Multiple Sclerosis Flashcards
Most important factor in increasing survival for people with MS
normal physical and physiological stress does not activate the disease process
BED REST KILLS
Stages of MS Care
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
Definition of MS
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
T/F: Steroids help to gain back function.
FALSE.
Steroids will only decrease inflammatory response
Axons are destroyed (irreversible)
Triggers of MS
- abnormal immune response to virus
- environmental trigger
in genetically susceptible individuals
Pathophysiology of MS
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
Can myelin repair itself?
YES.
Once axons are damaged, they cannot be repaired.
Best time for treatment?
During an exacerbation to prevent damage to axon
Is MS hereditary?
No. But likely at risk in those with an affected relative compared to those with no family history.
Age of diagnosis?
Typically 20-50
90% of cases diagnosed between 16-60
T/F: MS is more common in women than men
TRUE
2-3:1
Spinal MS
- 55-75% of pts. have spinal cord lesions at some point
- 20% of patients with spinal lesions DO NOT intracranial plaques
Neuromyelitis optica (NMO)
Devic disease; sequential episodes of optic nerve involvement and a longitudinally extensive myelopathy
**MS treatments DO NOT WORK for this disease
MS Classification (5)
- Relapse remitting MS
- Secondary progressive MS
- Primary progressive MS
- Progressive relapsing MS
- Malignant MS
- Response to medications are different for each type
What is the most common type of MS
Relapse remitting MS
RRMS
Acute attacks with full recovery or partial residual deficit
The disease does not progress between attacks
85% of people initially diagnosed with this form
When should you start exercising and medication?
Day of diagnosis
- ultimately the patient’s choice
SPMS
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
PPMS
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
PRMS
Progression from onset but with clear acute relapses
Only 5% diagnosed with this form
Malignant MS
Very rare
Death usually occurs within 1 year of diagnosis
Relapse
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
Medications
slow down the disease process
Diagnosis
Very difficult:
- no symptom pattern
- no single test
Based on:
- clinical presentation
- MRI– shows plaques
- confirmed with lab tests
- treated after first attack
