Multiple Sclerosis Flashcards
what is the pathophysiology of MS?
immune-mediated disease that primarily affects the CNS (auto-immune)
what are the “exacerbations” associated with MS?
random attacks of inflammation towards the CNS (brain or SC)
What is the etiology of MS?
abnormal autoimmune response to some infection or environmental trigger in a genetically susceptible individual
what is the pathophysiology?
inflammatory disease DESTROYING areas of myelin in the CNS, primarily white matter
what are the four locations that MS affects?
- brain
- SC
- brainstem
- CN
with MS, what is a result of the inflammation
irreversible damage of axons
what cause the irreversible damage of the axons?
scarring or sclerosis
what is the epidemiology of MS?
women > men
caucasians > hispanics/AA >asians
prevalent in temperate zones
genetic link
what are the most common s/s of MS?
- fatigue (88%)
- difficulty walking (87%)
- B and B (65%)
- pain/sensory changes (60%)
- visual disturbances (58%)
- cognitive problems (44%)
- tremors (41%)
what are some cognitive problems associated with MS
difficulty with:
- dual and multi tasking
- following detailed instructions
- ST memory
what is the most common emotional instability related to MS?
depression
what is the initial presentation of an initial attack for MS?
- transient
- mild
- self-limited
don’t know they are having an attack
what are some things associated with diagnosis of MS?
- clinical attacks
- MRI
- CSF
- positive evoked potentials (nerve conduction testing)
what is the timing of the attacks to be diagnosed with MS?
2 attack separated by 30 days
what is the gold standard for diagnosing MS?
MRI - lesion dissemination over space and/or time
what level is elevated in CSF with diagnosis of MS?
gamma globulin
what are the factors for more positive prognosis
female, onset < 35, monoregional, and complete recovery after exacerbation
what are the factors for more negative prognosis
male, onset > 35, brainstem symptoms, poor recovery following exacerbation, frequent attacks, AA
what are special issues for PTs with MS?
- ambiguity of the disease
- unpredictability of the disease
- covert symptoms
what are considered covert symptoms?
fatigue, pain, vision, B and B, and paresthesias
what are the 4 categories of MS?
relapsing-remitting
primary-progressive
secondary-progressive
progressive-relapsing
what is the most common form of MS?
relapsing-remitting
what are some characteristics of relapsing-remitting?
defined disease flare-ups with full recovery/minimal residual deficit; periods between disease relapses (remissions)
what percentage of patients with relapsing-remitting develop secondary progressive?
50%
what are characteristics of secondary progressive MS?
initial relapsing-remitting course followed by progression with or w/o occasional relapses, minor remissions with some recovery and plateau
what is the progression of secondary progressive MS?
attack – progressively worse – plateau – another attac
what are the characteristics of primary progressive MS?
disease progression from onset; without plateaus OR with occasional plateau and temporary minor improvements
what are the characteristics of progressive-relapsing MS?
progressive from onset; clear acute relapses with or w/o full recovery; periods between relapses characterized by continuing progression
what are the 5 categories of treatment for MS?
- treatment of acute exacerbations
- symptom management
- disease modification
- rehabilitation
- psycho-social support
what are 5 factors triggering a relapse?
- unpredictable
- infections
- physical and emotional stress
- heat
- last trimester of pregnancy offers a natural protection against relapse
what are some tips for acute relapse management?
natural improvement over 4-12 weeks; degree of improvement varies, and IV or oral corticosteroids
what attempts to end the attack sooner and leave fewer permanent lesions?
methylprednisolone followed by oral corticosteroid
what are some symptoms to manage?
fatigue, pain, depression, bowel and bladder, spasticity, dizziness/vertigo, and intention tremor
what are the goals of disease modifying agents?
reduce frequency of relapses, progression of disability, and number/volume of brain lesions
Avonex
treatment of all relapsing forms of MS; weekly IM injection
-can use for a single clinical episode if MRI is consistent with MS
Rebif
all relapsing forms of MS
-3x/week IM injection
Betaseron and Extavia
treatment of all relapsing forms of MS;
-every other day subcutaneous injection
what is a precaution for betaseron and extavia
should not be given to patients with severe and untreated depression due to increased risk of suicide associated with this treatment
copaxone
treatment of relapsing/remitting MS
-daily subcutaneous injection
novantrone (serono)
worsening relapsing/remitting MS and for progressive relapsing or secondary progressive MS
-4x/year IV infusion
Tysabri
relapsing forms of MS
-every 4 weeks IV infusion
what are some tests that can be demonstrated during the comprehensive neuro eval?
SF-36, Fatigue Impact Scale, MMSE, MMT & Gonio, Modified Ashworth, Vestibular/Ocular Exam, 6MWT, Berg, FIM, Barthel
what are some areas that PT could help with treatment?
wellness/health, fatigue, weakness, spasticity, balance/vestibular, coordination, sensory problems, ambulation/mobility, ADLs
What are issues that need to be addressed when trying to help fatigue management?
sleep, poor diet, deconditioning, movement limitations, depression, neuromuscular conditions (more energy consumption by demyelinated axons), body core temp (increasing = slows conduction velocity), emotional stress
What is the effect of heat on MS?
heat sensitive = aggravate common symptoms (does not cause exacerbation)
- pool temp <85 degrees
- cooling garments
what are four outcomes measures commonly used with MS?
- satisfaction with life scale
- SF-36
- MSQOL-54
- Modified Falls Efficacy Scale
