multiple sclerosis Flashcards
symptoms
- speech
- swallowing
- lack of coordination and balance
- weakness in limbs
- fatigue
- memory problems
- paralysis
- blurred vision and blindness
- bladder problems
- pain
age of onset
20-40 years
risk factors
- geographical differences
- racial differences
- ? viral trigger
pathogenesis
- heterogeneous disorder (inflammation, demyelination, neuronal degeneration)
- dysimmune phenomena
characteristic features
- optic neuritis (painful vision loss)
- internuclear opthalmoplegia (double vision)
- fatigue
- Lhermittes phenomenon
- Uhthoff’s phenomenon
Lhermittes phenomenon
- at certain angles, a nerve might send out a sudden and very strong signal
- powerful jolt that can knock things over, etc.
- broken phone charger that only works at specific angles
Uhthoff’s phenomenon
- increase in temperatures slows nerve conduction which worsens neurological symptoms (including fatigue)
- may occur due to hot weather, exercise, fever, saunas, hot tubs, hot baths, and hot food and drink
clinical patterns (types of MS)
- clinically isolated syndrome
- relapsing remitting
- primary progressive
- secondary progressive
- progressive relapsing
progressive-relapsing MS
secondary progressive MS
primary progressive MS
relapsing-remitting MS
diagnostic criteria
- objective clinical evidence of 2+ attacks disseminated in space and time
- MRI and LP tests to confirm (or with less objective clinical evidence)
lumbar puncture (LP)
- normal cell count and protein
- oligoclonal bands in CSF
prognosis
- shorter life expectancy
- 50% of patients cannot walk unaided after 16 years since symptom onset
- relapsing-remitting MS has a better prognosis
- younger age onset suggests slower prognosis
treatment aims
- reduce relapse rate
- reduce disability progression
- slow accumulation of MRI lesions
- most “active” treatments aimed at relapsing-remitting MS
- symptomatic treatments for all types
disease modifying treatment
- interferon beta and glatiramer acetate (injection Rx)
- tysabri (natalizumab-intravenous infusion)
- mitoxantrone
interferon beta
- injection Rx
- reducing inflammation in the CNS
- decreasing T-cell migration into the CNS
- reduces relapses by 30%
- slows disability progression
- reduces MRI-detected brain lesions
tysabri (natalizumab-intravenous infusion)
- prevents immune cells from crossing the blood-brain barrier into the CNS
- reduces CNS inflammation and myelin damage
- reduces relapse rates by 68%
- slows disability progression
- decreases new/enlarging brain lesions (MRI)
mitoxantrone
- only for severe or rapidly progressing cases
- immunosuppressant (suppresses B cells, T cells, and macrophages involved in the autoimmune attack on myelin)
- potent chemotherapeutic agent
- risk of cardiotoxicity and leukemia
symptomatic treatment for relapses
high dose steroids speed up recovery
symptomatic treatment for spasticity
- baclofen (muscle relaxer)
- tizanidine (muscle relaxer)
symptomatic treatment for bladder
- medications
- self catherization
symptomatic treatment for pain
- medication
- alternative therapy
MDT
- neurologist
- neurorehab
- MS specialist nurses
- PT
- OT
- SLT
- social services
- palliative care
psychological and cognitive effects in MS
- depression
- anxiety
- dementia
oligoclonal bands
- point to a diagnosis of multiple sclerosis
- high levels of immunoglobulins indicate inflammation, infection, or autoimmune diseases
evoked potential tests
- measures the speed of the messages along your sensory nerves to the brain
- damage to the nerves in MS can slow down the transmission of nerve signals
- show slow, damaged nerve pathways
glatiramer acetate
- injection Rx
- mimics myelin basic protein, diverting the immune response away from attacking the myelin sheath
- induces regulatory T cells to reduce inflammation
- reduces relapses by 30%
- neuroprotective effects
- well-tolerated long term
?% dysarthria in MS
45%
most common dysarthria in MS
- spastic-ataxic symptoms
MS dysarthria: articulation
slow rate, imprecise consonants
MS dysarthria: phonation
pitch, loudness instability
MS dysarthria: respiration
reduced phonatory time and expiratory pressure
MS dysarthria: prosody
- variable intonation
- volume and pitch variation
most common speech deviations in MS
- impaired loudness control
- harsh voice quality
is hypernasality common in MS
no, more common in MND
dysarthria assessments for MS
- Frenchay Dysarthria
- AIDS
QOL in dysarthria
negative impacts on employment status, social participation, quality of life
dysarthria management
- respiration
- energy conservation, loudness regulation
- prosody
- paced speech and visual feedback
- adaptive compensation
- education
- AAC
EMST for MS?
- good for breath support
- no effect on speech or articulation
?% dysphagia in MS
40%
is the sensory or motor function of swallowing affected in MS
both
nature of swallow problems dependent on ?
site of lesions (which CNs are involved)
dysphagia in MS
- everything slows down
- fatigue element
- heat sensitivity
- physical disability
MS specific swallow scales
- Multiple Sclerosis Swallowing Performance Scale
- DYMUS
Multiple Sclerosis Swallowing Performance Scale
- a summary score from 1 (WFL) to 7 (NPO) of oral impairment, pharyngeal impairment, aspiration, and diet
- higher scores indicate worse swallowing
DYMUS
- questionnaire
- self-perception of FEDS
broad dysphagia management techniques
- remove distractions
- sensory stimulation
- positioning/posture
- maintain hydration
- avoid warm environments
- little and often
specific dysphagia management techniques
- compensatory techniques
- rehabilitation
- diet modification
- alternative feeding
