MS Flashcards
Epidemiology of MS
- Women more likely then men
- Commonly diagnosed 25-35 (YOUNG!)
Global distribution of MS
Further from the equator = higher the incidence
Environmental factors: sun and smoking
Sun - increased vitamin D may reduce likelihood of MS
Smoking - may increase likelihood of MS
Genetic factors
IT’S NOT HEREDITARY!
- Though may be a genetic predisposition
Infectious factors
Viruses/bacteria can cause demyelination (Herpes, chlamydia, measles, Epstein-Barr)
*No evidence that they cause MS
McDonald Criteria
Dissemination in time: 2 or more distinct attacks
Dissemination in space: 2 or more lesions in the CNS
T1 weighted MRI scans
Detect active inflammation
T2 weighted MRI scans
Detect old and new lesions (CSF is bright white)
FLAIR MRI scans
Good to detect edema (best for dx MS)
Evoked potentials
Measure activity in the brain in response to stimulation - abnormalities indicate demyelination
Sensory evoked potentials
Impulses administered to arms and legs
Brainstem auditory evoked potentials
Listen for series of clicks in each ear
Visual evoked potentials
Identifies pathology along optic nerve pathway
**Only type proven useful in dx MS
CSF fluid analysis
Most immune-related conditions have abnormalities but this isn’t specific to MS (not all individuals have abnormalities)
Signs and symptoms of MS
- Motor/spasticity
- Sensory/pain
- Vision
- Heat intolerance
- Cerebellar dysfunction
- Urinary
- Cognitive
Sensory symptoms
- Paresthesias
- Loss of proprioception and vibratory sense
Visual symptoms
- Optic neuritis
- Nystagmus
- Oscillopsia
- Intranucear opthalmoplegia
- Optic disc pallor
Uhthoff phenomenon
Increase in body temperature causes increase in neurological symptoms
Neuroblockade hypothesis of heat intolerance
Rise in temperature decrease nerve conduction due to greater demyelination
Cerebellar symptoms
- Ataxia
- Incoordination
- Dizziness
Bladder symptoms
- Incontinent (UTIs are common)
Relapsing remitting MS
- Marked by temporary relapses (exacerbations) that last 1-3 months
- Result in complete or partial remission between attacks
Secondary progressive MS
- Starts off as relapsing remitting (second phase)
- Characterized by progressive worsening of symptoms
- May or may not have relapses/remissions
Primary progressive MS
- Steady decline of neurological symptoms without relapses or remissions
Progressive relapsing MS
- Steady worsening of symptoms
- MAY experience intermittent acute flare ups/exacerbations where symptoms worsen and relapse to previous levels
Shortened life expectance
6 years cut short
Positive prognostic factors (MS)
- Relapsing remitting type MS
- Only one sx at onset
Negative prognostic factors (MS)
- Male, African American
- Older age at onset
- Smoking/low vitamin D levels
- Early cerebellar/pyramidal involvement
- Progressive type MS
Meds for relapse/exacerbation management
Corticosteroids
*High dose, short duration
Disease modifying medications
- Shown to reduce the number and severity of relapses
- Reduce the development of new areas of inflammation
- Delay progression of disability
Injectables
- Avonex - intramuscularly, weekly
- Betaseron - subcutaneously, every other day
- Copaxone - subcutaneously, daily
- Rebif - subcutaneously, 3x week
Oral meds
- Abugaio - daily
- Gilenya - daily
- Tecfidera - 2x /day
Infused meds
- Mitoxantrone - intravenously every 3 months
- Tysabri - intravenously, monthly
- Lemtrada - intravenously, 2 courses
MS Progressive exercise recommendations
Duration: 10-40 minutes
Frequency: >2-3 days per week
Intensity: 50-70% max O2 consumption
Reps: 10-12 rep max (1-3 sets)
Exercise and it’s effects on pathogenesis, neutrophic factors, CNS structure preservation
Pathogenesis - no effect
Neurotrophic factors - no effect
CNS - yes in older individuals but lacking in MS population
Exercise and fatigue
No worsening and possible improvement in fatigue
8 week lower body resistance training program benefits on walking mechanics in MS
- Improved swing phase, step length, stride length, and foot angle
- Decrease in time in stance and double limit support phase, and toe clearance
- Improvement in isometric strength, disability score, and 3 minute stepping
4 weeks of aerobic treadmill training on fatigue (55-85% max HR)
- Increased gait speed
- Improved endurance and fatigue levels
MS and thermoregulation wit hexercise
Core temperature rises without appropriate response = leads to OH and increase in HR
**Uhthoff’s phenomenon
Aquatic therapy benefits
- Improved QOL
- Decreased fatigue
- Improved gait speed, BBS score, and TUG score
- Increased grip strength
Symptoms following exercise?
Change in symptoms in which they may worsen but it is considered temporary and unlikely to have any major effect on fatigue and function
MS Exercise recommendations to reduce fatigue
Endurance, resistance, combined training
- 2-3 days/week
- 60-80% HR max
- 30 minutes/day
MS acute care recommended tests
- 12- Item MS Walking Scale
- 9-Hole Peg Test
- BBS
- MS Impact Scale (MSIS-29)
- Timed 25 Foot Walk
- TUB with Cognitive and Manual Tasks
12-Item MS Walking Scale
Questionnaire designer to subjectively measure an individuals ability to ambulate
- 12 items rated from 1-5
- Greater number = greater disability
- No cutoff score
9-Hole Peg Test
Timed test to measure finger dexterity
- Scoring: time take to place all pegs in holes and return to container one by one
- No cutoff scores but norms have been established
MS Impact Scale (MSIS-29)
Questionnaire to measure the physical and psychological impact of MS on daily life
- Scoring 1 (no impact) - 5 (extreme impact)
- No cutoff scores
Timed 25 Foot Walk
Designed to obtain quantitative measure of mobility and leg function
- Scoring: average of 2 timed trials for walking a distance of 25 ft
- No cutoff scores
TUG manual and cognitive cut off scores
Manual: 14.5 seconds
**Difference of 4.5 seconds or greater between 2 trials
Cognitive: 15 seconds
MS inpatient/outpatient recommended measures
All previous tests plus:
- BBS
- DHI
- MS Functional Composite
- MS Quality of Life (MS QOL-54)
Dizziness Handicap Inventory
Scale used to determine amount of limitation perceived due to effects of dizziness
- Scoring 0-100 (higher number = greater handicap)
- Cutoff: >59 suggests increased risk for falls
MS Functional Composite
Evaluates cognition, gait, and UE function in individuals with MS
- *Includes Timed 24-Foot Walk Test, 9-Hole Peg Test, and Paced Auditory Serial Addition Test
- Scoring - each score of above tests is converted to a z-score and then averaged
- No cutoff scores
MS Quality of Life (MS QOL-54)
- Quality of life questionnaire focusing on physical health and mental health tailored towards MS specific issues
- Scoring - no overall score for the test; summary scores for physical and mental health are weighted based on combination of scale scores
- No cutoff scores
