Week 10 - Multiple Sclerosis Flashcards
what is multiple sclerosis
- autoimmune & chronic disorder that damages the myelin sheath of neurons
- causing a variety of sensory, motor, and cognitive deficits
what is the hallmark of MS
- presence of multifocal regions of myelin destruction (demyelination) & sclerosis of white matter in the brain, spinal cord, and/or optic nerve
- causes multiple sclerotic plaques (scar tissue) throughout the CNS
what is the cause of MS
- unknown
- thought to be autoimmune or due to an immune attack on virally infected oligodendrocytes
what are risk factors for MS (9)
- female
- age 20-40
- colder climate
- vitamin D deficiency
- european descent
- family history
- genetic risk
- smoking
- obesity
describe the sex risk factor of MS
- twice as common in women than men
why is a coler climate a risk factor for MS
- less sun exposure = lower vitamin D lvls
at what age do symptoms of MS occur
- between ages 20-40
describe the family history risk factor of MS
- risk of developing MS if 15x greater in individuals who have an affected first-degree relative
describe the genetic risk of MS
- genetic risk in individuals with certain MHC polymorphisms = supports autoimmune eitology
what does demyelination of neurons during MS cause
- slowed or blocked conduction = variety of neurological S+S
what do early lesions during MS occur as? what does it progress to?
- early lesions occur as small areas of inflammation which eventually remyelinate
- but eventually progress to firm demyelinated plaques, absent of oligodendrocytes (= no remyelination)
what are oligodendrocytes
- type of glial cell in the NS
- responsible for producing the myelin sheath
what pattern do symptoms of MS follow
- pattern of exacerbations & remission
what is a remission
- periods of recovery
what are periods of exacerbations
- flare ups or relapse
what are 3 triggers of MS
- stress
- infection
- fatigue
what causes remissions during MS
- if the initial inflammation subsides, neural function will return
- occurs with early lesions
what do multiple exacerbations cause
- over time, as oligodendrocytes die off, no longer get remyelination
- permanent loss of neural function
describe the symptoms of MS between individuals
- varies between affected individuals since location & severity of plaques is variable
what are common initial symptoms of MS (7)
- weakness
- numbness
- burning
- tingling
- unsteady limb
- visual disturbances
- sphincter dysfunction
at what point might symptoms of MS disapear
- after a few days to weeks, although examination shows a residual effect
what does a MRI of an individual w MS show
- presence of multiple lesions in the brain or spinal cord
what does analysis of CSF during MS show
- lymphocytosis
- elevated antibodies (indicate autoimmune)
what changes in mental status might you see during an assessment of MS (5)
- depression
- short term memory
- uncontrollable laughter & crying
- mood swings
- bipolar disorder
what changes in sensation might you see during an assessment of MS (7)
- numbness
- tingling
- burning
- itching
- “MS hug”
- nerve pain
- bladder dysfunction
what is a “MS hug”
- feels like a tight, painful hug
- feeling of tightness or pressure around the chest & stomach
what changes in movement might you see during an assessment of MS (9)
- dysphagia
- dysphasia
- dysarthria
- spasticity
- tremor
- weakness
- fatigue
- leg dragging
- weak resp. muscle
what changes in balance & coordination might you see during assessment of MS? (5)
- loss of balance
- ataxia
- unstable walking
- vertigo
- dizziness
what changes in reflexes might you see during assessment of MS
- positive babinski reflex
what nerves might MS effect (4 groups, 8 in total)
- CN2
- CN 3,4,6
- CN 8
- CN 9, 10, 12
what signs might you see during MS due to the effect it has on CN 2
- loss of vision
- blurred vision
- diplopia
what is diplopia
- double vision
what is one of the first signs of MS
- diplopia
what signs might you see during MS due to the effect it has on CN 3,4,6
- nystagmus
what signs might you see during MS due to the effect it has on CN 8
- tinnitus
what signs might you see during MS due to the effect it has on CN 9, 10, 12 (2)
issues with
- speech
- swallowing
overall with the neuro assessment findings of MS, danielle said not to worry about memorizing them all too crazy bc MS can pre much cause any neuro sign depending where the plaques occur
- it is important to know how this will effect ADLs
- and that diplopia is often a 1st sign of MS tho
….
describe the diagnosis of MS
- no definitive test
- combo of history, manifestations, and presence of multiple lesions on MRI
what effect would MS have on eating
- risk of aspiration
- dependence
- risk for malnutrition
how does MS cause a risk of aspiration (3)
due to:
- difficulty swallowing
- difficulty chewing
- weak muscles in the mouth
how does MS cause dependence during eating
- muscle weakness & paralysis affects their ability to eat on their own
what effect does MS have on toileting (4)
- incontinence
- retention
- dependence
- risk for UTI
how does MS cause dependence during toileting
- due to muscle weakness & paralysis = may require assistance to the bathroom
what effect does MS have on walking
- risk for falls
- dependence
how does MS cause a risk of falls & dependence (3)
- unstable walking
- weakness
- tremors
= may need assistance w ambulation
what effect does MS have on dressing
- dependent
how does MS cause dependence during dressing (2)
- may be dependent on others for fine motor tasks
- difficulty seeing
etc.
what are 4 possible consequences of immobility
- DVT
- pneumonia & atelectasis
- pressure sores/ulcers
- constipation
what are some signs of a DVT (4)
- swelling
- pain
- warmth
- redness
all in one leg
what is a risk associated w DVT
may cause pulmonary embolism
what are signs of pneumonia & atelectasis (6)
- fever
- sputum changes
- decreased air entry to bases
- increased WOB
- decreased O2 sat
- increased resp rate
how does immbolity increase the risk of pneumonia & atlectasis
- pooling & thickening of secretions
describe how to assess for pressure ulcers/sores (3)
- CWCM
- skin assessment
- Braden scale
describe how to assess for constipation (4)
- ins/outs
- abdominal distension
- BS
- abdominal pain
what 3 classes of meds are used for MS
- corticosteroids
- immunomodulators
- immunosuppressants
(bc its autoimmune)
what is a corticosteroid used for MS
- prednisone
what is the MOA of prednisone
..
what are the indications for prednisone
- acute MS exacerbations
what effects does prednisone have (2)
- potent anti-inflammatory & immunosuppressant effects
what are 3 side effects of prednisone
- susceptibility to infection
- increased BG
- hypokalemia
is long or short term therapy preferred for prednisone
- short term –> to limit adverse effects
describe the discontinuation of prednisone
- should not be abruptly stopped
- must tape off due to adrenal suppression
what is an immunomodulator for MS
- interferon beta
what is MOA of interferon beta in MS (2)
- stops inflammatory leukocytes from crossing the BBB = cannot reach neurons
- suppresses helper T cells which attack neurons in MS
how is interferon beta administered
- via injection (subcut)
what are adverse effects of interferon beta (3)
- flu-like symptoms
- liver toxicity
- BMS
what implication does the flu-like adverse effects of interferon beta have (2)
- take in the evening
- take a tyenol to counteract
what should monitor for a pt on interferon beta (2)
- CBC (due to BMS)
- LFTs
what is a type of immunosuppressant used for MS
- mitoxantrone
what is the MOA of mitoxantrone
- decreases production of immune cells in the bone marrow = decreased immune destruction of myelin
what is a pro and con to mitoxantrone
- stronger immunosuppression effects than immunomodulatory
- con = bigger risk for toxicity
what is the indication for mitoxantrone
- for pts who are not well managed on interferon beta
- or for pts with more aggressive symptoms
list adverse effects of mitoxantrone (3)
- marked BMS
- increased risk of severe infection
- cardiotoxic
what specific effect can mitoxantrone have on the heart
- can cause permanent damage to the heart & lead to HF
who can mitoxantrone not be used for
- for pts w lover disease –> can cause severe drug toxicity
what should be monitored during mitoxantrone use
- CBC
- LFT
