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PATHO 2 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Most important factor in increasing survival for people with MS

A

normal physical and physiological stress does not activate the disease process

BED REST KILLS

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2
Q

Stages of MS Care

A

Phase I: disease of ambulation
Phase II: disease of several systems

*Phase III: (occurring now) complex disease whose management is patient-centered in which the total disability is more than the sum of all affected systems- seen as malfunction in the multitasking of life

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3
Q

Definition of MS

A

Immune mediated inflammatory disease of the CNS
- characterized by exacerbations/ relapses (inflammatory attacks)

  • There is myelin damage and scarring and IRREVERSIBLE axonal damage in variable degrees
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4
Q

T/F: Steroids help to gain back function.

A

FALSE.

Steroids will only decrease inflammatory response
Axons are destroyed (irreversible)

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5
Q

Triggers of MS

A
  • abnormal immune response to virus
  • environmental trigger

in genetically susceptible individuals

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6
Q

Pathophysiology of MS

A

Activated peripheral t-cells break the blood-brain barrier
- they release chemicals that rally other immune system forces

  • Inflammatory response against myeline, axons, and oligodendocytes
  • Neurologic signs result from conduction blocks and axonal transection
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7
Q

Can myelin repair itself?

A

YES.

Once axons are damaged, they cannot be repaired.

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8
Q

Best time for treatment?

A

During an exacerbation to prevent damage to axon

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9
Q

Is MS hereditary?

A

No. But likely at risk in those with an affected relative compared to those with no family history.

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10
Q

Age of diagnosis?

A

Typically 20-50

90% of cases diagnosed between 16-60

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11
Q

T/F: MS is more common in women than men

A

TRUE

2-3:1

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12
Q

Spinal MS

A
  • 55-75% of pts. have spinal cord lesions at some point

- 20% of patients with spinal lesions DO NOT intracranial plaques

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13
Q

Neuromyelitis optica (NMO)

A

Devic disease; sequential episodes of optic nerve involvement and a longitudinally extensive myelopathy

**MS treatments DO NOT WORK for this disease

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14
Q

MS Classification (5)

A
  1. Relapse remitting MS
  2. Secondary progressive MS
  3. Primary progressive MS
  4. Progressive relapsing MS
  5. Malignant MS
  • Response to medications are different for each type
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15
Q

What is the most common type of MS

A

Relapse remitting MS

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16
Q

RRMS

A

Acute attacks with full recovery or partial residual deficit

The disease does not progress between attacks

85% of people initially diagnosed with this form

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17
Q

When should you start exercising and medication?

A

Day of diagnosis

  • ultimately the patient’s choice
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18
Q

SPMS

A

Starts with RRMS followed by progression at a variable rate that may include occasional relapses and plateaus

More than 50% of the people with RRMS will transform to this type of MS in 10 years

90% within 25 years

19
Q

PPMS

A

Progression of disability from the onset with or without plateaus or remissions or minor improvements
- only 10% with this form

Male patients with this form have the worst prognosis

  • poor response to treatment
  • rapid accumulating disability
20
Q

PRMS

A

Progression from onset but with clear acute relapses

Only 5% diagnosed with this form

21
Q

Malignant MS

A

Very rare

Death usually occurs within 1 year of diagnosis

22
Q

Relapse

A

Symptoms lasting for more than one or two days
- TREAT EARLY TO PREVENT AXONAL DAMAGE

Inflammation is continuous– not usually picked up by MRI

  • leads to irreversible axonal damage
  • neurological impairments and long term disability
23
Q

Medications

A

slow down the disease process

24
Q

Diagnosis

A

Very difficult:

  • no symptom pattern
  • no single test

Based on:

  • clinical presentation
  • MRI– shows plaques
  • confirmed with lab tests
  • treated after first attack
25
Q

What will an MRI show in people with MS?

A
  • Lesions deep in the brain

- involvement of white matter

26
Q

Lesions

A

Grouped into 4 patterns

  • each pattern may represent a separate disease
  • may show the same mechanism of demyelination
27
Q

Classification System

A

Expanded Disability Status Scale (EDSS)

  • Kurtzke Scale
  • Quantifies disability in eight functional systems

Scores:

  1. 0- 4.5: fully ambulatory
  2. 0- 9.5: impairment to ambulation
28
Q

Symptoms

A
  • Fatigue
  • Pain
  • Bowel/ bladder dysfunction
  • Visual disturbances
  • cognitive impairment
  • emotional changes
29
Q

More symtpoms

A
  • Tremor
  • Spasticity
  • Weakness
  • Imbalance
  • Incoordination
  • Sensory changes
  • Dysarthria
  • Dysphagia
  • Sexual dysfunction
30
Q

Prognosis

A

1/3 will have a very mild course (no AD)

1/3 will have a moderate course

1/3 will become disabled

31
Q

Prognostic indicators of a more favorable course:

A
  • Female
  • Onset before 35
  • Monoregional vs. polyregional lesions
  • Sensory vs. motor symptoms
  • complete recovery after exacerbation
32
Q

Prognostic indicators of a less favorable course:

A
  • Male
  • Onset after 35
  • cerebellar symptoms
  • poor recovery following a relapse
  • Frequent attacks
  • African Americans
33
Q

T/F: Rehab is an ongoing process

A

TRUE: In the health care system forever

- Frequent reassessments are required with the programs updated

34
Q

Two aspects of medication

A
  1. Immunomodulatory therapy

2. Symptom modifying

35
Q

Disease modifying Drugs

A
  • Reduce the frequency of attacks
  • Reduce the scarring on MRI
  • Slows disease process

THEY DO NOT:

  • cure disease
  • make people feel better
  • alleviate symptoms
36
Q

Treatment strategies

A
  • Steroids– for relapses
  • symptom management
  • disease modification
  • psychosocial support
  • rehab : MAINTAIN/ IMPROVE FUNCTION
37
Q

T/F: Treatment is effective during later, neurodegenerative phase

A

FALSE.

Treatment is most effective during early, inflammatory phase. Damage has already occurred once diagnosis is made

38
Q

Exercise

A

Decreases the deconditioning process that occurs on top of the neurological impairments

Improves FUNCTION

39
Q

PT Implications

A

Pts. have less muscle endurance and show increase in muscle fatigue

Have 30% less aerobic capacity

Relapses may account for memory loss and mood dysfunction.

40
Q

What is the most common symptom?

A

FATIGUE

  • most troubling
  • lack of physical or mental energy perceived by the individual or caregiver
41
Q

Types of Fatigue

A

Primary– related to disease process

Secondary– caused by pathological consequences of the disease

42
Q

Peripheral fatigue

A

happens at the muscle level

  • disuse
  • fiber type conversion
  • reduced oxidative capacity
  • impaired excitation
  • exaggerated metabolic response to exercise
  • impairment of calcium kinetics
43
Q

What improves fatigue?

A

Rest after exercise (within 20-30 mintues)
Medication: central fatigue
Exercise: peripheral fatigue

Aerobic exercise– improve oxidative capacity

PATHO 2 (4 decks)

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