MS-bloch Flashcards
What is MS?
an immune-mediated disease of the CNS
Immune cells are made throughout the body except in the (blank and blank)
brain and spinal cord
In MS you have imbalance between what 2 things?
proinflammatory and anti-inflammatory cytokines
What is this:
an immune mediated disease of the CNS, it is a disease of myelin and axons
multiple sclerosis
MS is a disease of axons and (blank)
myelin
It has been shown that active inflammation results in both (blank) and (blank)
demyelination and axonal transection
Who typically gets MS?
Women (3:1 men) typically in their 20-50s, typically caucasians (rare among asians)
common in temperate areas of the owrld
Where do you have the least amount of MS?
What are some variables that might be related to MS?
on the equator, the further north or south of this the more likely you will have MS
-environmental factors, genetic factors, lower vit D exposure, combo
(blank) percent of people with MS have a blood relative with MS which means that it is a (blank and blank) disease
20%
genetic and environmental
T or F
The risk of MS is higher in any family in which there are several family members with the disease (multiplex families)
T
The risk of getting MS is:
for the gen pop?
first degree relative?
identical twin?
0.1%
3%
25%
MS is a (blank) diagnosis
clinical (signs and symptoms and medical history)
What tests are helpful in diagnosing MS and what is the diagnostic criteria?
Paraclinical tests provide support -Magnetic resonance imaging -Spinal fluid -Evoked potentials Diagnostic criteria: -Dissemination in time and space: evidence that damage has occurred in at least two separate areas of the CNS at different points in time -There must be no other explanation
What are potential symptoms of MS?
Numbness Diplopia Visual Loss Bladder Dysfunction Gait Impairment Fatigue Vertigo Bowel Dysfunction Cognitive Dysfunction Pain Depression Sexual Dysfunction Paresis
What factors should increase your suspicion for MS?
- female
- age 25-40
- clinically isolated syndrome (CIS)
i. e optic neuritis, transverse myelitis
What is the MS work-up?
1) MRI with gadolinium
2) Potential MS mimetics ruled out (blood testing, etc)
3) Lumbar Puncture (OBs and/or elevated IgG index or synthesis)
4) Evoked Potentials
(blank) is the first neurologic event suggestive of demyelination. Individuals with (blank) are at high risk for developing clinically definitie MS if the neurologic event is accompanied by multiple, clinically silent (asymptomatic) lesions on MRI typical of MS.
Clinically Isolated Syndrome (CIS)
CIS
What are the 2 common clinically isolated syndromes (CIS)?
optic neuritis
transverse myelitis
What is this:
Sudden, but transient loss of visual acuity
Unilateral or bilateral
Retro-orbital pain exacerbated by eye movement
Normal optic disc
Reduced color perception
Decreased vision following activities that elevate body temperature
optic neuritis
What is this: Ascending numbness from the feet, up the torso, potentially from hands to arms Ataxia, balance problems Electric shock sensations while flexing neck Partial or complete paralysis Bladder dysfunction Bowel dysfunction Sexual dysfunction
transverse myelitis
What is the most common type of MS?
Relapsing-remitting (RR) MS
(blanK) begins as RR disease. The vast majority of people with RR disease eventually develop SP MS, in which the disease becomes more steadily progressive, with or without relapses. At any given time about 30% of the general MS population is SP.
Secondary-progressive (SP) MS
(blank) MS affects about 10% of patients. In PPMS, the disease is progressive from onset, without any relapses or remissions.
Primary-progressive (PP)
(blank) MS is the least common form, affecting about 5% of patients. In PRMS, the disease is progressive from onset, with occasional relapses along the way.
Progressive-relapsing (PR)
What are the negative prognostic indicators for MS?
Frequent, multifocal attacks Heavy MRI burden on initial scans Pyramidal involvement Ataxia Cognitive difficulties 5 year accumulation of disability Spinal progression (primary progressive MS)
What is this:
new symptom or sudden worsening of old symptom lasting at least 24 hours, and usually accompanied by an objective change in neurologic findings
How do you treat this?
relapse
corticosteroids (high dose oral steroids or high dose IV methylprednisolone)
OR
Rehab
What drug can improve walking speed in MS?
Dalfampridine
(blank) sensitivity is common in MS
heat
sensitivity to cold can also occur
Even a slight elevation in core body temperature can cause temporary worsening of symptoms this is called a (blank).
Cooling strategies are beneficial during:
Hot, humid weather
Exercise
Cooking
pseudoexacerbation
Infections of any kind can increase body temperature and thereby cause a sudden worsening of symptoms. Checking for a (blank) is one important strategy for determining if a person is having a true relapse or a pseudo relapse.
urinary tract infection
How can you treat bladder dysfunction in MS (CANT STORE urine)?
Oxybutynin in various forms
Tolteridine
Trospium chloride
How can you treat bladder dysfunction in MS (CANT EMPTY urine)?
Stimulating medication
Intermittent self-catheterization
How do you treat dysnergic bladder?
Sometimes the bladder contracts while the sphincter (the exit from the bladder) contracts as well. This is called a dysynergia.
Alpha adrenergic agonists -dibenzyline, -terazosin (Hytrin), -Cardura Intermittent self-catheterization
How do you treat nocturia?
DDAVP-desmopressin
How do manage bowel dysfunction in MS?
Regular bowel regimen High fiber diet; sufficient liquids Bulk formers Stool softeners Mini enemas Suppositories Enemas
How do you manage dysethesia or parasthesias?
Pharmacological: -gabapentin -lamotrigine -carbamazepine -amitriptyline -pregabalin Mechanical: gloves, counter-irritant Other: accupuncture, biofeedback
Whats the pain like in MS?
a burning, irritating “neuropathic” pain
People with MS often are depressed, how do you treat this?
psychotherapy and medication and exercise
Suicide is (blank)x more common in MS than in general population
7.5X
Is cognitive impairment common in MS?
no, it only occurs in late stage MS or severe MS
MS is a white matter disease and does not affect what three things?
- brain volume
- gray matter
- cerebral cortex
If an MS patient can pass a brief mental status exam, everything is OK.
Memory problems reported by MS patients are usually caused by what?
stress, anxiety, and/or depression.
(blank) correlates with lesion load and brain atrophy.
Cognitive function
