Symptoms, Risk Factors, and Treatment

Question 1

What is the term used to describe exacerbations, attacks, flare-ups, episodes, or bouts of MS symptoms?

Answer 1

Relapse

Question 2

What are the three forms of relapse?

Answer 2

Relapsing-remitting: patients have relapses of MS and periods of stability in relapsing.

Progressive-relapsing- progression or worsening of the condition from the beginning.

Secondary-relapsing- a stage of MS which comes after relapsing remitting MS for many people; condition gets steadily worse.

Question 3

During relapse, inflammation is occurring along the ________ and the ________.

Answer 3

nerves, myelin

Question 4

What are eight common early signs of multiple sclerosis?

Answer 4

vision problems.
tingling and numbness.
pains and spasms.
weakness or fatigue.
balance problems or dizziness.
bladder issues.
sexual dysfunction.
cognitive problems.

Question 5

How long can a relapse last?

Answer 5

Symptoms can range from a few days to a few months followed by complete or partial recovery (remission).

Question 6

True or False: There is no cure for MS.

Answer 6

True

Question 7

What types of interventions are used to treat a relapse?

Answer 7

Corticosteroids to reduce inflammation.

Plasmapheresis is used if patients experience new, severe symptoms that are not responding to steroid treatment.

Question 8

What kind of treatments, in general, are used to modify disease progression?

Answer 8

Disease modifying therapies

Question 9

What is the purpose of disease modifying therapies?

Answer 9

Reducing how many relapses someone has and how serious they are. DMTs can also slow down the damage caused by relapsing multiple sclerosis that builds up overtime.

Question 10

Why are immunosuppressants used to treat MS?

Answer 10

They are used to treat MS based on the hypothesis that MS is a T cell-mediated autoimmune disease.

Question 11

Azathioprine, Cyclophosphamide, Methotrexate, and Mitoxantrone are the most commonly used ______________ agents.

Answer 11

immunosuppressive

Question 12

____________ DMT therapies are administered in dedicated centers with protocols specific to the individual.

Answer 12

Infusible

Question 13

What was the first drug approved by the FDA to treat both relapsing MS and primary progressive MS?

Answer 13

Ocrelizumab (Ocrevus): first drug approved by the FDA to treat both relapsing MS and Primary-progressive MS.
- Shown to reduce relapses
- Slow disease progression
- Administration: IV Infusion initially twice in two weeks; after that it is given every six months

Question 14

What MS drug is a monoclonal antibody that reduces the migration of immune cells across the blood-brain barrier into the central nervous system?

Answer 14

Natalizumab (Tysabri)
- Effective against relapsing MS; reducing the relapse rate by about two thirds
- It is associated with a small but important risk of a serious brain infection
- Administration: intravenously every four weeks

Question 15

What MS drug reduces relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells?

Answer 15

Alemtuzumab (Lemtrada)
- The effect can limit potential nerve damage caused by the white blood cells, but it also increases the risk of infections and autoimmune disorders.
- Administration: five consecutive days of drug infusions followed by three days of infusions a year later
- Due to the risk associated with this medication, the FDA recommends extensive screening before using the drug.

Question 16

How is the medication Gilenya administered?

Answer 16

orally

Question 17

What unique medication can bind to many different types of body cells and traps white blood cells inside lymph nodes so that they can’t enter the brain and cause new MS lesions?

Answer 17

Fingolimod (Gilenya)

Question 18

Describe the two different types of fatigue that a MS patient may experience.

Answer 18

The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.

A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.

Question 19

What type of pain is short term and potentially recurring?

Answer 19

Acute

Question 20

What type of pain occurs in sudden attacks?

Answer 20

Paroxysmal

Question 21

What type of pain is long-lasting?

Answer 21

Chronic

Question 22

What can cause acute or paroxysmal pain in the form of spasms and cramping in the arms and legs?

Answer 22

Nerve pain

Question 23

What is often one of the first MS symptoms that a person may experience?

Answer 23

Optic neuritis

This is caused by inflammation of your optic nerve and usually only affects one eye. Problems with sight, like blurred or double vision, might come on with a sudden sharp pain behind your eye. The pain might be aggravated when you move your eye to look around.

Question 24

What term describes a sudden brief pain or electrical buzzing sensation that runs down the neck, into the spine, and may then spread to the arms and legs?

Answer 24

Lhermitte’s Sign

Question 25

This term describes an uncommon symptom which presents itself as a sudden severe pain in the face that comes and goes?

Answer 25

Trigeminal Neuralgia This is an uncommon symptom that affects only 2 - 5% of people with MS at some time. It presents itself as a sudden severe pain in your face that comes and goes. It’s caused by damage to the trigeminal nerve inside your head. This large nerve has three main branches so the place you feel pain depends on which branches of the nerve are damaged.

Question 26

Patients with MS may experience __________, which is associated with stiffness, spasms, cramping, and gait impairment. One Study found that approximately 80% of MS patients experience __________.

Answer 26

spasticity

Question 27

__________ are usually caused by damage to myelin in an area of the brain known as the cerebellum and the nerves leading to and from it.

Answer 27

MS tremors

Question 28

What is myelin?

Answer 28

Myelin is a mixture of proteins and phospholipids that form a whitish insulating sheath around many nerve fibers, increasing the speed at which impulses are conducted.

Question 29

What does the cerebellum control?

Answer 29

The cerebellum is the part of the brain that controls your balance and coordination. It ‘smoothes out’ the movement of your limbs, eyes and speech.

Question 30

MS tremors may be caused by demyelination in which three areas of the brain?

Answer 30

The cerebellum, thalamus and the basal ganglia; these regions are all involved in controlling movement.

Question 31

What is a common treatment for muscle weakness and fatigue caused by MS?

Answer 31

A physical therapist may recommend progressive resistive exercise with weights / a weight training routine that is appropriate for the patient's abilities.

Question 32

If MS has affected the message pathways between your inner _______ and the brain, the information may be disrupted or missing, which can add to balance problems.

Answer 32

ear

Question 33

Approximately 50% of MS patients will experience this form of visual impairment during the disease course.

Answer 33

optic neuritis — inflammation of the optic (vision) nerve.

Question 34

How is optic neuritis treated in MS patients?

Answer 34

High-dose corticosteroids & Training in visual compensation, environmental modifications, adaptive equipment, as needed.

Question 35

In what ways can cognitive impairment manifest in MS patients?

Answer 35

Cognitive impairment often manifests as deficits in recent memory, attention, information-processing speed, executive functions, and visuospatial perception. EXAMPLES: Memory Loss Language Problems Attention-Reasoning Judgment-Complex Decision-Making

Question 36

__________ is a general term used to describe a decline in mental function that is severe enough to interfere with daily living.

Answer 36

Dementia

Question 37

True or False: Impairments in bladder function with multiple sclerosis (MS) are uncommon and only affect 10 to 15 percent of patients during the course of MS.

Answer 37

False: Impairments in bladder function with multiple sclerosis (MS) are common and may affect up to 78 to 90 percent of patients during the course of MS.

Question 38

What is dysphagia and what causes it?

Answer 38

Dysphagia is characterized by trouble swallowing, and may also cause speech problems. This happens when the disease damages the nerves in the brain and spinal cord that make these tasks happen. For some people, these problems are mild.

Question 39

MS lesions (damaged areas) in different parts of the brain can cause several types of changes in normal speech patterns. They range from mild difficulties to severe problems that make it difficult to be understood. Medically, problems with speech are called ___________.

Answer 39

dysarthria

Question 40

Sometimes due to weakness in the ____________, speech volume can be affected and it may be difficult to be heard.

Answer 40

diaphragm

Question 41

Three types of altered physical sensations that a MS patient may feel are:

Answer 41

pins and needles; burning or crawling sensations; numbness or tightness These unusual sensations are a type of nerve (neuropathic) pain.

Question 42

How common are anxiety disorders in MS patients, compared to the general population?

Answer 42

Anxiety disorders are three times more common in MS than in the general population.

Question 43

True or False: Obesity is a possible risk factor for developing MS.

Answer 43

True: The incidence of MS appears to be increasing worldwide at the same time that caloric intake and being overweight or obese are increasing. In recent studies, obesity and body size at age 18-20 were associated with an increased risk of MS, as was higher Body Mass Index (BMI) at age 7-13.

Question 44

In an observational study, people who consumed a moderate or high amount of _________ had a higher rate of relapses and a greater risk of developing a new lesion on MRI than people who consumed a low amount.

Answer 44

sodium