Multiple Sclerosis

Question 1

What is distrupted which enables inflammatory cells to further disrupt neural pathways?

Answer 1

The blood- brain barrier

Question 2

Give the four main features of the pathophysiological causes of MS

Answer 2

Disruption of blood-brain barrier
Leakage of inflammatory cells
Destruction of oligodendrocytes and myelin sheath
Disruption of nerve signals, rate of conduction of nerves is slowed down

Question 3

What is the name of the insulating material that surrounds the axon of a neurone to facilitate neural conduction?

Answer 3

Myelin Sheath

Question 4

What are the four main types of MS?

Answer 4

Silent/benign - Not common, usually occurs as one episode but does not develop

Relapsing-remitting - Relapses occur and remits, progressively worsens; Lasts 10-15 years before progressing into secondary progressive

Secondary progressive - Often relapsing-remitting patients progress into secondary progressive where there are no relapses. Progressively worsens

Primary progressive - Progressive from start to finish, much more rapid progression

The disease inflammatory leakage and damage to myelin sheath and oligodendrocytes which repair and create this sheath around the axon of neurons can be damaged at different rates. This leads to FOUR different types of MS

Question 5

Identify the two areas of the brain that when affected by multiple sclerosis cause symptoms of ataxia and poor coordination, dizziness (vertigo) and poor balance

Answer 5

Cerebellum or Vestibular System

Question 6

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of sexual dysfunction, spinchter disturbance

Answer 6

Spinal cord

Question 7

What are the initial symptoms of MS

Answer 7

Limb weakness 40% - Tripping over
Optic neuritis 22% - Inflammation of optic nerve leads to visual changes
Parasthaesia 21% - Pins and needles sensory deficit
Diplopia 12% - Double vision
Vertigo 5% - Feeling of movement with no movement; dizziness type symptoms
Micturition problems 5% - Loss of control of bladder

Question 8

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of limb weakness, spasticity or hyperreflexia

Answer 8

Motor cortex, descending pathways

Question 9

What treatments can PTs give Ms patients

Answer 9

we use a variety of treatment techniques in order to assist patients to manage these symptoms and maintain optimal function over time:
Specific Stretches, Specific Strengthening Exercises, Balance exercises, Gait re-education, Transfers practice, Functional Activity Practice, Pain Management, Fatigue Management, Compensatory Strategies, Education

Rx is to prevent plaques from forming and to reduce inflammatory response to reduce destruction of myelin sheath

Question 10

What is MS relapse

Answer 10

1. Clinical event of the type usually seen in MS
2. Event must last at least 24 hours
3. Objective findings must be present - i.e., symptoms alone, no matter how characteristic, do not count
4. The event is not a temporary worsening entirely due to fever or infection (UTI)(= pseudo attack)
5. To count as a distinct (new) attack, the onset of a clinical event must be at least 30 days after the onset of any prior attack
6. A single paroxysmal episode (e.g. tonic spasm) does not constitute a relapse, but multiple paroxysmal events occurring over 24 hours or more can equal an attack

Question 11

What is an outcome measure for MS

Answer 11

Expanded Disability Status Scale (EDSS) used to to give an overall functional assessment of each individual

1 = no disability
2 = minimal disability
3 = moderate disability
4 = relatively severe disability
5 = disability affects daily routine
6 = assistance required to work
7 = restricted to wheelchair
8 = restricted to bed or wheelchair
9 = confined to bed

Question 12

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of fatigue

Answer 12

Many reasons

Question 13

Name some key symptoms people with MS experience

Answer 13

Fatigue, motor dysfunction (i.e ataxia, weakness), sensory disturbance and loss, visual problems (i.e diplopia), spasticity, cognitive issues ( i.e decreased intellectual function), sexual dysfunction, sphincter dysfunction

Question 14

People with MS also experience psychological and psychiatric disorders. What area of the brain may be affected to cause these symptoms?

Answer 14

Frontal Lobe

Question 15

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of decreased intellectual function

Answer 15

Frontal lobe

Question 16

What is thought to cause MS?

Answer 16

A combination of environmental and genetic factors increase the risk of an individual developing MS, the exact cause is still unknown.

Question 17

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of visual acuity, diplopia

Answer 17

Occipital lobe, optic nerve, thalamus

Question 18

What is the prognosis of MS

Answer 18

Highly variable, difficult to predict

Earlier age at diagnosis favours slower onset of progression; Progression more rapid after age 40, regardless of MS type

Only 50% still walking unaided 15 years after diagnosis

Health related quality of life on average 30% lower than age-matched population

Suicide risk 7.5 times national average

Wide variation in impact on lifespan - common causes of death are chronic bed sores, urogenital sepsis and aspiration or bacterial pneumonia , infections (chest, UTI, cellulitis)

Disease modifying treatment - limited not much

Question 19

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of parasthesia, tingling or burning

Answer 19

Sensory cortex or ascending pathways

Question 20

Identify the area of the brain that when affected by multiple sclerosis cause symptoms of psychiatric or psychological disturbances

Answer 20

Limbic system, dopamine system, hypothalamus

Question 21

Where can plaques and subsequent scarring occur?

Answer 21

Anywhere within the CNS: the Brain and Spinal Cord

Question 22

Give the definition of MS

Answer 22

MS is a chronic demyelinating disease of the CNS characterised by an inflammatory process and causing widespread degeneration of the CNS, gradually resulting in severe neurological deficit

Question 23

What are the types of ataxia and how to treat each type?

Answer 23

1. Cerebellar – core stability and coordination exercises
2. Vestibular – Cooksey cawthorne exercises
3. Sensory – sensory stimulation++