Multiple sclerosis Flashcards
Immune-related response in which antibodies induce demyelination by antibody-dependent, cell-mediated cytotoxicity.
Cytokines attack myelin, macrophages help uptake myelin, oligodendrocyte apoptosis leads to an increase in demyelination, increased axonal injury occurs and becomes sclerosed.
-Inflammatory
-Demyelinating
-CNS- white matter in SC, brainstem, or cerebral hemispheres
-Plaques
Multiple Sclerosis
Environmental risk factors for MS
- Vitamin D deficiency (people living further from the equator have a greater risk)
- smoking
- infection (people w/ hx of Epstein-Barr virus or HHV-6 have greater risk)
Genetic risk factors for MS
- First degree relative w/ MS
- Female > Male
What is the most common age for MS diagnosis?
20-50
Types of MS
Clinically isolated syndrome
Relapsing Remitting
Primary Progressive
Secondary Progressive
Clinically isolated syndrome
- First episode of neuro symptoms that lasts at least 24 hours
- Mono-focal lesion: single neurologic sign or symptom that’s caused by a single lesion
- Multifocal lesion: more than one sign or symptom caused by lesions in more than one place
- usually no association with fever or infection
- followed by a complete or partial recovery
Relapsing Remitting
- Most common disease course
- clearly defined attacks of new or increasing neurologic symptoms
- increase in disability is confirmed when the person exhibits the same level of disability at the next scheduled neurological evaluation, typically 6-12 months later
Primary progressive
-Worsening neurologic function from the onset of symptoms, without early relapses or remissions
Secondary progressive
- follows initial relapsing-remitting course
- most who are diagnosed with RRMS will eventually transition to secondary progressive worsening of neurologic function over time.
Activity of disease
Relapses or new increasing neurologic dysfunction, followed by full or potential recovery in the absence of fever or infection
(active or not active)
Progression of disease
steadily increasing neurologic dysfunction without recovery
progressive or not progressive
Traditional diagnosis of MS
- Evidence of damage in at least two separate areas of the CNS
- Evidence that the damage occurred at two distinct points in time, at least one month apart
- Other possible causes for the symptoms ruled out
Revised diagnosis of MS
“In patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of Multiple Sclerosis”
Clinical features of MS
- Optic neuritis (vision loss, pain w eye movement, usually unilateral)
- brainstem/cerebellar dysfunction (ataxia, dysarthria, intention tremor, nystagmus, balance dysfunction)
- pyramidal symptoms (UMN, paresthesia, spasticity, loss of dexterity)
- spinal cord involvement (spasticity/flaccidity, sensory loss, motor loss, loss of bowel/bladder control)
- fatigue(exacerbated by heat)
- heat tolerance
- cognitive dysfunction
- depression
- sexual dysfunction
Medical management of MS
Medications to…
- modify disease course
- manage relapses
- manage symptoms
Good prognosis of MS
Few attacks
good recovery from attacks
relapsing-remitting
early medical management and adherence
Poor prognosis of MS
multiple attacks poor recovery from attacks primary progressive type pyramidal brainstem cerebellar signs
Prognosis is better depending on…
Gender (women > men)
Age of onset (< 35 at onset)
length between exacerbations (longer durations)
duration of impairments during exacerbation (shorter duration, < 1 month)
remission of initial impairments
only 1 impairment during the first year (fewer impairments early in dx)
Prognosis is worse depending on…
pyramidal tract impairments at onset
cerebellar impairments at onset
sphincter impairments at onset
progressive course at onset
Possible impairments causing limitations in rolling and coming to sit
spasticity
timing & sequencing
central weakness
cerebellar ataxia
Possible impairments causing limitations in sitting balance
spasticity timing & sequencing of strategy central weakness cerebellar ataxia sensory system impaired for strategies inadequate vestibular function
Possible impairments causing limitations in sit to stand
spasticity timing & sequencing of strategy central weakness cerebellar ataxia sensory system impaired for strategies inadequate vestibular function
Possible impairments causing limitations in standing balance
spasticity timing & sequencing of strategy central weakness cerebellar ataxia somatosensory impaired for reaction time inadequate vestibular function fatigue
