Multiple Sclerosis

Question 1

Where is the prevalence of MS highest geographically?

Answer 1

Northern US, Canada, Northern Europe (highest in Scotland), Scandinavia, New Zealand, Australia

Question 2

Where is the prevalence of MS medium geographically?

Answer 2

Some parts of Europe, Central and South America, Eastern Europe

Question 3

Where is the prevalence of MS lowest geographically?

Answer 3

Low/probably low: Asia and Africa

Question 4

The etiology of MS is…

Answer 4

Ultimately unknown

Question 5

What is the leading theory behind the etiology of MS?

Answer 5

It is an autoimmune disease that occurs in genetically susceptible individuals that is triggered by a viral (or other) infection

Question 6

What are common infections that can precipitate MS?

Answer 6

Herpes ( I, II, and VI) and Chlamydial Pneumonia

Question 7

What are the initial symptoms for Corticospinal MS?

Answer 7

Spastic paralysis
Stiffness
Slowness
Weakness
Decreased endurance
Symmetrical with LE affected greater than UE
Incontinence of bowel and bladder

Question 8

What are the initial symptoms for Brainstem MS?

Answer 8

UMN CN III-XII
Internuclear opthalmoplegia (affected eye cannot adduct
Nystagmus
Dysarthria
Vertigo
Tinnitus
Facial weakness
Facial sensory loss

Question 9

What are the initial symptoms for Cerebellar MS?

Answer 9

Ataxia (movement decomposition and dysdiadochokinesia)
Hypotonia
Paresis
Symmetrical in all 4 extremities

Question 10

What are the initial symptoms for Cerebral MS?

Answer 10

Affected cerebral hemispheres
Optic neuritis (CNII)
Intellectual and/or emotional changes
Seizures
Hemiparesis
Hemisensory loss

Question 11

What is the often the initial presenting symptom of MS?

Answer 11

Optic neuritis

Question 12

What is optic neuritis?

Answer 12

Inflammatory demyelination of the optic nerve (CNII)

Question 13

What are the symptoms of optic neuritis?

Answer 13

Eye pain w/ movement (ice pick in eye)

Monocular vision problems

Question 14

What are examples of monocular vision problems?

Answer 14

Central scotoma: “disappearing image”, missing image
Decreased visual acuity
Impaired color vision

Question 15

What is the course of optic neuritis like?

Answer 15

Typically occurs as an acute event (days) or can progress slowly

Question 16

What is the prognosis of optic neuritis?

Answer 16

Recovery is common and typically occurs within 6-8 weeks, although it may take several months

Question 17

What are general common signs and symptoms of MS?

Answer 17

Visual
Motor
Sensory
Bowel and Bladder
Sexual
Cognitive and emotional
Speech and swallowing
Pattern of symptoms

Question 18

What is the most common “package” of symptoms of MS?

Answer 18

Balance
Fatigue
Gait
Bladder/bowel
Vision

Question 19

What are the 4 different stages/groups of MS that represent its clinical course?

Answer 19

Clinically isolated syndrome (formerly called benign)
Relapsing remitting (RRMS)
Primary progressive (PPMS)
Secondary progressive (SPMS)

Question 20

What percentage of MS cases are Clinically isolated syndrome?

Answer 20

Less than 20%

Question 21

What percentage of MS cases are relapsing remitting?

Answer 21

85%

Question 22

What percentage of MS cases are primary progressive?

Answer 22

10% of cases

Question 23

Majority of cases w/ RRMS progress to…

Answer 23

SPMS

Question 24

What are the precipitating factors for MS?

Answer 24

Changes in health status

Transient deterioration

Question 25

What are examples of changes in health status in MS that encompass its precipitating factors?

Answer 25

Viral or bacterial infections (Cold, flu, UTI)
Physical injury (Lumbar puncture)
Pregnancy/birth

Question 26

What are examples of transient deterioration in MS that encompass its precipitating factors

Answer 26

Adverse reaction to heat: such as modalities, prolonged exercise, fever
Hyperventilation
Stress: Physiological or psychological (major and minor)
Exhaustion
Dehydration
Malnutrition
Sleep deprivation

Question 27

___ of relapses are preceded by a viral infection

Answer 27

33%