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Adult Neuro > Multiple Sclerosis (MS) > Flashcards

Multiple Sclerosis (MS) Flashcards

1
Q

Function and location of neurons (oligodendrocytes, ependymal cells, astrocytes, microglia)

A

Oliogdendrocytes: CNS myelination
Ependymal Cells: line the ventricles, circulate in CSF
Astrocytes: throughout parenchyma, formulate BBB
Microglia: phagocytes in CNS, very close to blood vessels

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2
Q

Etiology/Pathogenesis

A

Autoimmune disorder

acute inflammation and demyelination of CNS (like GBS, only CNS involvement)

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3
Q

3 patterns of MS

A

pattern 1: macrophage mediated demyelination
pattern 2: immunoglobulin depositions and complement activities within the plaques
pattern 3: primary oligodendropathy (more detrimental than demyelination)

  • IDed by Leucchinetti
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4
Q

Fibrous Gliosis

A

“Sclerotic Plaque” formation
disrupted BBB –> WBC/monocytes/macrophages enter the brain –> intra + extracellular swelling –> scarring/sclerotic plaques –> secondary axonal degeneration

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5
Q

T2 v T1 imaging on MRI

A

T2 - presence of lesions on gross pathology (bright white signal)
T1 - visualization of axonal dropout (during acute phase, could be secondary to edema and resolve

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6
Q

age of onset, gender, race, geographics

A

Age of onset: 15-50 (pediatric = 2-5%)
Gender: F>M
Race: Caucasians
Geography: higher prevalence further from equator (incidence highest in UK)

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7
Q

Cause of MS: genetic or viral?

A

unknown, but both thought to be involved

EBV: MS pt more likely (+) for EBV

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8
Q

Types of MS (based on clinical presentation)

A
  1. Relapsing/Remitting MS (RR-MS)
  2. Primary Progressive MS (PP-MS)
  3. Secondary Progressive MS (SP-MS)
  4. Progressive Relapsing (PR-MS)
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9
Q

RR-MS

A

85%- most common
episodes of exacerbation + recovery (almost full) –> Accumulation of deficits
Exacerbations not always in the same place

*Subtype = benign RR-MS = infrequent relapse rate (years in between replaces)

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10
Q

PP-MS

A

10%
male more likely
steady degredation/decline (no clear relapse + recovery rate)

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11
Q

SP-MS

A

> 50% RR-MS turn into SP-MS >15yrs after diagnosis

now pt’s on a downward trend- some relapses+ recovery, but less recovery before next relapse

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12
Q

PR-MS

A

5%
a couple small relapse + slight recovery episodes, then decline smooths off
looks very similar to PP-MS; difference = slight recovery at the beginning of PR-MS

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13
Q

Clinically Isolated Syndrome (CIS)

A

1st sign of anything- first demyelinated episode
50-80% conversion risk to MS
treatment with immunosuppressant drugs (IVIG- prevent progression to CDMS)
evidence is seen on MRI- ONLY 1 lesion!

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14
Q

Clinically Definite MS (CDMS)

A

Multiple lesions in the CNS on MRI

Evidence of >/= 2 distinct episodes (MD will have to figure this out with interview)

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15
Q

Signs and Symptoms: Visual system

A

visual = common 1st clinical exacerbation (although sx vary)

  • worsening throughout the day
  • optomologist doesn’t see anything on eye exam
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16
Q

Signs and symptoms: non-visual

A
  1. weakness (rapid onset of shutdown in particular function)
  2. tremor
  3. paresthesias
  4. incoordination
  5. cognitive complaints
  6. fatigue

insidious onset! pt may not even pay attention to it

17
Q

Prognosis

  • AD use
  • non-ambulatory status
  • life-span (pre and post IMD)
A

AD use: 50% with dx >/= 15yrs
Non-ambulatory status: 40% with an attack that renders them non-ambulatory
Life span pre IMD: 15-40yrs
Life span post IMD: similar to normal population (mortality by other diseases, not MS)

*depends on relapse rate; RR-MS = best prognosis

18
Q

When a pt complains of cognitive symptoms (impaired memory/not thinking clearly), do they actually have these issues?

A

YES!- seen biologically
treat pt with TBI techniques
cognitive issues in large % of MS and non related to severity

19
Q

Medical Management during acute exacerbation

A

High does steroids for 3-5 days via IV (taper with oral)

*prevention of inflammation

20
Q

Medical management: long term immune modulating drugs:

A
  1. Interferons beta 1a/1b (IFNB)
  2. Glatiramer Acetate (copaxone)
  3. IVIG- prevention of CIS to CDMS; does nothing to RR-MS
  4. Plasma exchange (only for certain subtypes)
  5. Texadera
21
Q

Interferons beta 1a/1b (IFNB)

  • dosage
  • administration
  • subtypes useful in
A 
1a = ayonex --> 1x/wk
1b = betaseron --> every other day
  • injection into muscle
  • subtypes: RR-MS, CIS (50% reduced conversion to CDMS), not useful in PP-MS
22
Q

Glatiramer Acetate (copaxone)

  • dosage
  • administration
  • subtypes useful in
A

administered every day
injection into muscle
Subtypes: RR-MS, NOT in PP-MS
*higher reduction in relpase than IFNB, but still not preferred due to every day injection

23
Q

Studies examining IFNB and copaxone- effect on prognosis

A

included MS pts with at least 2x/year relapse rate and RR-MS for 5 years

  • found decreased accumulation of lesion size and number of relapses that the pt has in a 1 or 2yr period
  • huge reduction in rate of relapse
  • less lesion load in MRI
  • pts able to do more for a longer time
  • decreased cognitive defects
24
Q

Texadera

  • adminiatration
  • dosage
  • side effect
A

Oral pill
every day
decreases lymphocyte count –> more susceptible to infections

25
Q

Ion channel medication: fampridine/ampyra-4aminopyridine

  • purpose/use
  • dosage
A

purpose: useful in increasing ambulation speed
dosage: 10 and 15mg, 2x/day

26
Q

Spasticity medications

A

antispasticity drugs, baclofen pump (spinal precautions), botox

27
Q

Amantadine (what does this medication address)

A

fatigue

28
Q

Kurtzke Expanded Disability Status Scale (EDSS/FSS)

A

ordinal scale- 0-6; grades MS based on severity (determined by ambulation status and AD use)
0 = best score; higher score = worse prognosis
5.5 = ambulating without AD
6 = ambulating with AD

29
Q

How is nerve conduction velocity affected by temperature changes

A

increase in core temperature = decrease in conductivity speed

  • ability to jump over several nodes is impaired
  • AP may be stopped all together
  • note: 80% of MS pts have heat sensitivity
30
Q

What pt responses may make you think the pt has a heat sensitivity problem?

A

“I take cold showers every day”
“I really need to stay in the AC”
“Evening is much more difficult/uncomportable for me”

31
Q

Measures useful in gait evaluation of MS population

A
  1. 6MWT (endurance is the biggest consideration)
  2. velocity (10m/25ft)
  3. MSWS-12
  4. AI
32
Q

Measures useful in balance evaluation of MS population

A
  1. DGI
  2. BBS
  3. Foam and dome
  4. TUG cog/man (dual task is a particular issue)
33
Q

MSWS-12

A

MS walking scale- pt rates themselves
ordinal scale
problem: doesn’t look at speed or endurance

34
Q

MFIS

A

Pt qualifies how fatigue impacts their day

Ordinal scale

35
Q

MSQOL 54

A

Measure of health related QOL
12 subscales: physical function, role limitations-physical, role limitations-emotional, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall quality of life, and sexual function

36
Q

Impairments commonly treated by PTs

A
  1. Deconditioned and reduced fitness
  2. Fatigue
  3. Weakness
  4. Spasticity
  5. Balance and coordination **
  6. Sensory dysfunction
  7. Cognitive dysfunction
  8. Dysphagia/Dysarthria
37
Q

Difference between MS Fatigue and regular fatigue

A

MS fatigue: inability to recover 20-30min post exercise with rest; increased fatigue as the day wears on- limits ADL functioning
*rest is required, not prefered with MS fatigue

38
Q

How to avoid MS fatigue

A
  1. exercise in the morning- at the lowest core body temperature
  2. everything in intermittent fashion (built in rests)
  3. teach energy conservation techniques

*will have to ask them after every session if it took more than 30min for them to recover

39
Q

Main targets of comprehensive rehabilitation program

A
  1. flexibility
  2. strengthening
  3. aerobic
  4. balance

Adult Neuro (15 decks)

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