Multiple Sclerosis Flashcards
Multiple Sclerosis Etiology/Basics
-leading cuase of non traumatic disability in young adults
-Black > White > Asian
-females >males
-onset 20-50y
-reduces life expectancy by 7-14 years
Multiple Sclerosis Causes
-cause unknown
-~20% of heritability
-immune mediated disease of CNS
-movement of autoreactive T cells and demyelinating antibodies from systemic circulation into CNS through disruption of BBB
Environmental RK:
-EBV virus exposure
-low sun exposure
-obesity
-smoking
Multiple Sclerosis Types
Progressive-Relaspsing MS:
-steady decline since onset with super attacks
-<10%
Secondary Progressive MS:
-intial relapsing remitting MS that suddenly begins to have decline w/o remission
Primary Progressive MS:
-steady increase in disability w/o attacks
-10-20%
Relapsing-Remitting MS:
-unpredictable attacks
-leave permanent deficits followed by remission
-80-90%
Multiple Sclerosis Progression
Onset:
-85%: RRMS
-15%: PPMS
After 10 years:
-40%: RRMS
-15%: PPMS
-45%: SPMS
-as time goes on=more relapses=less brain volume= more disability and cognitive dysfunction= less relapses
most relapses at relapsing remitting after initial event, clinical diagnosis
Multiple Sclerosis Prognosis
Better:
-caucasian
-monofocal onset
-low relapse rate
-no or low disabiltiy @5 yrs
-low lesion load on initial MRI
Worse:
-non white/males
-smoking or obesity
-multifocal onset
-high relapse rate
-disability @5yr
-MRI with high lesion load
Multiple Sclerosis Symptoms (s/s)
Cognitive:
-fatigue
-cognitive impairment
-depression
-subcortical dementia
Motor:
-corticospinal and corticobulbar tract lesion w/ UMN spatic weakness (80%)
-spatic paraparesis most common
-Cerebellar Pathways w/ ataxia, temor, scanning speech (usually later)
Sensory:
-spinothalamic lesion (dysesthesias and pain/early sign)
-DCML less common
-Lhermitte’s Phenomenon: electric sensation passing down back and limbs with neck flx
-trigenimal neuralgia and optic neuritis
-vestibular
Brainstem:
-nystagmus, diplopia (early), facial weakness, vertigo, dysphagia, trigeminal neuralgia
-internuclear ophthalmolegia
Fatigue:
-Primary: due to location of plaques and hypometabolism (decrease in myelin and inc energy needs to transmit signals)
-Secondary: due to increased energy required
MS Diagnosis Requirments: Clinically Isolated Syndrome
-first attack
-single incident indicationg CNS demmyelination
-must last at least 24h
1 Lesion:
-increase in tone
-Lhermitte’s sign
-Uhthoff’s sign
MS Diagnosis Requirments: Relapses/Exacerbations/Attacks
-new s/s lasting >24 hrs
-unrelated to another etiology
-MRI lesions seen; at least 2 attacks and 2 lesions
Exacerbating factors:
-infections
-organ disease
-stress
Lhermitte’s Sign
-unique sign of MS
-neck flexion causes electric shock like sensations down spine
Uhthoff’s Phenomenon
-unique sign of MS
-excessive heat causes temporary worsening of s/s
Charcot’s Triad
-when cerebellum is affected
1. Scanning speech
2. Intention tremor
3. Nystagmus
Visual Dysfunction
-diplopia
-marcus gun pupil
-dimished visual
-blindness
-lateral gaze palsy
Bladder Control
-Mixed Pattern: overactive and underactive
-Overactive: increased frequency, incontinence due to detrusor
-Underactive: difficulty starting urination, difficultty emptying
Bowel Control
Mixed Pattern: spastic and flaccid
Spastic: constipation, difficulty emptying
Flaccid: incontinence, decreased motility
MS Movement System Impairment Diagnoses
- Movement Pattern Coordination Deficit
- Force Production deficit
- Fractionated Movement Deficit
- Hypermetria
PT Intervention
-Education: disease process/energy conservation/rest breaks/heat sensitivity
-Address Impairments
-Fatigue Management
-Gait and mobility training
