Multiple Sclerosis Flashcards
what is MS?
-a progressive long term neurological disorder of the CNS that affects the brain, spinal cord and optic nerve
-acquired auto-immune inflammatory disease
describe the epidemiology of MS
-peak age onset 25-35 years
-females more common than males
-white races mainly
what are the causes of MS?
- no known cause
-but there is environmental & genetic factors eg Epstein Barr virus, immune response to virus
describe the pathophysiology of MS
-MS attacks the myelin sheath in the CNS
-this results in less effective action potential conduction by the neuron
-sclerotic plaques in the cortex, spinal cord and optic nerve
-there is re-myelination following acute demyelination
what are the initial clinical symptoms of MS?
-lack of energy
-headache
-depression
-aches in limbs
-limb weakness
-double vision /diplopia
- vertigo, axtaia etc
what are the motor symptoms of MS?
-muscle weakness - often asymmetric
-spasticity
-clonus
-spasms
-hyperreflexia, pos babinski sign
what are examples of visual symptoms of MS?
-diplopia
-blurred vision
-loss of visual acuity
-sudden onset of optic neuritis (inflammation of optic nerve- pain, visual loss etc )
what are examples of cerebellar signs associated with MS?
-hypotonia
-ataxia (lack of co-ordination)
-intention tremor
-poor co-ordination
-nystagmus (rapid repetitive eye movement)
what are examples of somatosensory symptoms associated with MS?
-pain, temp touch alteration
-pins and needles or numbness
-sense of position/ proprioception could be altered
what kind of autonomic symptoms can be seen in MS?
-bladder dysfunction
-bowel problems
-sexual dysfunction
what kind of cognitive, psychological and psychiatric symptoms are associated with MS?
-cognitive dysfunction
-memory and higher executive function loss
-mood swings
-anxiety
-depression
what is the Lhermitte’s symptoms with MS?
-when the patient flexes their bed (eg reaching from the bed to grab shoes) - they get electric shock symptoms along the back of neck down the spine and may move into LL
what is relapsing-remitting MS?
-most common type of MS
-characterised by attacks and remissions
-during remission there are fewer or no symptoms
-during a relapse, new symptoms may occur or previous symptoms may return
what is primary progressive MS?
-some people with MS never have distinct relapses and remissions
-from the onset of the disease, patients experience steadily worsening symptoms and progressive disability
-it may level off at any time, or may continue to get worse
what is secondary progressive MS?
-starts as relapsing remitting MS but after repeated attacks the remissions stop and the disease moves into a progressive phase
-40% of people with RRMS develop secondary progressive MS
describe benign MS
-usually starts with mild attacks followed by a recovery
-does not worsen over time and is a rarely permanent disability
-these people have little to no sign of disability 10-15 yrs after the onset of the disease
-around 10% have the benign form
describe the pharmacological rx for MS
-steroids - treatment of relapses
-Beta interferons - prevents relapses eg Avonex, rebif
-immunomodulators - disease modifiers
what kind of symptoms can be treated with drugs?
-spasticity eg baclofen
-urinary symptoms
-fatigue
-neuropathic pain eg Lyrica
-depression - amitryptylline
what is important information to get out of the database
-database- has the diagnosis been confirmed by neurologist?
-is pt aware?
-has the neurologist classified the disease?
-is pt currently in relapse?
-what medications is the pt on?
what kind of subjective questions are important to answer?
-what problems did you notice that brought you into hospital?
-have you ever had anything like this before?
-how is it affecting your daily life - mobility, ADLs etc
-how are you coping?
-did the steroids make a difference?
what is an important question to ask for a patient with MS who has a known diagnosis?
-since you were last assessed, has any activity you used to undertake been limited, stopped or affected?
-are you still able to do tasks eg work, family roles, leisure activities, washing, dressing etc ?
what kind of objective things can you assess?
-observation
-neuro exam - tone, power, co-ordination, sensation, reflexes
-ROM
-functional assessment eg transfers, gait
what outcome measures could be used for pts with MS - using ICF?
-impairment - Oxford scale, 5XSTS, nine hole peg test
-activity limitation - timed up and go, Berg balance scale, multiple sclerosis functional composite scale, MS fatigue impact scale
what are the main aims of physio rx?
-maintain soft tissue length and manage tone
-maximise muscle activity and strength
-support and sustain physical activity
-consider MSK triggers
-gait training
-balance rehab
-fatigue management
-incontenance management
what kind of exercise is suitable for pts with ms?
-encourage people with MS to exercise - beneficial effects and does not have any harmful effects
-aerobic training (low to mod intensity)
-balance exercises- reduce fall rates and improve balance
-resistance training - improves fatigue and walking
what is some advice re managing fatigue in MS?
-build up energy levels - sleep, good nutrition, staying active
-use that energy effectively - planning in advance, pacing etc
-could use activity
-accept that fatigue is part of MS but can be managed
