Multiple Sclerosis Flashcards
What type of disease is MS?
Chronic disease of the CNS
- Effects the brain and the spinal cord
Describe the prevalence of MS?
2.8 million people affected worldwide
- Not the most prevalent disease but arguably one of the most vtraumatic diseases
When is MS commonly diagnosed? Why is this a concern?
Commonly diagnosed between the ages of 20-40 years old
Diagnosed when 20 years old - Live many years with it and be disabling
What is the concern of MS in younger adults?
Most common form of non-traumatic disability in young adults
Describe the difference in MS between males and females? Severity differences?
Women are affected approx. 3:1
Males tend to have a more severe disease course than females
Describe the pathophtsiology of MS?
Myselin sheath gets damaged
Axon gets exposed and open for damage –> get damage and see complications of MS
Something in the immune system that causes the body to attck the myelin
Something that happens to the myelin and myselin calls in immune system –> Immune system attacks the myelin sheath
Describe the distribution of MS? Therapy?
High in North America –> Canada and the USA, western side of Europe
MS incidence higher in northern climates; speculated that vit D deficiency may contribute
Individuals often supplemented higher with vitamin D - likely no benefit
What are two hypothesis that can describe the variation in distribution of MS?
Due to vitamin D levels –> Due to the lack of vitamin D (nothing found definitively)
Do not have acess to diagnostics; not picking it up to diagnose in those areas –> More prominent worries
Describe the etyiology of MS. Examples?
Immunological:
- Myelin sheath is attcking itself do know their is an immune component
Genetic
- First degree relative with MS - Higher risk but not purely genetic
Environmental
- Sunlight, gestation time (born in May higher risk of MS), agriculture (pesticides, gas wells, agriculture)
Infectious
-Infectious: Epstein Barr Virus
- Followed veterans for decades, 32x more likely to develop MS if you had the Epstein
Describe the overall summary of the etyiology of MS
Something you have in genetic makeup and something you are exposed too –> Leads to MS
What are some symptoms of MS? Most common side effects?
Lhermitte’s Sign
-Uhtohoff’s Phenomena
-“MS Hug”
Big Ones –> Nu8mbness, tingling, fatigue, and pain, vision problems, weakness
Describe the cognitive sx that may occur in MS?
Brain fog, difficulty thinking
What is the most common early symptom of MS?
Vision problems common early on
Can’t see out of one eye or both eyes
What is a common commorbidity in MS that makes symptom presentation complicated?
Wheelchair is common; a lot of these sx are invisble
Do not present with outward sx
Are the symptoms an individual experiences with MS the same in primary disease and in a relapse? Prognosis?
Sx can change in different relapses
Someone presents with first clinical sx as(optic neuritis) –> Better prognosis
Define the following:
-Lhermitte’s Sign
-Uhtohoff’s Phenomena
-“MS Hug”
Lhermittes –> Tuck head down –> Shooting pain downwards
Uhtohoffs –> Heat intolerance – sx get worse and cannot handle the heat
MS Hug –> Tightness around mid-section, sensation around mid-section
What is an issue with the symptoms of MS?
Can write off these sx – Do not always think of MS
Not uncommon to see someone get a diagnosis and say they have had these sx for a long time until a sx ike vision loss makes them go to ER
Describe the different types of MS
Describe relapses of MS in regards to symptoms and timing
Cannot predict when relapses will occur
Cannot predict what will happen in a relapse
Define Relapsing-Remitting MS. Prognosis?
Patients have discrete attacks over days to weeks with some recovery over weeks to months
Function us relatively stable between attacks
- 30% of cases will will convert to Secondary progressive MS (SPMS) after 10 yrs
Define secondary progressive MS.Medications?
Progression of disability may occur in the abscence of active MS or with continued active MS (after 10 years, 30% of RRMS convert to SPMS)
- Medications can delay/possibly prevent the conversion of RRMS to SPMS
- Clinicians may treat SPMS with DMT’s
Define primary progressive MS. Therapy?
- Around 10% of cases
Characterized by steady deterioration of fucntion from onset
- Ocrelizumab is the only officially indicated PPMS medication
Define clinically isolated syndrome (CIS). Medications?
A single dymylenating event event and not fully diagnostic criteria of MS
Starting meds can delay, but NOT likely prevent, conversion to MS
Describe the prevalence of the different types of MS
85%-90% will have relapsing-remitting and then eventually leads to secondary progressive (hard to predict but on average 15-20 years)
–> Cannot predict what the disease will do
Body can repair the myselin a bit, cannot repair the axon
10-15% are primary progressive –> Right from the start have progressive
- Continual increasing disability over time
- Men tend to have the progressive phenotype