Multiple Sclerosis Flashcards
1
Q
what is multiple sclerosis?
A
- acquired chronic immune- mediated inflammatory condition of the CNS
2
Q
what structures does multiple sclerosis affect?
A
- affects both brain and spinal cord
3
Q
is multiple sclerosis present at birth?
A
- not present at birth
- frequently diagnosed in young adulthood so people live with it for many years
4
Q
is there a cure for multiple sclerosis ?
A
- no cure but medical treatment can reduce the number and severity of relapses as well as manage symptoms + improve the impact of those symptoms
5
Q
what is thought to be the cause of multiple sclerosis?
A
- mix of genetic + environmental factors
- no clear cut causes
6
Q
how does multiple sclerosis occur in people who are genetically predisposed?
A
- abnormal immune response to environment triggers in people who are genetically predisposed
7
Q
how many people in the UK have multiple sclerosis?
A
- approximately 130,000 people with MS in the UK
- 1 in 500 people
8
Q
what is the median age of onset of multiple sclerosis?
A
- 28 years
9
Q
what gender is more affected by multiple sclerosis?
A
- 2-3x more females than males are affected
10
Q
when are you more likely to develop multiple sclerosis?
A
- more likely to develop MS if a family member has the condition
11
Q
what is the pathophysiology of multiple sclerosis?
A
- body’s immune system attacks the myelin sheaths of the axon bundles in the CNS
12
Q
what happens to the myelin in multiple sclerosis? what is affected?
A
- myelin is degraded
- partially or completely stripped from nerve fibres
- affects the transmission through the nerve fibre
13
Q
what happens to the tissue in multiple sclerosis?
A
- inflammation of the damaged tissue
14
Q
what happens when the inflammation clears?
A
- when the inflammation clears, the myelin sheath may heal and repair
- and nerve fibres start to function again
15
Q
what is formed as a result of healing and repairing?
A
- small scars/ plaques (sclerosis)
16
Q
what can the scars and plaques do?
A
- can permanently damage the nerve fibres
17
Q
what is there a loss of at the time of inflammation?
A
- massive axonal loss at the time of inflammation
18
Q
what is low grade axonal degeneration?
A
- stable symptoms but silent process of axonal loss
19
Q
what is ataxia?
A
- lack of muscle coordination
- awkward clumsy movement
20
Q
what visual impairments may happen due to multiple sclerosis? (2)
A
- optic neuritis
- cerebella dysfunction = double function
21
Q
what are sensory impairments caused by multiple sclerosis? (2)
A
- sensation
- proprioception
22
Q
what is trigeminal neuralgia?
A
- severe neck pain in parts of the face
23
Q
what is Lhermittes sign?
A
- if you bend neck forwards, shooting sensation sent down the back and possibly to the legs
24
Q
what difficulties does multiple sclerosis cause? (3)
A
- mobility difficulties
- speech difficulties
- swallowing difficulties
25
what are the symptoms of multiple sclerosis?
- balance
- bladder/ bowel problems
- fatigue
- tremor
- weakness
- spasticity and spasms
26
what cognitive problems are caused by multiple sclerosis? (2)
- memory
- concentration
27
what mood problems can multiple sclerosis cause?
- depression
28
what can tremors relate to?
- relate to ataxia
29
what stimuli is dizziness?
- vestibular stimuli
30
what pain is involved in multiple sclerosis?
- neuropathic
- MSK
- MS hug
31
when may symptoms be worse?
- symptoms may be worse with heat
- struggle to get back out e.g., hydrotherapy
32
what happens when people move in an asymmetrical way?
- puts stresses on joints which weren't designed for this stress
33
what is a MS hug?
- crushing pain around the ribs
34
what is essential in balance and co-ordination?
- cerebellum
35
what is dysarthria?
- speech disorder that occurs due to weakness in the muscle necessary for speech production
36
what difficulties are very common in multiple sclerosis?
- walking difficulties
37
what do you need to look at when diagnosing the patient with multiple sclerosis?
- need to look at the whole holistic picture of the patient as everything interrelated
38
what may the patient present to their GP with a history of? (5)
- loss or reduction in vision with painful eye movements
- double vision
- sensory disturbance/ weakness
- problems with balance or clumsiness
- Lhermitte's phenomenon
39
what happens after the patient presents to the GP with symptoms of MS?
- some may be referred to a neurologist for further investigation whereas others may be hospitalised due to relapse
40
what are the three tests that are used in the diagnosis of multiple sclerosis?
- MRI
- lumbar puncture
- visual evoked potentials
41
how does an MRI detect multiple sclerosis?
- lesions can be seen in the brain and spinal cord
42
what patients are MRI's more effective?
- more effective with younger patients
43
what does a lumbar puncture of an individual with multiple sclerosis show?
- can show raised protein and presence of antibodies in the CSF
- helps to distinguish between MS and other conditions
44
what are visual evoked potentials?
- mostly used in research in which a visual stimulus is present
45
what do visual evoked potentials measure?
- measure how quickly the eyes can register the stimulus
46
what are the 4 classifications of multiple sclerosis?
- progressive relapsing MS
- secondary progressive MS
- primary progressive MS
- relapsing/ remitting MS
47
what is progressive relapsing MS?
- steady decline since onset with super- imposed attacks
48
what is secondary progressive MS?
- initial RRMS that suddenly begins to decline without periods of remission and relapses
49
what is primary progressive MS?
- gradual progression of the disease from its onset with no relapses or remissions
50
what is relapsing remitting MS?
- unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
51
what percentage of cases are primary progressive?
- approx 10-15%
52
what reduces over time in secondary progressive MS?
- frequency of remission reduces over time
53
what percentage of relapsing remitting cases develop into secondary progressive MS within 15 years?
- 65%
54
what percentage of cases at diagnosis are relapsing remitting?
- 85%
55
what are the three medical treatments for MS ?
- drugs which modify the course of the disease (DMT)
- drugs which treat relapses
- drugs to manage symptoms
56
how many drugs are available in disease modifying therapy?
- 14 drugs are currently available
57
what is the aim of disease modifying therapies?
- reduce the number and severity of relapses
- overall goal of achieving NEDA (no evidence of disease activity)
58
what can the most effective drug modifying therapies reduce relapses by?
- reduce relapses by up to 70%
59
what types of MS are disease modifying therapies used in?
- used in relapsing remitting MS
- and people who go to develop secondary progressive MS
60
what other patients are prescribed disease modifying drugs after?
- after first episode of symptoms
- clinical isolated syndrome
61
why is the acceptance of disease modifying drugs so complex?
- due to the side effects
62
what was the first DMD that was approved for primary progressive MS?
- ocrelizumab
63
what are the two most effective disease modifying drugs?
- tecfidera
- tysabri
64
what are the side effects from disease modifying therapy? (3)
- flu like symptoms e.g., headaches, stomach problems
- increased risk of other diseases
65
what does PML stand for?
- progressive multifocal leukoencephalopathy
66
what is PML?
- disease of the white matter of the brain c
- degenerative disease that can end up to be fatal
67
what is PML caused by?
- caused by a virus infection that targets cells that make myelin
68
what is a relapse?
- onset of new symptoms or the worsening of pre- existing symptoms
- lasting for more than 24 hours
69
why is relapse an important concept for healthcare professionals?
- because professionals need to be certain that it is a relapse before treating it as a relapse
e.g., if patient is unwell, it may exacerbate symptoms
70
what are the 5 routine treatment options for a relapse?
- no treatment
- symptomatic treatment
- wait and see and treat with steroids if worsen
- high dose methylprednisolone (oral or IV)
- plasma exchange
71
when is plasma exchange used?
- used if there is no response to methylprednisolone
72
what is the benefit of steroids? do they have long term differences?
- shorten recovery time from relapse
- no long term differences to the courses of the person's MS
73
why would drugs be used to treat symptoms? - give some examples
- used to help manage day to day symptoms to cope with ADLs
e.g., medical management for treating bladder dysfunction, fatigue, pain, spasticity
74
what is the EDSS?
- assessment of disability and function expanded disease severity scale
75
what healthcare professionals should be involved in an MDT care plan? (12)
- consultant neurologists
- MS nurses
- physios
- occupational therapists
- speech and language therapists
- dieticians
- social care
- contingence specialists
- GPs
- orthotists
- wheelchair services
- consultants in rehab - symptomatic management
76
what does core muscle weakness lead to? (3)
- poor posture
- difficulties with upper limb activities
- risk of falls
77
what does the cerebellum create problems with? (2)
- balance
- co ordination
78
what is physiotherapy treatment of multiple sclerosis focused on?
- focused on maintaining and improving function where possible
79
what programmes have evidence of value for multiple sclerosis patients?
- strengthening programme
- pilates- type exercise
80
what did the NICE guidelines encourage people with multiple sclerosis to do? why?
- encouraged to exercise
- advised that exercise may have beneficial effects on their MS and that it doesn't have nay harmful effects
81
what is helpful in treating fatigue? (3)
- aerobic
- balance
- stretching
82
what should a comprehensive programme for multiple sclerosis include according to the NICE guidelines?
- aerobic and moderate progressive resistance activity
- combined with cognitive behavioural therapy who have moderately impaired mobility and fatigue
83
how can you help individuals with multiple sclerosis to keep exercising?
- refer them to exercise referral schemes (long term)
84
how much exercise should people between 18 and 65 with mild to moderate disability do?
- 2 x 30 minute sessions per week of moderate to vigorous physical exercise and 2x weekly strength training for major muscle groups
85
what intensity should people with mild to moderate disability exercise at? - give some examples
- moderate to vigorous intensity
- climbing stairs, washing floors or windows, mowing lawn
- running and team sports
- dancing
- cycling
86
what does exercise reduce in multiple sclerosis patients?
- reduces fatigue
87
what does exercise improve in people with multiple sclerosis?
- mobility
88
what does exercise enhance in people with multiple sclerosis?
- health related quality of life
