Multiple Sclerosis (Exam 2) Flashcards
Multiple Sclerosis
Chronic, inflammatory autoimmune disorder
Involving the degeneration of CNS myelin (loss of myelin sheath)
Brain and spinal cord
MS: Characteristics
Inflammation (white and grey matter)
Demyelination (nerve fibers)
Scar development (Gliosis)
MS: Etiology
Unknown
-Genetic predisposition
-Problem with immune system
-Environmental trigger
MS: Risk Factors
Age: 20-40
Gender: More common in Women (Men have worse course) (above 40th parallel in north and below 40th parallel in south)
Moderately cool climate (northern US)
Caucasian
Genetics: Family history (parent) (Identical twin RISK)
MS: POSSIBLE Risk Factors
Smoking
Vitamin D deficiency
Obesity
(Epstein-Barr) Infection
MS: Pathogenesis
Autoimmune attack against the myelin sheath
-T lymphocytes migrate to CNS and cross the BBB
-Antigen antibody reaction in CNS initiates an inflammatory response
-Axons are de-myelinated and plaques/sclerosis forms
-Axons are destroyed
damage to myelin sheath in MS leads to
Slow nerve impulse and damage to nerve itself
Brain Atrophy
Neurons Affected by MS: Early Disease
Inflammation but nerve fiber not affected
Impulses still transmitted
May notice weakness
Neurons Affected by MS: Late disease
Myelin sheath begins to detach
Axons are destroyed
Impulses are totally blocked
Permanent loss of function
MS: Disease Course Types of Progression
Benign
-No disability w/ return to normal after relapse
Relapsing remitting (RRMS)
-Unpredictable attack which may leave permanent deficits followed by remession
Primary-Progressive (PPMS)
-Steady increase is disability
Secondary-Progressive (SPMS)
-Initial relapsing-remetting multiple sclerosis that suddenly begins to decline with periods of remission
Progressive-relapsing (PRMS)
-Steady decline since disease onset with superimposed attacks
Benign MS Disease Course
-No disability w/ return to normal after relapse
Relapsing remitting (RRMS) Disease Course
-Most common
-Unpredictable attack which may leave permanent deficits followed by remession
-Won’t return to baseline and they get a little worse each time
Primary-Progressive (PPMS) Disease Course
-Steady increase in disability without remission
Secondary-Progressive (SPMS) Disease Course
-Initial relapsing-remitting multiple sclerosis that suddenly begins to decline with periods of remission
Progressive-relapsing (PRMS) Disease Course
-Steady decline since disease onset with superimposed attacks
-Remessions are their but far and few between
MS: How long does relapse / exacerbation last?
Less than one week = 20%
1-2 weeks = 27%
2 weeks - 1 month = 25%
MS: Clinical Manifestations
(MOST COMMON)
–Paresthesia of face - trunk - limbs (numbness and tingling)
-Loss of muscle function
-Headache
-Weakness
-Optic Neuritis / Unilateral vision loss
-Urinary incontinence
-Impaired gait
-Seizures
-Emotional changes
MS: Symptoms to Monitor
Cognitive problems
(Cog Fog) - Can not think clearly
Vision problems
Depression (loss of function)
Fatigue (need more rest)
Pain (Chronic or acute) (Burning or stabbing)
Bowel/bladder
(constipation / incontinence)
Weakness (paralysis)
Sexual Issues
Muscle stiffness / spasm
(muscle tingling)
Walking / balance
(vertigo)
Goal of Pharmacotherapy MS
Slow disability
Reduce frequency of relapses
Reduce new brain lesions
