Multiple Sclerosis

Question 1

MS definition

Answer 1

Life long inflammation of brain and spinal cord.

Remissions and exacerbation

Question 2

Spinal nerves

Answer 2

8 cervical
12 thoracic 
5 lumbar 
5 sacral
1 coccyx

Question 3

Four major types of MS

Answer 3

Relapsing-remitting
Primary progressive
Secondary progressive
Progressive-relapsing

Question 4

Relapsing-remitting

Answer 4

Classic.

Develop and resolve

Question 5

Primary progressive

Answer 5

Steady and gradual deterioration without remission

Question 6

Secondary progressive

Answer 6

Begins with relapsing-remitting then becomes steadily progressive

Question 7

Progressive-relapsing

Answer 7

Frequent relapses with partial recovery, but never a return to baseline

Question 8

Most often seen in

Answer 8

Cold climates
European ancestry
20-40 years
Women’s twice as often

Question 9

Medical history

Answer 9

Ability to move 
Progression?
Aggravating factors- fatigue, stress, cold 
Behavior changes- mood, judgement 
Family history

Question 10

Assessment of neuro

Answer 10

\+babinski 
Tinnitus 
Tremors
Slurred/slowed speech
Unstable gait
Dysphagia 
Dysarthria 
Scanning- long pauses between words

Question 11

Assessment of visual

Answer 11

Blurred vision
Diplopia
Scotomas(peripheral)
Nystagmus

Question 12

GI assessment

Answer 12

Bowel and bladder dysfunction

A reflexive bladder

Question 13

Sexual assessment

Answer 13

Impotence

Decreased libido

Question 14

Sensory assessment

Answer 14

Parasthesia
Facial pain
Decreased temperature sensation

Question 15

Interferon-beta

Answer 15

Immunomodulators

Given sub Q- self administer

Question 16

Glatiramer acetate

Answer 16

Synthetic protein
Sub Q
Teaching: avoid crowds, rotate site, infection, draw it up

Question 17

Natalizumab

Answer 17

Binds to WBC to prevent further damage.
IV form controversial for side effects.
Metabolized in liver
Builds up in body

Question 18

Patients receiving natalizumab are at high risk for

Answer 18

Progressive multi focal leukoencephalopathy (PML)

An opportunistic viral infection

Question 19

Fingolimod

Answer 19

1st oral immunomodular approved for tx of MS

Causes bradycardia especially in first 6 hours

Question 20

Immunosuppressive therapy

Answer 20

Combo of cytocan and solu-medrol

If having flare up

Question 21

Treatment of bladder dysfunction

Answer 21

Anticholinergics

Question 22

PT

Answer 22

ROM exercise

Stretching and strengthening

Question 23

OT

Answer 23

Fine motor

Question 24

Diagnosis

Answer 24

CSF
Increased protein
Slight increase WBC
CSF electrophoresis increase in myelin basic protein and IgG

Question 25

CT

Answer 25

Increased density of white matter and MS plaques

Question 26

MRI

Answer 26

Shows plaques

Question 27

EMG

Electromyography

Answer 27

Grossly abnormal if advanced