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NCS > MS > Flashcards

MS Flashcards

1
Q

Epidemiology of MS

A
  • Women more likely then men

- Commonly diagnosed 25-35 (YOUNG!)

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2
Q

Global distribution of MS

A

Further from the equator = higher the incidence

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3
Q

Environmental factors: sun and smoking

A

Sun - increased vitamin D may reduce likelihood of MS

Smoking - may increase likelihood of MS

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4
Q

Genetic factors

A

IT’S NOT HEREDITARY!

- Though may be a genetic predisposition

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5
Q

Infectious factors

A

Viruses/bacteria can cause demyelination (Herpes, chlamydia, measles, Epstein-Barr)
*No evidence that they cause MS

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6
Q

McDonald Criteria

A

Dissemination in time: 2 or more distinct attacks

Dissemination in space: 2 or more lesions in the CNS

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7
Q

T1 weighted MRI scans

A

Detect active inflammation

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8
Q

T2 weighted MRI scans

A

Detect old and new lesions (CSF is bright white)

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9
Q

FLAIR MRI scans

A

Good to detect edema (best for dx MS)

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10
Q

Evoked potentials

A

Measure activity in the brain in response to stimulation - abnormalities indicate demyelination

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11
Q

Sensory evoked potentials

A

Impulses administered to arms and legs

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12
Q

Brainstem auditory evoked potentials

A

Listen for series of clicks in each ear

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13
Q

Visual evoked potentials

A

Identifies pathology along optic nerve pathway

**Only type proven useful in dx MS

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14
Q

CSF fluid analysis

A

Most immune-related conditions have abnormalities but this isn’t specific to MS (not all individuals have abnormalities)

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15
Q

Signs and symptoms of MS

A
  • Motor/spasticity
  • Sensory/pain
  • Vision
  • Heat intolerance
  • Cerebellar dysfunction
  • Urinary
  • Cognitive
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16
Q

Sensory symptoms

A
  • Paresthesias

- Loss of proprioception and vibratory sense

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17
Q

Visual symptoms

A
  • Optic neuritis
  • Nystagmus
  • Oscillopsia
  • Intranucear opthalmoplegia
  • Optic disc pallor
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18
Q

Uhthoff phenomenon

A

Increase in body temperature causes increase in neurological symptoms

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19
Q

Neuroblockade hypothesis of heat intolerance

A

Rise in temperature decrease nerve conduction due to greater demyelination

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20
Q

Cerebellar symptoms

A
  • Ataxia
  • Incoordination
  • Dizziness
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21
Q

Bladder symptoms

A
  • Incontinent (UTIs are common)
22
Q

Relapsing remitting MS

A
  • Marked by temporary relapses (exacerbations) that last 1-3 months
  • Result in complete or partial remission between attacks
23
Q

Secondary progressive MS

A
  • Starts off as relapsing remitting (second phase)
  • Characterized by progressive worsening of symptoms
  • May or may not have relapses/remissions
24
Q

Primary progressive MS

A
  • Steady decline of neurological symptoms without relapses or remissions
25
Q

Progressive relapsing MS

A
  • Steady worsening of symptoms

- MAY experience intermittent acute flare ups/exacerbations where symptoms worsen and relapse to previous levels

26
Q

Shortened life expectance

A

6 years cut short

27
Q

Positive prognostic factors (MS)

A
  • Relapsing remitting type MS

- Only one sx at onset

28
Q

Negative prognostic factors (MS)

A
  • Male, African American
  • Older age at onset
  • Smoking/low vitamin D levels
  • Early cerebellar/pyramidal involvement
  • Progressive type MS
29
Q

Meds for relapse/exacerbation management

A

Corticosteroids

*High dose, short duration

30
Q

Disease modifying medications

A
  • Shown to reduce the number and severity of relapses
  • Reduce the development of new areas of inflammation
  • Delay progression of disability
31
Q

Injectables

A
  • Avonex - intramuscularly, weekly
  • Betaseron - subcutaneously, every other day
  • Copaxone - subcutaneously, daily
  • Rebif - subcutaneously, 3x week
32
Q

Oral meds

A
  • Abugaio - daily
  • Gilenya - daily
  • Tecfidera - 2x /day
33
Q

Infused meds

A
  • Mitoxantrone - intravenously every 3 months
  • Tysabri - intravenously, monthly
  • Lemtrada - intravenously, 2 courses
34
Q

MS Progressive exercise recommendations

A

Duration: 10-40 minutes
Frequency: >2-3 days per week
Intensity: 50-70% max O2 consumption
Reps: 10-12 rep max (1-3 sets)

35
Q

Exercise and it’s effects on pathogenesis, neutrophic factors, CNS structure preservation

A

Pathogenesis - no effect
Neurotrophic factors - no effect
CNS - yes in older individuals but lacking in MS population

36
Q

Exercise and fatigue

A

No worsening and possible improvement in fatigue

37
Q

8 week lower body resistance training program benefits on walking mechanics in MS

A
  • 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
38
Q

4 weeks of aerobic treadmill training on fatigue (55-85% max HR)

A
  • Increased gait speed

- Improved endurance and fatigue levels

39
Q

MS and thermoregulation wit hexercise

A

Core temperature rises without appropriate response = leads to OH and increase in HR
**Uhthoff’s phenomenon

40
Q

Aquatic therapy benefits

A
  • Improved QOL
  • Decreased fatigue
  • Improved gait speed, BBS score, and TUG score
  • Increased grip strength
41
Q

Symptoms following exercise?

A

Change in symptoms in which they may worsen but it is considered temporary and unlikely to have any major effect on fatigue and function

42
Q

MS Exercise recommendations to reduce fatigue

A

Endurance, resistance, combined training

  • 2-3 days/week
  • 60-80% HR max
  • 30 minutes/day
43
Q

MS acute care recommended tests

A
  • 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
44
Q

12-Item MS Walking Scale

A

Questionnaire designer to subjectively measure an individuals ability to ambulate

  • 12 items rated from 1-5
  • Greater number = greater disability
  • No cutoff score
45
Q

9-Hole Peg Test

A

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
46
Q

MS Impact Scale (MSIS-29)

A

Questionnaire to measure the physical and psychological impact of MS on daily life

  • Scoring 1 (no impact) - 5 (extreme impact)
  • No cutoff scores
47
Q

Timed 25 Foot Walk

A

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
48
Q

TUG manual and cognitive cut off scores

A

Manual: 14.5 seconds
**Difference of 4.5 seconds or greater between 2 trials
Cognitive: 15 seconds

49
Q

MS inpatient/outpatient recommended measures

A

All previous tests plus:

  • BBS
  • DHI
  • MS Functional Composite
  • MS Quality of Life (MS QOL-54)
50
Q

Dizziness Handicap Inventory

A

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
51
Q

MS Functional Composite

A

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
52
Q

MS Quality of Life (MS QOL-54)

A
  • 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

NCS (19 decks)

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