MS and ALS

Question 1

Amyotrophic lateral sclerosis is commonly called _________.

Answer 1

Lou Gehrig’s disease

Question 2

Epidemiology of ALS

Answer 2

M > F, 40-60 yo

Question 3

Pathophysiology of ALS

Answer 3

degeneration/death of motor neurons in CNS; motor cortex, spinal cord, lower brainstem

Question 4

Signs of ALS

Answer 4

• progressive weakness of voluntary muscles
• affects speech and swallowing
• NO SENSORY LOSS

Question 5

What muscles are spared in ALS?

Answer 5

ocular, bladder/bowel, genitals

Question 6

What lab value is elevated in ALS?

Answer 6

creatinine kinase

Question 7

ALS treatment

Answer 7

No meds proven beneficial (Riluzole extends survival, Baclofen)

Support for breathing (tracheostomy), support for swallowing (gastrostomy), PT, speech synthesizers

Question 8

Who is most likely to get MS?

Answer 8

females, 20-30 yo, Caucasian, Northern Hemisphere

Question 9

4 subtypes of MS progression

Answer 9

Relapsing-Remitting
Primary Progression
Secondary Progression
Progressive-Relapsing

*never gets back to baseline

Question 10

Etiology of MS

Answer 10

autoimmune inflammatory disease that causes demyelination of white matter in brain and spinal cord

Question 11

clinically isolated syndrome

Answer 11

1st neuro episode resembling MS that lasts at least 24 hrs

Question 12

Possible triggers of MS

Answer 12

viruses, low Vit D, enviro factors

Question 13

signs/sx of MS?

Answer 13

• highly variable since based on location of lesions

- numbness/tingling, imbalance, optic neuritis, stiffness, changes in bowel/bladder, sexual dysfunction

Question 14

Uhthoff’s Phenomenon

Answer 14

increased symptoms with high temps

Question 15

Lhermitte’s Sign

Answer 15

shock running down back into limbs when neck flexed

Question 16

What are the differences in history of ALS vs MS?

Answer 16

• 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

Question 17

What makes MS doubtful?

Answer 17

No symptoms above the neck, fhx of neurologic disease, persistent back pain, normal MRI

Question 18

What imaging is done for MS?

Answer 18

MRI > CT
MRI w/ Gadolinium IV contrast
Not diagnostic, but crucial for assessing time progression of lesions or “plaques”

Question 19

What criteria may help diagnose MS?

Answer 19

McDonald criteria, Poster Diagnostic criteria

Question 20

PE tests that can follow progression of MS?

Answer 20

25 ft timed walk
9 hole peg test
Leg tone, tested supine for spasticity

Question 21

How is MS treated?

Answer 21

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

Question 22

What can PCPs do for MS patients?

Answer 22

Vit D supplements
Encourage regular izzies
Treat depression
Refer to PT/OT for home modifications and mobility aids

Question 23

How are MS and ALS similar?

Answer 23

Both degeneration of CNS, progressive weakness, affect motor neurons, no known cures

Question 24

Only way to definitively diagnose MS?

Answer 24

tissue biopsy on post-mortem exam