MS - RS Flashcards
what is MS
autoimmune dz
characterized by a course of inflammatory attacks leading to demyelination and slowing down of saltatory conduction in CNS
eventually halting
where is MS
there will be multiple areas of scarring (Sclerotic tissue) or plaques
glial scarring
reactive astrogliosis
what is disrupted
BBB
what does a disrupted BBB cause
triggers astrogliosis and production of brain antigen called Glial Fibrillary Acid Protein (GFAP)
what do macrophages do
initiate destruction of myelin sheaths and cell bodies of oligodendrocytes
what do fibrous astrocytes do
fill the demyelinated areas and form the glial scar or plaque
dz characteristics
episodes of CNS inflammation called attacks, relapses or exacerbations
more characteristics
astrogliosis (glial scarring)
destruction of myelin
destruction of oligodendrocytes
irreversible axonal damage
demyelinating lesions of MS are termed
plaques
plaques
have sharply delineated lesions that can be viewed on MRI
typical lesions are where
in the periventricular region of the lateral ventricles and the optic nerves
often a primary lesion
how can MS present
number of ways
depending on where the lesion is located
most frequently reported symptoms
fatigue (88%)
gait disturbance (87%)
BB issues (65%)
pain and other sensations (60%)
visual disturbance (58%)
cognitive deficits (44%)
tremors (41%)
what is the most common single complaint
fatigue
fatigue
out of proportion to the task that is causing it
sensory symptoms
anesthesia
Lhermitte’s sign
trigeminal neuralgia
anesthesia
rare
paresthesia and dysesthesia are more frequent
paraesthesia
tingling
pricking
numbness
pins & needles
“falling asleep”
dysesthesia
abnormal sensations such as burning, itching, electric shock, wetness, tight banding
“MS hug/girdle band” sensation
feeling of having a tight band around chest or ribs
pressure on one side of torso, may make it painful to breath
Lhermitte’s sign
shock like sensation in the spine or LEs produced by rapid neck flexion
as in coughing
what is Lhermittes sign indicative of
dorsal column demyelinating damage
trigeminal neuralgia
found in a small # of pts (3%)
results from demyelination of CN V in the pons region
trigeminal neuralgia feels like
acute
piercing
electric shock-like pain
other symptoms
weakness
visual disturbances
spasticity
heat sensitivity
bladder dysfunction
visual disturbances
optic neuritis
optic neuritis
common presenting complaint
transient
abrupt
loss of vision over 2-3 days
what is spasticity d/t
UMN involvement
dx
difficult and largely clinical
what does dx require
very accurate history that may reveal vague complains that have gone on for years w/o being dx
what picks up a new lesion
MRI w/ gadolinium
evoked potentials
measures conduction velocity along visual/auditory, sensory pathways to detect demyelination
CSF contains
gamma globulin and WBCs
definitive MS
documentation of 2 separate neurological lesions in the CNS that are temporally (greater than 30 days apart) and spatially distinct (anatomically separate)
primary progressive MS
a slow progression of S&S over at least 6 months is required for dx
confirming MS dx
MRI, EP, CSF
medication
high dose of corticosteroids and immunomodulators
high does corticosteroids
high does of IV methylprednisolone
what do high does corticosteroids the treatment of choice for
acute exacerbations
how do high dose corticosteroids treat acute exacerbations
limits inflammatory response
reduces tissue edema
restoration of the BBB
immunomodulation
immunomodulators
CRAB
C - CRAB
copaxone
glatiramer acetate
R - CRAB
rebif
interferon beta 1a
A- CRAB
avonex
interferon beta 1a
B - CRAB
betaseron
interferon beta 1b
betaseron
has been shown to be effective in decreasing the frequency and severity of RR MS
less effective in chronic progressive MS
side effects of betaseron
flu like symptoms
other medications
mitoxantrone (novantrone)
methotrexate (cytoxan)
mitoxantrone
for worsening RR, PR, SP
methotrexate
for SP
suppresses the immune system
rehab considerations
fatigue and exercise
there is a
fear of fatigue
lifestyle of inactivity and physical deconditioning and disuse
how can exercise help w/ fatigue
when administered correctly and appropriately
–> can help modulate fatigue symptoms and prevent deconditioning
Exercise
can exacerbate fatigue
will not cause further neurologic damage or increase the likelihood of having a further relapse or exacerbation
over-exercising can
cause significant danger of injury to a person w/ MS
fatigue may lead to
to the start of using inappropriate movement patterns or increases fall risk
what should be carefully considered
the type of exercise given to people w/ MS
they have a decreasing ability to tolerate certain amounts of exercise
when should exercise be scheduled
time of increased energy may be more effective
although pt may want to use those times for other activities
