MS and ALS Flashcards
Amyotrophic lateral sclerosis is commonly called _________.
Lou Gehrig’s disease
Epidemiology of ALS
M > F, 40-60 yo
Pathophysiology of ALS
degeneration/death of motor neurons in CNS; motor cortex, spinal cord, lower brainstem
Signs of ALS
- progressive weakness of voluntary muscles
- affects speech and swallowing
- NO SENSORY LOSS
What muscles are spared in ALS?
ocular, bladder/bowel, genitals
What lab value is elevated in ALS?
creatinine kinase
ALS treatment
No meds proven beneficial (Riluzole extends survival, Baclofen)
Support for breathing (tracheostomy), support for swallowing (gastrostomy), PT, speech synthesizers
Who is most likely to get MS?
females, 20-30 yo, Caucasian, Northern Hemisphere
4 subtypes of MS progression
Relapsing-Remitting
Primary Progression
Secondary Progression
Progressive-Relapsing
*never gets back to baseline
Etiology of MS
autoimmune inflammatory disease that causes demyelination of white matter in brain and spinal cord
clinically isolated syndrome
1st neuro episode resembling MS that lasts at least 24 hrs
Possible triggers of MS
viruses, low Vit D, enviro factors
signs/sx of MS?
- highly variable since based on location of lesions
- numbness/tingling, imbalance, optic neuritis, stiffness, changes in bowel/bladder, sexual dysfunction
Uhthoff’s Phenomenon
increased symptoms with high temps
Lhermitte’s Sign
shock running down back into limbs when neck flexed
What are the differences in history of ALS vs MS?
- ALS steady progression of sx, MS episodic
- ALS males 40-60 yo; MS females 20-30 yo
- Bladder/bowel/sex dysfunction only in MS
- MS commonly has abnormal MRI
What makes MS doubtful?
No symptoms above the neck, fhx of neurologic disease, persistent back pain, normal MRI
What imaging is done for MS?
MRI > CT
MRI w/ Gadolinium IV contrast
Not diagnostic, but crucial for assessing time progression of lesions or “plaques”
What criteria may help diagnose MS?
McDonald criteria, Poster Diagnostic criteria
PE tests that can follow progression of MS?
25 ft timed walk
9 hole peg test
Leg tone, tested supine for spasticity
How is MS treated?
NO CURE!
Disease Modifying Therapy (start early, slows progression, rescue from acute relapses)
- Chronic: Beta interferon injections, immunosuppressants, anti-inflams
- Acute: HD steroids, plasma exchange
What can PCPs do for MS patients?
Vit D supplements
Encourage regular izzies
Treat depression
Refer to PT/OT for home modifications and mobility aids
How are MS and ALS similar?
Both degeneration of CNS, progressive weakness, affect motor neurons, no known cures
Only way to definitively diagnose MS?
tissue biopsy on post-mortem exam
