Multiple Sclerosis Flashcards
what are the systems involved with Ms
neuro and immune
at what age does ms strike
20 to 40 yo
is ms curable
no but it can be slowed down (degenerative)
is ms more common in men or women
women > men
what member of our faculty does ms research
Dr. Peter Darlington
why does Kayla (athlete with ms) fall down in the video
because of fatigue and loss of sensation
she can’t feel her legs bc of swelling, raise in body temp and no more transmission of motor connection
what is ms and what does the name stand for
ms is a chronic, progressive disease that leads to increasing disability in most individuals
multiple: many scattered areas of the brain and sc are affected
sclerosis: “sclerosed” or hardened tissue in damaged areas
what happens with the immune system in ms
immune system attacks the myelin sheath causing communication problems btw the brain and the rest of the body
how can meds help ms
- speed recovery from attacks
2. modify the course of the disease and symptoms
what can be bad about ms meds
they can lower the immune system but the benefits far out-weight the side effects
Ms lesions can affect what structures and what can be lost because of it
it can affect the brain and/or the sc
loss of motor control
myelin damage and the nervous system
In ms, the protective coating on nerve fibers (myelin) in the cns becomes detached and eventually destroyed. This creates a lesion that may cause numbness, pain ot tingling in parts of the body + loss of motor control.
why is it important to know about ms
bc its the most common cns disease among young adults in canada
how many canadians have ms and from what ages
55 000 to 75 000 canadians have ms or 166 people/ 100 000
from 20 to 40 yo
____ are spent each year on medical expenses and special services. Lost productivity adds to the financial toll.
Billions of dollars
average age of clinical onset and average age of dx
30-33 but average dx is 37
why is there a delay in the age of clinical onset and the dx
bc symptoms come and go, ms gets mixed up w other conditions and symptoms vary from person to person
in ___ , only __ of patients were reported to survive beyond __ years after onset of illness, but a patient can now expect to live ___
1936
8%
20
the average population life-expectancy minus 7 years
what are the causes of ms and what is it considered as
unknown
ms is considered an autoimmune disease in which the body’s immune system attacks its own tissues by mistake
what do T-cells and monocytes do
they work together to fight invaders bu they can get confused and start to attack the body itself by destroying the myelin sheath
what are the factors that increase the risk of ms (8)
- age
- sex (women > men)
- family history
- certain infections (Epstein-barr)
- climate (more common in temperate climate; canada, northern usa, new zealand, southeastern australia and europe)
- certain autoimmune diseases (thyroid disease, type 1 diabetes or inflammatory bowel disease)
- smoking
- race (white northen european descent > asian, african or native american)
what are the incidences for inuits, scottish, canada and white/vs/no-white people
inuit; very low
scottish and canada; very high
more white > not white
s/s optic n lesion
blurred vision
s/s brain stem lesion
dizziness and may cause double vision
s/s cerebellum and cerebrum lesion (4)
balance problems, speech problems, uncoordinated mvts and tremors
s/s motor n tract lesion (4)
m. weakness, spasticity paralysis, bladder and bowel impairments
s/s sensory n tract lesion (4)
altered sensation, numbness, prickling and burning sensations
symptoms of ms differ greatly from person to person and over the course of the disease depending on
MS type and location of the lesion within the ns
other symptoms of ms
fatigue (78% of patients)
tremor, lack of coordination or unsteady gait
ms walking patterns
lack of opposition of arms and legs
usually a stronger and more stable side, will cause the patient to take shorter and faster steps on less stable side
what is the course of the disease
exacerbation (flare-up, attacks and relapse)
will lead to either remission or myelin becoming inflamed and myelin inflammation can lead to either no scar formation then complete recovery and no loss of function or scar formation which will lead to permanent myelin damage and loss of function
what can disease modifying therapies help with and what meds are used
decrease of severity and frequency of relapses
immunosuppressant drugs
what is ms classification based on
rate of disease progression and frequency of flare-ups
what is relapsing/remitting ms (RRMS) (3)
- most common type
- unpredictable but clearly defined relapses during which new symptoms appear or existing ones get worse
- in the period btw relapses, recovery is complete or nearly complete to pre-relapse function (remission)
what is secondary progressive MS (SPMS)
- some people stay in this stage for a long time
- follows a dx of RRMS, over time, distinct relapses and remissions become less apparent and the disease begins to progress steadily sometimes w plateaus
- about 1/2 of people with RRMS start to worsen within 10-20 years of dx, often with increasing levels of disability
what is primary progressive MS (PPMS)
- will die before they are supposed to
- slow accumulation of disability without defined relapses
- may stabilize for periods of time, and even offer minor temporary improvement but overall, there are no periods of remission, about 10% of people with MS have PPMS
what is progressive relapsing MS (PRMS)
- as severe as primary but with flare ups
- rarest course of MS, occurring in only 5% of all MS cases
- people with this form of MS experience relapses with or without recovery and steadily worsening disease from the beginning
can people with MS train, can exercise be beneficial/harmful?
yes they can train
can be beneficial if done correctly
can be harmful if too much too fast
but overall beneficial > harmful
how can the guidelines help
people w MS who have mild to moderate disability who meet the guidelines will have reduced fatigue, improved mobility and enhance elements of health-related quality of life
who are the guidelines for
minimal to moderate disability resulting from either relapsing, remitting or progressive forms of MS
who can train MS people
KCEPs, qualified exercise professional
what can physically inactive MS people do
activities performed at a lower intensity, frequency and duration than recommended may bring some benefits
what can be done to meet the guidelines
gradually increasing duration, frequency, and intensity as a progression towards meeting the guidelines
guidelines: how often
aerobic: 2 times / week
strength training: 2 times / week
guidelines: how much
aerobic: at least 30 min during each workout sesh
strength training: 2 sets of 10-15 reps of each exercise
guidelines: how hard
aerobic:
-mod intensity pa is usually 5 or 6 on a scale of 10 and causes HR to go up
-as a general rule, if you’re doing mod-intensity pa you can talk, but not sing a song during the activity
strength training:
-pick a resistance (free weights, cable pulleys, bands, etc) heavy enough that you can barely, but safely, finish 10-15 reps of the last set
guidelines: how to
aerobic activities:
- upper body exercises; arm cycling
- lower body exercises; walking, leg cycling
- combined upper and lower body exercises; elliptical trainer
strength training activities for upper and lower body:
- weight machines
- free weights
- cable pulleys
other types of exercises that can bring benefits:
-aquatic exercises
what are special considerations concerning MS vs exercise (5)
- lower level of fitness; cardiovascular, muscular strength and endurance (decreased balance)
- fatigue
- heat intolerance (higher than 0.5°)
- depression
- exercise does not trigger periods of exacerbation when properly managed
Effects of exercise on people with ms
increase aerobic capacity, m. strength and endurance, quality of life, independence in ADL
