MS Diagnosis Overview Flashcards
What is MS?
-autoimmune
-chronic, attacks the CNS due to dysregulated immune system
-most common neuro condition in young adults
-an autoimmune-mediated neurodegeneration of the CNS characterized by inflammatory demyelination
What happens to neurons in an individual with MS?
inflammation, demyelination, axonal and nerve loss, scarring
-lesions of pro-inflammatory components
Most common age of diagnosis of MS and most common gender?
Late teens to 35
mean age of dx: 32 yo
women> men: 2.5-2.8: 1–> Most likely due to hormones
What is the cause of MS?
A combination of environmental and genetic factors
environmental- EBV- mononucleosis
genetic- HLA-DRB1 gene
-levels of vitamin D may impact onset of MS
Diagnosis of MS:
** must capture dissemination of lesions in space and time - in brain or sc; distinct lesions in multiple places
- in 2 of 4 areas: periventricular, brainstem, juxtacortical, spinal cord
-location of lesions is most common in C or T spine
clinical exam - neuro exam for signs of UMN involvement
med history
MRI images
lab tests- CSF
What other condition can present similarly to MS?
neuromyelitis optica
3 types of MS
RRMS
PPMS
SPMS
PPMS
neurologic function/disability progresses without relapses
SPMS
if RRMS disease course progresses, it is considered SPMS
RRMS
symptom relapse followed by remission
-slow progression over time
-if progression occurs rapidly after period of remission–> SPMS
Expanded Disability Status Scale
“EDSS”
0-3.5: MILD
4-5.5: MODERATE
>6: SEVERE
7 - restricted to wheelchair
9- bedridden
provides a snapshot of the patient’s disease status
PROS
-telemedicine
-remote activity monitoring
-provides a snapshot of the patient’s disease status
CONS
-highly variable
-used to require an in-person visit
Positive prognostic factors for MS
RRMS course
complete recovery from attacks
reduced disability at 5 years
Neg prognostic factors for MS
older age
male
not European
high relapse rate
initial symptoms involving brainstem
MOST COMMON 10 SYMPTOMS IN MS
fatigue
diff walking
stiffness and spasms
memory or cognitive problems
bladder problems
pain and other unpleasant sensations
emotional or mood problems
vision prob
dizziness or vertigo
bowel problems
tremors
sex problems
diff moving arms
swallowing probs
speech probs
seizures
What is the primary concern of ppl with MS?
difficulty walking
followed by visual function
followed by: hand function, sensation, pain, bowel and bladder, alertness and cognition, speech, swallowing, mood, sexuality
What other systems need to be screened in patients with MS?
CV - CV autonomic modulation is altered in MS
autonomic functions - GI, sexual function, sudomotor
integumentary- particularly among assistive technology users
memory/cognition- diff dual tasking associated with falling and gait problems, diff with executive functioning–> FOF
bowel/bladder- common to have urinary tract dysfunction, assoc with increased falls, ** pelvic floor ms. training
Main categories of PT examination:
strength
sensory
visual/vestibular - visual acuity, vestibular function
coordination- ataxia, dyskinesia
muscle tone- spasticity>rigidity
functional mobility
Fatigue vs Fatiguability:
fatigue: subjective
fatiguability: a more objectively measurable and quantifiable performance decline in physical or cognitive tasks
An OM for fatigue:
Modified fatigue impact scale
- determine what aggravates and eases this fatigue
An OM for fatiguability:
EX: 6MWT and measure distance walked at 2 min vs 5-6 min
How are many individuals with MS influenced by body temperature?
often worsening of symptoms with a rise in body temp
due to slowing of APs in de-myelinated nerves
- spray bottle and fan usually helpful
3 common difficulties with balance for the population with MS
delayed response to postural perturbations
increased body sway while standing quietly
inability to move outside of BOS
PDDS
patient determined disease steps
patient-reported version of the EDSS
0-2: mild symptoms, very littel trouble walking
3-4: some gait problems, some cane use
5-8: needs AD, VC, to bedridden
MS EDGE highly recommended outcome measures
12 item MS walking scale
6MWT
9HPT
BBS
Dizziness handicap inventory
MS functional composite
MS impact scale
MS quality of life
Timed 25-foot walk
Timed up and go with cognitive and manual
