W10 MS Flashcards
what are Demyelinating disorders?
- alterations in CNS structures
- result of damage to the myelin nerve sheath and affect neural transmission
- can occur in either the central (e.g. MS) or peripheral (e.g., Guillani-Barre Syndrome nervous system
what is Multiple Sclerosis?
-Progressive, chronic, inflammatory, demyelinating, autoimmune disorder of the CNS
-degeneration of CNS myelin
-Scarring (Sclerosis or plaque formation)
-Loss of axon
-onset is 20-40 yrs of age
Etiology is unknown but affects mainly women
what are the risk factors to multiple sclerosis?
Smoking, vitamin D deficiency, and Epstein-Barr virus infection
“Clinically isolated syndrome”: single episode neurologic dysfunction (lasting 24 hrs), precursor to MS
what is the patho of MS?
-Diffuse and progressive CNS inflammatory autoimmune disease that affects white and gray matter
-Autoreactive T & B cells and macrophages breach blood-brain barrier and spinal cord accompanied by upregulation of adhesion molecules and inflammation
-Recognize myelin autoantigens which produce antibodies and cause inflammation demyelination
-Loss of myelin sheaths, relative preservation of axons, and glial (astrocytic) scar formation
Diffuse injury and CNS–> MS lesions occur anywhere in white or grey matter
what are the consequences of MS pathophysiology?
- loss of myelin–> which disrupts the nerve conduction and cause symptoms
- also neurons die and brain atrophies
what is clinically isolated syndrome?
- an acute neurologic episode, is the first manifestation of the disease
- Symptoms: Paresthesias of the face, trunk, or limbs; weakness; impaired gait; visual, hearing & speech abnormalities; or urinary incontinence, indicating diffuse CNS involvement
what is optic neuritis
one eye with progressive blurring vision and pain with eye movement
what is spinal cord syndrome?
both sensory and motor tracts starting on one side and progressing to the other
what is brainstorm syndrome?
facial sensory loss or weakness, vertigo, or double vision
what is cerebellar syndrome?
lack of coordination, tremor, gait instability, and ataxia
what is cognitive deficits?
-memory and attention as well as later dementia and psychiatric disorders
symptoms subtypes of MS
-relapsing/remitting
Most common and is characterized by relapses or exacerbations (flares) of previous symptoms or worsening of neurologic symptoms
symptom subtypes of MS
primary progressive MS
-least common and is characterized characterized by a gradual progression of the disease without periods of remission
symptom subtypes of MS (secondary progressive MS)
Characterized by an initial period of relapsing/remitting MS followed by a gradual worsening of the symptoms between relapses
symptom subtypes of MS (progressive relapsing MS (PRMS)
Characterized by steadily worsening symptoms from the onset with clear acute relapses but often with more severe symptoms
evaluation and treatment of MS
- no single test available to diagnose or rule out MS
- treatment: prevent exacerbations and control symptoms
- corticosteroids
- immunotherapy
- immune system modulators
- continuous monitoring
- vitamin D
- stem cells
non pharamoctherpay treatment
- Regular exercise program
- Smoking cessation
- Avoidance of overwork, extreme fatigue, and heat exposure
goal of pharmacotherapy
- is to slow the progression of MS
-Immunomodulators are the main strategy to modify the abnormal immune response and prevent exacerbations
Initiated after diagnosis of MS is confirmed
-Two basic types used in MS
-Those that simulate or boost the immune response
-Those that suppress some aspect of immune function
Interferon Beta-1b: betaseron
- Indication: Ambulatory patients with relapsing or remitting multiple sclerosis
- Mechanisms of action: drug that’s not clearly understood. Believed to act by suppressing the activity of T-cells and reducing the inflammatory actions of cytokines.
- Desired effects: Decreased symptoms of multiple sclerosis
Interferon Beta-1b: Betaseron-adverse effects
Adverse effects: transient flu-like symptoms, leukopenia, headache, insomnia, asthenia, increased liver enzymes, rash, peripheral edema, and malaise
non-pharamolgocial interventions for MS
- protect pt from injury
- promote regular bladder and bladder elimination
- instruct the pt in safety measure r/t sensory and motor loss
- encourage independence
