Neuromuscular Multiple Sclerosis (MS) and ALS Flashcards
What is the Epidemiology of MS?
- Onset typcically 20-40 years, more likely affecting woman
- Caucasions highest risk
- Living above 40° latitue (unknown reason)
These are important for Differential Diagnosis
What is MS?
What may increase the chances of getting MS?
A chronic demyelinating disease of the CNS
- An autoimmune disease
- Viral infection triggers immune response
- This can happen in the brain or in the spinal cord
- May be genetic susceptibility
- Increased risk with Vitamin D deficiency and smoking
With MS, lesions (plaques) can occur anywhere in the CNS. What are common structures that are attacked by this autoimmune disease?
MS typically attacts white matter
- Optic pathway
- Corticospinal tract
- Dorsal Column of spinal cord
- Cerebellar peduncles
These are all susceptible to attacts
What is the Pathophysioligy of MS?
When a person is exposed to a virus, this sets off an immune response. This inadvertently fights off or attacks the myelin in the CNS.
- Due to this nerve conduction is impaired and slow, if the myelin is greatly damaged it can block conduction
- Oligodendrocytes will also be affected by the immune response
What are common impairments of MS?
This is based on the sturcutres typically attacked, optic pathway, corticospinal tract, dorsal column, and cerebral peduncels
- Optic pathway: Blurred vision, altered acuity
- Corticospinal Tract: Paresis/Plegia, spasticity
- Dorsal Column: Proprioception, Parestesias (Pins and needles), dysesthesias
- Cerebral Peduncels: Balance, coordination, tremor, ataxia, hypotonia, vestibular disorders, dysmetria, dysdiadochokinesia
What are Sx of MS?
(Theres a lot)
This is based on the sturcutres typically attacked, optic pathway, corticospinal tract, dorsal column, and cerebral peduncels
- Sensory
- Pain
- Visual
- Motor
- Fatigue
- Coordination and Balance
- Gait/mobility
- Speech and swallowing
- Depression
- Emotional
- Cognitive
- Bladder and Bowel (may have incontience, increases risk of infection)
- Sexual
Bolded are more specific to MS
MS
What are Exacerbations?
These are new and recurrent MS symptoms lasting more than 24 hours
- Multiple bouts of exacerbations over a 1 year period is needed for diagnosis
Factors that are linked to increased risk of exacerbations or relapse:
- Viral or bacterial infection (common cold, FLU, UTI, sinus infection, etc)
- Disease of major organs systoms (Hepatitis, pancreatitis, asthma attacts,etc)
- Stress
MS
What are Pseudoexacerbations?
These is a temporary worsening of symptoms; resovled within 24 hours
- The most common one is called Uthoff’’s syndrome: Heat sensitivity - Patients will have temporary worsening of Sx (Overexertion, exposure to heat)
Considerations for those in south FL
Precautions in warm gyms and aquatic therapy
A large number of individuals suffer from this
Clinical Subtype of MS
What is Relapsing-Remitting MS (RRMS)?
This is the most common (85% of pts have this type)
- This is characterized by acute attacks or relapses, followed by partial or full revovery or remissions.
- Of all the subtypes this has the best prognosis
- However at some point, the oligodendrocytes get wiped out and they are unable to fully remelinate the nerves, and the patients ability to fully recover goes down.
- At this point when the pt relapses and remites they cant go to baseline anymore, this is called permanent deficit
- These patient then progress to Secondary Progresive MS
Remission can last weeks, months , or years. Symptoms may be a litle worse then the 1st relapse.
Ex. if a patient goes through their first relapse and they have blurred vision and then they remit back to baseline. After the pt remits after a period of time they may relapse again but this time their sx are worse they may have foot drop and paresthesia in addition to the blurred vision. But after some time they remit once again back to baseline. However, once the patient losses all the oligodendrocytes they cannot full recover or get back to baseline (right side of pic). So when they have a relapse and remission they do not get back to baseline anymore. So now if the patient may have permanent foot drop
How does Secondary Progressive Relapse (SPMS) begin?
How is it characterized?
- It begins with a Relapsing Remitting Course, followed by a progression to Secondary Progressive MS
- This is characterized by a steady and irreversible decline with or without acute attacks (relapse)
- Whether the person has those acute attacks or not, they are never recover/remit and they continue to lose function over time
What is Primary Progressive MS?
This type is not as common ~10% have this subtype
- This is characterized by a steady functional decline from onset
- In this subtype there are no attacks or exacerbations and there are no periods of remission
- Overtime the Sx get worse and worse at a steady decline
- There are periods of platues, where the patient does not get worse but after the platues are over they continue to get further away from the baseline
What is Progressive Relapsing MS (PRMS)?
Least common: 5%, however most severe
- Its characterized by a steady deterioration from onset
- Is this subtype the patient are in a steady decline from onset and they have occasional acute attacks and the Sx get way worse (or heightened) and after the relapse they continue on their steady decline without remission (recovery)
How is Relapse-Remitting MS (RRMS) clincally Diagnosed?
When the patient has experienced at leat 2 attacks (exacerbations) or relapses that last more than one day and are separated by more than 1 month
For example, if a pt complains of blurred vision that lasted 2 days and then a month and a half later complained of foot drop that lasted for a few days will be RRMS.
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How is Primary Progressive MS Clinically Diagnosed?
The pts impairments need to be present for greater than 6 months
What test are used to Diagnose MS?
- Lumbar Puncture: This is the CSF analysis. Doctors look for evidence of myeline proteins and elevated IgG proteins in the CSF cells. (You’ll get little bits of myelin floating around in the CSF as well as IgG bands, if those are present the test would be positive)
- Evoked Potentials (EP): This test measures the electrical activity of the brain in response to stimulation of a specific sensory nerve pathway. It can detect the slowing of electrical conduction caused by demyelination. (Often looking at the optic pathway, because its a common finding with MS)
- MRI: This is the perferred imaging method, to help with diagnosis and help monitor the course of the disease. Pts with MS can have both acute lesions, which are areas of inflammation on their brains and spinal cord and chronic plaques, which are scars in the myline sheath
