Multiple Sclerosis

Question 1

What is MS?

Answer 1

Chronic, autoimmune disorder

Demyelination of the CNS which leads to loss of communication

Question 2

MS etiology

Answer 2

• book* Unknown trigger in susceptible person activates an autoimmune process orchestrated by activation of T cells.
  Activated T cells migrate to CNS, disrupting the blood-brain barrier.
  Antigen-antibody reaction within CNS activate inflammatory response and leads to demyelination of axons.
  Myelin can regenerate.
  When they do symptoms disappear and patient experiences remission.

Question 3

Relapsing - Remitting MS (RRMS)

Answer 3

• most common (85% ppl have this type) & often seen at hospital
• has periods of stability( remission) in between relapses (attacks)
• inflammatory attacks of myelin sheath & surrounding CNS fibers
• diagnosed 20-30’s
• symptoms >48hrs
• lack of progression of disease

Question 4

Primary Progressive MS (PPMS)

Answer 4

• Rare (10-15% ppl have this type)
• progression of disability from onset. Gets worse over time.
• book steadily worsening neurological function from beginning with minor improvements but NO distinct relapses or remissions.
• MAINLY EFFECTS Nerves of spinal cord
• little to no inflammation

Question 5

Secondary Progressive MS (SPMS)

Answer 5

• starts out as RRMS
• have RRMS for > 10 yrs
• with or w/o relapses, remissions, and plateaus
• most diagnosed with RRMS usually transition to SPMS
• book NEW tx may slow progression

Question 6

Progressive- Relapsing MS (PRMS)

Answer 6

• Rare ( 5% ppl have this type)
• progression of disease from onset
• clear acute relapses
• with or w/o full recovery

Question 7

MS risk factors

Answer 7

• genetic : 1 or more family members have MS
• environmental :
  Smoking
  Exposure to toxins
  Climate
  Certain states have higher MS rates

Question 8

Clinical manifestations (Part I)

Answer 8

• Lhermitte’s sign: electric shock radiating down back of neck to spine and to limbs. Flexion of neck.
• Paresthesia: “pins and needles” sensation in extremities
• Optic Neuritis
• tremors
• dizziness

Question 9

Clinical Manifestations (part II)

Answer 9

• dysarthria: slurred or slow speech
• dysphasia: nerves can’t properly control muscles which cause swallowing issues.
• constipation
• bladder dysfunction
• muscle spasms & PAIN

Question 10

Diagnosing MS

Answer 10

• H&P
• Blood work: R/O other causes
• MRI
• Spinal Tap: looks at cells
• Evoked potential test: make electrical currents; test muscles & signals
• urodynamic testing: bladder function

Question 11

Treatment Goals

Answer 11

• No Cure*
  1. Delaying progression of disease
  2. Manage the symptoms
  3. Treat acute exacerbations

Question 12

Pharmacological Management: Disease Modifying Drugs

Answer 12

• immunomodulators wipe out WBC! Infection & hyperglycemia*
• Immunomodulators : Glatiramer Acetate ( Copaxone)
• corticosteroids
• immunosuppressant: mitoxantrone

Question 13

Pharmacological Management: Symptom Management

Answer 13

• Muscle relaxants: Baclofen
• Fatigue: Amantadine (Symmetrel)
  BLADDER & BOWEL Management
• Anti-Cholinergic: Oxybutynin (use #2)
  -Cholinergic:Bethanecol (use #3)
• Alpha- Adrenergic: Tamsulosin (use #1 )

Question 14

Disease modifying Drug Goals

Answer 14

1. Number & size plaques seen on MRI
2. Slow progression of disease
3. Keep s/s as far away as possible
   ( you want exacerbations happening as far apart as possible)