Multiple Sclerosis Flashcards
What is the most important factor in increasing the survival rate of MS?
The realization that normal physical and physiological stress does not activate the disease process
What is MS?
Immune-mediated inflammatory disease of the CNS.
It is characterized by inflammatory attacks (relapses or exacerbations) that vary in number and frequency.
There is myelin damage and scarring and irreversible axonal damage in variable degrees.
What can cause MS?
Abnormal immune response to viruses or environmental trigger in genetically susceptible individuals.
Activated peripheral t-cells breach the blood-brain barrier. They release chemicals that rally other immune system forces.
What cells are attacked by the inflammatory response triggered by MS?
- Myelin
- Axons
- Oligodendrocytes.
Neurological signs associated with MS results from what 2 phenomena?
Conduction blocks
Axonal transection
Can myelin repair itself? What are cases when it cannot be repaired?
Myelin has some ability to repair itself BUT once the AXONS are damaged they cannot be repaired.
True or false: MS is hereditary
FALSE
MS is ___ times higher for persons with an affected relative than for those with no family history
10-50x
When is MS typically diagnosed? M vs F?
Typically diagnosed between the ages of 20 and 50
More common in women than men, 2-3:1
90% of MS cases are diagnosed between the ages of ___.
16-60 years of age
Approximately 55-75% of patients have _________ at some point during the course of the disease
spinal cord lesions
What part of the spine is most commonly affected with an MS spinal cord lesion?
Cervical spine (67% of cases)
What are the 5 disease classification of MS?
- Relapsing remitting MS (RRMS)
- Secondary Progressive MS (SPMS)
- Primary Progressive MS (PPMS)
- Progressive relapsing MS (PRMS)
- Malignant MS (die within 1 year, worst prognosis)
Characteristics of Relapse Remitting MS (RRMS)
- Acute attacks with full recovery or partial residual deficit.
- Lack of disease progression between the attacks.
- 85% of people initially diagnosed with this form
Characteristics of Secondary Progressive MS (SPMS)
- Starts with the RRMS followed by progression at 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
Characteristics of Primary Progressive MS (PPMS)
- Progression of disability from the onset with or without plateaus or remissions or minor improvements.
- Only 10% are diagnosed with this form.
- Male patients with this form have the worst prognosis with less favorable response to treatment and rapidly accumulating disability.
Characteristics of Progressive Relapsing MS (PRMS)
- Progression from onset but with clear acute relapses.
2. Only 5% are diagnoses with this form
Characteristics of malignant MS
Very rare and death usually results in one year from diagnosis
Relapse in MS is defined as what?
Defined as symptoms lasting for more than one or two days
Characteristics of inflammation in MS
Inflammation is continuous in this disease
MRI will show activity even though the person has no symptoms.
Continuous inflammation causes axonal damage and thus the irreversible neurological impairments and long-term disability noted in MS.
There is more inflammation activity early on in the course of the disease so once the person is diagnosed he/she must start treatment and buy a pair of sneakers.
What is the problem with diagnosing MS?
Difficult to diagnose
No symptom pattern or standard set of clinical signs to help physicians recognize this disease.
No single test that can determine if a person has MS.
How is MS diagnosed?
MRI : shows plaques and lesions (no other reason to explain presence)
Lesions are deep and involve white matter
Diagnosis is clinically based on medical history, signs, and symptoms.
They treat after the first attack
Why are lesions difficult to treat in patients with MS?
Lesions are dependent on the individual so it is difficult to mainstream the treatment
What scores on the Expanded disability status scale (EDSS) indicate ambulation or impairment to ambulation?
EDDS score of 1.0 to 4.5 refer to people with MS who are fully ambulatory.
EDDS score of 5.0 - 9.5 are defined by the impairment to ambulation
What are the symptoms associated with MS?
Fatigue (95%) Pain Impaired ambulation Emotional changes (BIPOLAR DISORDER) Weakness/imbalance Tremor/spasticity Dysarthria Dysphagia Cognitive/Visual impairment
What is the prognosis of MS?
1/3 will have a very mild course
1/3 will have a moderate course
1/3 will become disabled
What prognostic indicators are associated with a more favorable course of MS?
- Female
- Onset before age 35
- Monoregional vs. polyregional lesions
- Sensory vs. motor symptoms
- Complete recovery after exacerbation
What prognostic indicators are associated with a less favorable course of MS?
- Male
- Onset after 35
- Cerebellar symptoms – tremor, nystagmus, dysarthia, ataxia)
- Poor recovery following a relapse
- Frequent attacks
- African-Americans tend to have a more rapidly progressing course than Caucasians.
What are the 2 aspects of the general treatment for MS?
- Immunomodulatory therapy (IMT) for the underlying immune disorder
- Symptom modifying
What 3 medications are used to treat acute relapses?
Solu-Medrol
Plasmapheresis
Dexamethasone
What ABC drugs are used to treat relapsing remitting MS?
- Avonex®, Rebif®
- Betaseron®,Extavia®
- Copaxone®
What is the medical concern associated with the drug Tysabri? What side effects may arise?
Risk of PML - progressive multifocal leukoencephalopathy
- Progressive weakness on one side of the body
- Clumsiness of limbs
- Disturbance in vision
- Changes in thinking, memory, and orientation
- Confusion and personality changes
What are the effects of disease modifying drugs?
All reduce the frequency of attacks and the severity
Reduce the scarring on MRI
Slow disease progression
They DO NOT:
- Cure the disease
- Make people feel better
- Alleviate symptoms
How is MS treated?
Symptom management
Disease modification
Psychosocial support
Rehab: MAINTAIN or improve function
When should treatment for MS start?
Immediately after the first attack
When is treatment most effective?
early, inflammatory phase
When is treatment least effective?
later, neurodegenerative phase
Why is exercise beneficial for patients with MS?
Decrease the disuse process that occurs slowly and unnoticed
Decrease the deconditioning process that occurs on top of the neurological impairments
Patient with MS have normal muscle ____, less muscle _____, and an increase in muscle _____.
- strength
- endurance
- fatigue
Patients have at least ___% less aerobic capacity.
30%
Fatigue is worsened by:
Hot/humid weather Taking a hot bath/shower Having another MS attack Experiencing a stressful situation Sleep problems Having a feverish illness Increase in daily activity Exercise Age
What is primary fatigue?
Thought to be caused by factors related to the disease process – demyelinization, inflammation, axonal loss, immune factors, pyramidal tract involvement
What is secondary fatigue?
Caused by the pathological consequences of the disease –medications, depression, anxiety, disuse, deconditioning, sleep disturbances, heat sensitivity
What are the characteristics of central fatigue?
Subjective sense of fatigue
Mental/cognitive fatigue (memory, learning, attention, and information processing_
Neuronal hypometabolism and axonal damage
Global brain hypometabolism
What are the characteristics of peripheral fatigue?
Disorders of the muscle and neuromuscular junction Disuse Fiber type conversion Reduction and atrophy of muscle fibers Reduced muscle oxidative capacity Impaired excitation-contraction coupling
What treatments should be used to address central vs peripheral fatigue?
Central: disease modifying drugs
Peripheral: exercise
Exercise induced fatigue _____ after a rest period
IMPROVES
Fatigue will subside within 20-30 min
Overall, how can the global sensation of fatigue experienced by patients with MS be reduced?
Improve the oxidative capacity of the muscle
***Aerobic exercise works well for these patients
