Multiple Sclerosis Flashcards
Who is the typical/most common patient that is diagnosed with MS (4)?
- typical onset between 20-40 yr. old.
- predominately white populations
- more common in women (2-3:1)
- higher frequency in tempered zones (northern US/southern Canada, Scandinavian countries, northern Europe, New Zealand and southern Australia)
MS is characterized by (4) things.
- autoimmune disease
- inflammation
- selective demyelination
- gliosis
T/F - It appears a person can inherit MS?
False - a person may inherit a genetic susceptibility to immune system dysfunction.
When persons with genetic susceptibility are exposed to a viral agent, the immune system responds with activated myelin-reactive lymphocytes, what are the (5) viruses under investigation?
- Epstein-Barr
- Measles
- Canine distemper
- Human herpesvirus-6
- Chlamydia pneumonia
Name (2) risk factors that may increase your chances of developing MS?
- Vitamin D deficiency
- smoking
What is the pathophysiology or events (7) that take place with MS?
- immune response (to virus) triggers activation of immune cells
- cells activate autoantigens, producing cytotoxic effects within CNS “friendly fire”
- Phagocytic activity of macrophages may also contribute to demyelination
- demyelination slows neural transmission and causes nerve to fatigue rapidly
- Acute inflammatory event emerges (edema and infiltrates surround the acute lesion, can cause mass effect further interfering with nerve conduction)
- During early stages of MS, oligodendrocytes survive and can produce remyelination.
- Demyelinated areas become filled with fibrous astrocytes and undergoes gliosis. (this glial scare or plaque is a permanent change)
T/F - Damaged cells that result in demyelination (in MS) can regenerate myelin?
True - but often incomplete and to 100% of its pre-damaged function.
What is gliosis?
- proliferation of neuroglial tissue within the CNS resulting in glial scars (plaques)
- axon itself becomes interrupted and undergoes neurodegeneration
- this is the main cause of permanent disability
What are the four major clinical subtypes of MS?
- Relapsing-Remitting MS (about 85% of MS at diagnosis, lack of disease progression between periods of relapse)
- Secondary-Progressive MS (begins with RRMS course, followed by steady irreversible decline)
- Primary-Progressive MS (continuous worsening of disease, without discrete attacks)
- Progressive-Relapsing MS (steady deterioration from onset with occasional acute attacks)
T/F - There has been recently fewer incidences, due to newer medications, of persons diagnosed with Secondary-Progressive MS?
True - before newer medications, the majority of patients with RRMS progressed to SPMS.
Describe the disease course of MS (3).
- it DEPENDS!!!!!!
- it is highly variable and unpredictable from person to person and within an individual over time.
- relapses (exacerbations) = new and recurrent MS symptoms lasting more than 24 hours that are unrelated to another etiology.
What are (4) exacerbating factors that if possible should be avoided to ensure the MS patient’s optimal function?
- avoiding overall health decline (deteriorate)
- viral or bacterial infections
- diseases of major organ systems
- modest link between stress and relates
What is a pseudoexacerbation?
- temporary worsening of MS symptoms
- typically comes and goes within 24 hours
T/F - Increase in body temperature can bring on a pseudo-attack?
True
What are common sensory deficits seen in MS (4)?
- focal deficits produce limited areas of diminished sensation
- altered sensation is common, paresthesias (pins and needles)
- numbness, decreased proprioception also common
- pain, 80% and 50% chronic pain, trigeminal neuralgia (face, cheek, jaw) Lhermitte’s sign (flexion of neck produces electric shock-like sensation down spine and into LE’s)
What are common visual deficits seen in MS (3)?
- Optic Neuritis (inflammation of optic nerve)
- Nystagmus
- Diplopia (double vision)
- visual symptoms found in 80% of pt’s
What is described as an icepick-like pain behind the eye with blurring or graying of vision or blindness in one eye?
- optic neuritis
- generally improve with in 4 to 12 weeks
What are common motor symptoms in a patients with MS (4)?
- UPN syndrome (paresis, spasticity, brisk tendon reflex, involuntary flexor and extensor spasms, clonus, babinskis sign, loss of praise autonomic control)
- weakness (variable depending on lesion sites)
- spasticity (75% of pt’s, fluctuates on daily basis)
- “MS hug”
What are (4) characteristics of a MS patients fatigue?
- “subjective lack of physical and/or mental energy”
- experienced by 75-95% of pt with MS (50-60% report most troubling symptom)
- comes on abruptly without warning and typically gets worse throughout the day
- patient complaints may include feelings of overwhelming tiredness, exhaustion, and weakness together with difficulty concentrating and mental dullness
What are aggregating factors for a MS patient’s fatigue (5)?
- heat and humidity
- disturbed or reduced sleep
- depression
- low self-esteem
- mood disorders
Why is coordination and balance symptoms seen in MS?
- demyelination lesions in the cerebellum and cerebellar tracts are common.
What are common coordination and balance symptoms found in MS (5)?
- ataxia
- postural and intension tremors
- hypotonia
- truncal weakness
- vestibular dysfunctions of dizziness, vertigo, disequilibrium, nausea, etc. (lesions of central vestibular pathways)
Describe what ataxia might look like in a person with MS?
- staggering, uneven steps, poor foot placement, uncoordinated limb movements, frequent loss of balance
- mistaken for drunkenness
- half of RRMS pt will require some form of assistance during walking within 15 years of diagnosis
Besides sensory, visual, motor, fatigue, coordination and balance, gait and mobility, what other symptoms might a person with MS have (7)?
- speech and swallowing difficulties
- cognitive impairments
- depression
- emotional (pseudobulbar affect, euphoria)
- bladder dysfunction (80% of pt’s)
- bowel (constipation)
- sexual dysfunction (91% of men, 72% of women)
Diagnosis of MS is made by a neurologist, what (2) factors must be present?
- evidence of damage present in at least 2 separate areas of CNS
- damaged must have occurred at 2 separate points in time, at least 1 month apart.
T/F - both new damage and old damage to the CNS can be seen in the same MRI?
true - highly sensitive to plaques in while matter (new active inflammation with in 6 weeks are bright spots and long term disease is seen as black holes.
Other than MRI’s what other laboratory test are use with MS patients and why (2)?
- lumbar puncture for immunoglobulin (IgG) in CSF is a response to demyelination (PPMS have higher levels than RRMS)
- evoked potentials (nerve conduction test) 90% of MS pt’s have abnormal EP (basically slowed nerve conduction)
What drug(s) are used to manage acute relapse or episodes?
- corticosteroids
* *does NOT modify disease course or degree of recovery, can shorten duration of the episode.
What is the fist-line injectable drug(s) that are considered disease-modifying therapeutic agents for MS?
- synthetic interferon drugs
- examples are interferon beta-1b (Betaseron, Extavia) and Interferon beta-1a (Avonex, Rebif)
- slows down the immune system response by reducing inflammation, swelling, and rapid proliferation of T and B cells
- block activated T-cells from crossing blood-brain barrier and damaging myelin
When are disease-modifying therapeutic agents for MS contraindicated (2)?
- women who are pregnant
- women who are breastfeeding
What are (4) PT implications/considerations when working with a MS patient?
- Be supportive and understanding
- Educate patient on treatment benefits
- Work as a team with neurologist to maximize compliance to drug therapy
- Emphasize the benefits of early treatment and importance of consistency
What are the (7) symptoms of MS that are medically managed?
- Spasticity
- Pain
- Fatigue
- Tremor
- Cognitive and emotional impairments
- Bladder and bowel impairments
- Other: AMPYRA® (dalfampridine), an oral medication, treatment shown to improve walking in people with multiple sclerosis (MS)
There is STRONG evidence to support rehabilitation in producing significant gains in enhancing levels of _______ and ___________ for MS pt’s.
activity and participation
What types of rehabilitation intervention strategies are appropriate for patients with MS (4)?
- Restorative Interventions
- Preventative interventions
- Compensatory interventions
- Maintenance therapy
- A coordinated interdisciplinary team is NECESSARY
What test and measures are use to monitor fatigue in an MS patient (3)?
- Modified Fatigue Impact Scale (MFIS)
- Fatigue Scale for Motor and Cognitive Functions
- Visual analog scale (0-10 rating) can be used during treatment
What test and measures are use for gait and locomotion for an MS patient (4)?
- 10 Meter Walk Test
- 6 Minute Walk Test
- Dynamic Gait Index
- Rivermead Visual Gait Index
What test and measure are use for sensation with a MS patient (1)?
- Nottingham Sensory Assessment
What test and measure are use for affective and psychosocial function in an MS patient (1)?
- Beck Depression Inventory (5 minute, self report)
What test and measures are use for cognition in an MS patient (2)?
- Minimal Examination of Cognitive Function in MS (90 minute test, look for it in neuropsychologist report)
- Mini-mental Status Examination
What test and measures are use for pain in an MS patient (2)?
- McGill Pain Questionnaire
- Neuropathic Pain Scale
What outcome measures are specific to patients with MS (7)?
- Expanded Disability Status Scale (EDSS) for patients with MS (10 point scale for rating overall disability in MS, widely used in clinic and research)
- The Minimum Record of Disability (MRD)
- MS Functional Composite (MSFC) (25 foot walk, 9-Hole Peg test, Paced Auditory Serial Addition Test)
- Multiple Sclerosis Quality of Life – 54 (MSQOL-54)
- MS Quality of Life Inventory
- Functional Examination of MS (FAMS)
- Multiple Sclerosis Impact Scale (MSIS-29)
What are some common goals for patients with MS (5)
- Reduce impact of pathology, impairments
- Reduce disability associated with chronic illness
- Improve ability to perform physical activities
- Improve quality of life
- Improve patient satisfaction
When creating goals for your MS patient what things do you need to consider (3)?
- Patient’s current status
- Have they just had an acute relapse?
- What are the patient’s goals and what is the focus of treatment?
