
2
Q
Symptoms of MS may include:
A
- cognitive dysfunction
- depression
- fatigue
- gait impairment
3
Q
Describe the pathophysiology of MS
A
- heterogenous disorder characterized by
- inflammation
- dymelination
- axonal degeneration
- Early Disease
- autoreactive lympocytes cause inflammation (with BBB disruption)
- Late Disease
- microgrial activation
- chornic neurodegeneration
- Outside-in vs inside out
- outside-in = abnormal immune response crosses BBB to enter CNS, resulting in an inflammatory process => myelin, oligodendrocytes, and nerve fibers are attacked
- inside out = oligodendrocyte damage occurs first, triggering immune attack within CNS
- Focal deymylenating plaques, or glial scars, in both white and gray matter of the CNS
- Gliosis = nonspecific reaction of CNS tissue to injury
- Inflammatory/Immune response
- T cells, B cells, macrophages seen in biopsies
- Myelin reactive T cells in ms plaques and csf
- B cells found in csf
4
Q
Epidemiology of MS
A
- young adults, aged 20-40, typically affected
- F > M- 3:1
- Pediatric Cases (onset before age 18): 3-4%
- Prevalnce = 1 million people in the US
- geographic revleance decreases with sunlight exposure
- highest prevlance in Eurpe and North America => very low risk in Asia and Africa
5
Q
Medical Diagnosis of MS
A
- McDonald criteria, MRI, Differential Diagonsis, Lumbar Puncture, Medical History, Neurological exam, evoked potential tests
- MRI: recent neural plaques = “bright spots”
- evidence of damage in 2 seperate CNS locations AND
- at 2 seperate time points at least 1 month apart for diagnosis
- long-term disease activity seen as “black holes” via contrast T1 MRI
- evoked potentials
- electrophysiological responses of CNS to stimuli
- 90% experience slowed conduction, particuarly of visual evoked potentials (VEPS = measure function of visual pathway from retina to occiptal cortex => useful for testing optic nerve function)
- auditory and somatosensory EPS also impaired
- Lumbar puncture
- elevated total immuoglobulins (IGG) in CSF
- oligoclonal IGG bands (20 inflammatory demyelinating lesions)
- 90%-95% of cases
- This is higher in PPMS type than RRMS type
6
Q
Which subtype of MS has the following characteristics?
- 85% of case
- 1-2 attacks (relapses) every 1-3 years, followed by remission periods
- Relapses appear suddenly; last weeks to months; gradually disappear
- Neurological function worsens
- may resolve, or not progress, during remissions
A
Relapsing-Remitting MS (RRMS)
7
Q
Which subtype of MS has the following characteristics?
- In the past, progressed from RRMS
- Continuous deterioration after years of RRMS
- Disease-Modifying Medications have reduced this course
A
Secondary Progressive MS
8
Q
Which subtype of MS has the following characteristics?
- 10% of cases
- neurological function deteriorates from first occurrence
- No distinct attacks
A
Primary Progressive MS
9
Q
Which of subtype of MS has the following characteristics?
- 5% of cases
- Primary progressive MS with the addition of sudden, Distinct attacks
A
Progressive Relapsing MS
10
Q
Which subtype of MS has the following characteristics?
- pt remains fully functional 15 years after Dx
A
Benign
11
Q
Which subtype of MS has the following characteristics?
- Rapid onset with continual progression
A
Malignant
12
Q
What is the prognosis for MS?
A
- Variable Disease course
- Severity of signs/symptoms
- Frequency of relapses
- Rate of worsening
- Residual disability (after exacerbation)
- Mortality
- Life expectancy generally reduced by 7 – 14 years
- ½ or more of deaths directly related to complications of MS
- Increased rate of death from infection, respiratory diseases, suicide, and cardiovascular disease
- Life expectancy generally reduced by 7 – 14 years
13
Q
What are signs and symptoms of MS?
A
Exacerbating Factors
- general factors
- poor or failing health
- viral or bacterial infections
- stress
- Uthoff’s symptom
- adverse reaction to heat => acute loss of function + increased fatigue
14
Q
what is the use of immune-modulating drugs = disease-modifying therapy (DMT)
- ex: copaxone, avonex
A
- Used in the management of:
- RRMS (14 drugs now approved),
- SPMS (2 drugs) and
- PPMS (only 1 approved: ocrelizumab)
- For recently diagnosed RRMS, DMTS should be initiated with all patients
- administration methods include injectable, oral or infused modes
- Consistently shown to decrease relapse rate, with a slower accumulation of brain lesions on mri
15
Q
Medications for 20 MS Symptoms include:
A
Muscle Spasms
- Baclofen (may cause mm weakness)
- Tizanidine hydrochloride (Zanaflex)
Bladder dysfunction
- Anticholinergic and antimuscarinic drugs to relax detrusor and enhance urine storage
- Botox in detrusor muscle to relax it
- Alpha antagonist medications to facilitate bladder emptying
Bowel dysfunction
- Laxatives, enemas, high fiber diet
Cognitive impairments
- Disease modifying drugs may slow progression of cognitive decline
Fatigue
- Insure it is not related to depression or medication side effects
- Various pharmacological interventions
Depression
- antidepressants; specific selection depends on Co-Morbid presentation (ie, pain, anxiety, fatigue, incontinence)
- If no other symptoms, SSRI is appropriate
