Multiple Sclerosis (GOLD): Scorebuilders Flashcards
What is MS? What is affected?
Demyelination of the myelin sheaths in the brain and the spinal cord, leading to a decrease in efficiency of nerve impulses
- subsequent plaque formation and eventual failure of nerve impulses
Etiology
Unknown
Possibly epstien-barr virus
Possible Genetic Susceptibility, however is not a hereditary disease
Signs and Symptoms
- Visual problems (diplopia); optic nerve demyelination; optic neuritis.
- sensory changes (paresthesia, numbness of face, body, extremities)
- weakness
- ataxia, balance dysfunction (Cerebellar Involvement)
- fatigue
- Spasticity (UMN)
Treatments: Pharmacology; Goals
Pharmacology
- Goal is to lessen the length of exacerbations and maximize patients health
Which age range has the highest incidence rates?
- highest incidence between 20-35 y/o
Younger type of disorder
Which gender is more affected?
2x as common in Women
What climate is associated with a higher incidence of MS?
Temperate Climates
What ethnicity is most likely to have MS?
Caucasians
What is the most common classification of MS?
Relapsing-Remitting (85% of cases)
What laboratory or imaging studies would confirm the diagnosis early in the disease?
There is not a single testing procedure to diagnose MS early in the disease.
[MRI inconclusive]
What guidelines must be followed for a clinical diagnosis of MS to be made?
An individual experiences two separate attacks and shows evidence of two separate lesions.
Reliable patient history of symptoms are vital in the diagnosis of MS
What happens as the disease advances in terms of exacerbations and remissions?
Exacerbations lead to greater disability
length of remisions decrease
What PT interventions are indicated with MS
- relaxation and conservation energy techniques
- Normalization of tone (spasticity management)
- adaptive/assistive device training
[These are VITAL to quality of life]
What part of the day should exercise be adminstered?
Morning patient is rested; to avoid fatigue
What factors can influence exacerbations?
- HEAT: Sun exposure, hot muggy environments, hot baths, warm therapy pools
- Stress
- Infection
- Trauma
- Pregnancy
What do overall mortality rate and long-term outcomes correlate with?
- age of diagnosis
- number of attacks and exacerbations
- frequency and duration of remissions
- type of MS
Those with MS mostly die from?
Secondary Complications [Think things due to a sedentary life style]
- disuse atrophy
- pressures sores
- contractures
- pathological fractures
- renal infection
- pneumonia
What additional findings are likely with MS? (Non-Motor)
- Depression
- sexual dysfunction
- Bowel and Bladder Incontinence
What is Relapsing Remitting (RRMS)
-
Clearly Defined episodes of new or worsening symptoms
Hallmark Sign: Period of remission between attacks
Primary Progressive (PPMS)
- Slow accumulation of disability without relapses
- No clear periods of remission
Secondary Progressive (SPMS)
- Initially follows course of relapsing remitting
- Remissions become less apparent and disease worsens steadily over time
Progressive Relapsing (PRMS)
Steadily worsening of disease from beginning, but with clear attacks
- Does not experience clear remissions
Why is face pain common in patients with MS?
Trigeminal Neuralgia, demyelination of the sensory division of the trigeminal nerve innervating the face, cheek and jaw.
- Innocuous activities can trigger pain such as eating or touching the face.
What is Lhermitte’s Sign?
Flexion of the neck produces an electric shock-like sensation running down the spine into the LE’s
What is Uhthoff’s Phenomenon?
Increase in neurological symptoms secondary to heat exposure.
What is Optic Neuritis?
May be to 1st symptoms seen in MS.
Inflammation of the Optic Nerve CN II
