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Pathophysiology II > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the most important factor in increasing the survival rate of MS?

A

The realization that normal physical and physiological stress does not activate the disease process

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2
Q

What is MS?

A

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.

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3
Q

What can cause MS?

A

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.

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4
Q

What cells are attacked by the inflammatory response triggered by MS?

A
  1. Myelin
  2. Axons
  3. Oligodendrocytes.
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5
Q

Neurological signs associated with MS results from what 2 phenomena?

A

Conduction blocks

Axonal transection

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6
Q

Can myelin repair itself? What are cases when it cannot be repaired?

A

Myelin has some ability to repair itself BUT once the AXONS are damaged they cannot be repaired.

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7
Q

True or false: MS is hereditary

A

FALSE

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8
Q

MS is ___ times higher for persons with an affected relative than for those with no family history

A

10-50x

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9
Q

When is MS typically diagnosed? M vs F?

A

Typically diagnosed between the ages of 20 and 50

More common in women than men, 2-3:1

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10
Q

90% of MS cases are diagnosed between the ages of ___.

A

16-60 years of age

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11
Q

Approximately 55-75% of patients have _________ at some point during the course of the disease

A

spinal cord lesions

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12
Q

What part of the spine is most commonly affected with an MS spinal cord lesion?

A

Cervical spine (67% of cases)

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13
Q

What are the 5 disease classification of MS?

A
  1. Relapsing remitting MS (RRMS)
  2. Secondary Progressive MS (SPMS)
  3. Primary Progressive MS (PPMS)
  4. Progressive relapsing MS (PRMS)
  5. Malignant MS (die within 1 year, worst prognosis)
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14
Q

Characteristics of Relapse Remitting MS (RRMS)

A
  1. Acute attacks with full recovery or partial residual deficit.
  2. Lack of disease progression between the attacks.
  3. 85% of people initially diagnosed with this form
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15
Q

Characteristics of Secondary Progressive MS (SPMS)

A
  1. Starts with the RRMS followed by progression at variable rate that may include occasional relapses and plateaus.
  2. More than 50% of the people with RRMS will transform to this type of MS in 10 years, 90% within 25 years
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16
Q

Characteristics of Primary Progressive MS (PPMS)

A
  1. Progression of disability from the onset with or without plateaus or remissions or minor improvements.
  2. Only 10% are diagnosed with this form.
  3. Male patients with this form have the worst prognosis with less favorable response to treatment and rapidly accumulating disability.
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17
Q

Characteristics of Progressive Relapsing MS (PRMS)

A
  1. Progression from onset but with clear acute relapses.

2. Only 5% are diagnoses with this form

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18
Q

Characteristics of malignant MS

A

Very rare and death usually results in one year from diagnosis

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19
Q

Relapse in MS is defined as what?

A

Defined as symptoms lasting for more than one or two days

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20
Q

Characteristics of inflammation in MS

A

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.

21
Q

What is the problem with diagnosing MS?

A

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.

22
Q

How is MS diagnosed?

A

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

23
Q

Why are lesions difficult to treat in patients with MS?

A

Lesions are dependent on the individual so it is difficult to mainstream the treatment

24
Q

What scores on the Expanded disability status scale (EDSS) indicate ambulation or impairment to ambulation?

A

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

25
Q

What are the symptoms associated with MS?

A 
Fatigue (95%)
Pain 
Impaired ambulation 
Emotional changes (BIPOLAR DISORDER)
Weakness/imbalance 
Tremor/spasticity  
Dysarthria
Dysphagia 
Cognitive/Visual impairment
26
Q

What is the prognosis of MS?

A

1/3 will have a very mild course
1/3 will have a moderate course
1/3 will become disabled

27
Q

What prognostic indicators are associated with a more favorable course of MS?

A
  1. Female
  2. Onset before age 35
  3. Monoregional vs. polyregional lesions
  4. Sensory vs. motor symptoms
  5. Complete recovery after exacerbation
28
Q

What prognostic indicators are associated with a less favorable course of MS?

A
  1. Male
  2. Onset after 35
  3. Cerebellar symptoms – tremor, nystagmus, dysarthia, ataxia)
  4. Poor recovery following a relapse
  5. Frequent attacks
  6. African-Americans tend to have a more rapidly progressing course than Caucasians.
29
Q

What are the 2 aspects of the general treatment for MS?

A
  1. Immunomodulatory therapy (IMT) for the underlying immune disorder
  2. Symptom modifying
30
Q

What 3 medications are used to treat acute relapses?

A

Solu-Medrol
Plasmapheresis
Dexamethasone

31
Q

What ABC drugs are used to treat relapsing remitting MS?

A
  1. Avonex®, Rebif®
  2. Betaseron®,Extavia®
  3. Copaxone®
32
Q

What is the medical concern associated with the drug Tysabri? What side effects may arise?

A

Risk of PML - progressive multifocal leukoencephalopathy

  1. Progressive weakness on one side of the body
  2. Clumsiness of limbs
  3. Disturbance in vision
  4. Changes in thinking, memory, and orientation
  5. Confusion and personality changes
33
Q

What are the effects of disease modifying drugs?

A

All reduce the frequency of attacks and the severity
Reduce the scarring on MRI
Slow disease progression

They DO NOT:

  1. Cure the disease
  2. Make people feel better
  3. Alleviate symptoms
34
Q

How is MS treated?

A

Symptom management
Disease modification
Psychosocial support
Rehab: MAINTAIN or improve function

35
Q

When should treatment for MS start?

A

Immediately after the first attack

36
Q

When is treatment most effective?

A

early, inflammatory phase

37
Q

When is treatment least effective?

A

later, neurodegenerative phase

38
Q

Why is exercise beneficial for patients with MS?

A

Decrease the disuse process that occurs slowly and unnoticed

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

39
Q

Patient with MS have normal muscle ____, less muscle _____, and an increase in muscle _____.

A
  1. strength
  2. endurance
  3. fatigue
40
Q

Patients have at least ___% less aerobic capacity.

A

30%

41
Q

Fatigue is worsened by:

A 
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
42
Q

What is primary fatigue?

A

Thought to be caused by factors related to the disease process – demyelinization, inflammation, axonal loss, immune factors, pyramidal tract involvement

43
Q

What is secondary fatigue?

A

Caused by the pathological consequences of the disease –medications, depression, anxiety, disuse, deconditioning, sleep disturbances, heat sensitivity

44
Q

What are the characteristics of central fatigue?

A

Subjective sense of fatigue
Mental/cognitive fatigue (memory, learning, attention, and information processing_
Neuronal hypometabolism and axonal damage
Global brain hypometabolism

45
Q

What are the characteristics of peripheral fatigue?

A 
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
46
Q

What treatments should be used to address central vs peripheral fatigue?

A

Central: disease modifying drugs

Peripheral: exercise

47
Q

Exercise induced fatigue _____ after a rest period

A

IMPROVES

Fatigue will subside within 20-30 min

48
Q

Overall, how can the global sensation of fatigue experienced by patients with MS be reduced?

A

Improve the oxidative capacity of the muscle

***Aerobic exercise works well for these patients

Pathophysiology II (24 decks)

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