Multiple Sclerosis/Parkinsons

Question 1

signs of MS?

Answer 1

weakness or numbness, monocular visual loss, diplopia, vertigo, facial weakness, sphncter disturbances, ataxia, nystagmus, heat sensitivity

Question 2

what is Relapsing remitting MS

Answer 2

episodes resolve with good neuro function tween exacerbations and minimal to no cumulative deficits (can move into secondary progressive MS)

Question 3

what is primary progressive MS?

Answer 3

episodes do not fully resolve, cumulative defects.

Question 4

Age range commonly affected?

Answer 4

20-40 years old.

Question 5

Risk factors for MS?

Answer 5

family hx, neorthern european, women, viral infections, autoimmune dx

Question 6

diangose?

Answer 6

MRi

lumber puncture - rule out infections, see pleocytosis, pred monocytes, increase total protein, high immog G, oligoclonal bodies, increase myelin basic protein

potential testing -

Question 7

Tx MS?

Answer 7

exacerbation: systemic high dose corticosteroids

immunotherapy - intereron Beta1b (betaseron extavia); interferon beta 1a (avonex, rebif)

immunosupp - mitoxantrone
monocolonal antibody - natalizumab

subQ glatiramer acetate (copaxone) - block demylenation

fingolimod - traps immune cells in lymph nodes (monitor HR)

teriglunomide - inhibits production of T and B cells (monitor liver cells)

Question 8

What SE should be watched for monocolonal anitbody natalizumab?

Answer 8

progressive multifocal leukoencephalopathy.

Question 9

Parkinsons age at onset?

Answer 9

60+

Question 10

what are 6 cardinal features?

Answer 10

tremor at rest, rigidity, bradykinesia, flexed posture, loss postural reflexes, masklike facies

other:
little movement of hands/arms during ambulation, forward falls

Question 11

TX parkinsons?

Answer 11

1) dopamine agonists: ropinirole (requip), pramipexole (mirapex)

apomorphine - injectinle for rescue for off periods.

2) levodopa - can be given with carbidopa via sinemet.
3) amantadine (symmetrel) - antiviral drug to reduce dyskinesia

4) cOMT inhibitors - tolcapone (tasmar), entacapone (comtan), increase half ive of levodopa
5) MAO B inhibitor - selegeline, rasalgilin - reduce metabolism of levodopa to increase half life

6) anticholintergics - benzotropine (congentin). help with tremor

7) pallidotomy
8) deep brain stimulation

Question 12

how do dopamine agonists tx parkinons

Answer 12

neuroprotective effect