MS - Review

Question 1

MS - Classification

Answer 1

CIS = clinical isolated syndrome
RRMS = relapsing remitting MS
PPMS = primary progressive MS
SPMS = secondary progressive MS

Question 2

Plaque Location - Supratentorial

Answer 2

(Cortical area)
UMNS
Spatial orientation deficit
Proprioception deficit
Planning deficit
Emotional dysregulation

Question 3

Plaque Location - Infratentorial

Answer 3

(sub cortical)
Rigidity
Lack of mobility
Automatic reaction speed deficit
Dyskinetic behavior

Question 4

Plaque Location - SCI Related

Answer 4

Lack of strength
Lack of proprioception

Question 5

What is the cause of fatigue in MS (5)

Answer 5

Non-use
Lack of strength
Involuntary movements
Attention (increased cognitive load during tasks)
Depression - sleep disorders
Anxiety - involuntary thoughts

Question 6

What is the cause of Balance deficits in MS (12)

Answer 6

Dysdiadochokinesia
Bradykinesia*
Visual system
Attention
Extrapyr Hypertonia*
Planning
Spasticity*
Decreased sensation*
Ataxia*
Spatial orientation/reasoning/navigation
Vestibular system
Decreased strength*
*perceived by patient as decreased strength.

Question 7

Hemiparetic Spastic Gait

Answer 7

• Hypotoned: short step length, use trunk to move leg, knee cannot stabilize, risk of falling, no active DF on affected side.
• Hypertoned: prolonged swing duration on paretic side, prolonged stance on non-affected, step length asymmetry.

Question 8

Paraparetic Spastic Gait

Answer 8

Increased trunk oscillations, throw leg forward, bilateral walking aid.

Question 9

Paraparetic hypotoned or lacking muscle strength

Answer 9

Mostly cannot walk without orthrosis.

Question 10

Ataxic Gait

Answer 10

Dysmetria
Lowered CoG
Shoulders slouched forward
Because of damage to vermis cerebellum

Question 11

How does Ataxia increase muscle tone?

Answer 11

Involuntary movements: fast movements, repetitive movements, increased cognitive load, emotional component.

Question 12

Red flags and special considerations

Answer 12

Sudden changes in muscle tone (relapse?stroke?another disease?)
Increased risk of falls; either reported by the patient him/herself or
by care givers
Signs of depression or bipolar disorder
MRI non-compatible with symptomology (look for differential diagnose)
• Loss of sight or visual field
• Headaches
• Seizures
Suggest worsening of disease
• Signs of dementia
Fatigue