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Clinical Medicine - OT > Week 3 - Multiple Sclerosis > Flashcards

Week 3 - Multiple Sclerosis Flashcards

1
Q

What is Multiple Sclerosis?

A

A demyelinating disease of the central nervous system affecting the brain, spinal cord and optic nerves

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2
Q

Autoimmune demyelination results in?

A

Lesion specific symptoms

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3
Q

What are 4 lesion specific symptoms of MS?

A

Visual loss/symptoms
Sensory loss
Motor weakness
Vestibular system dysfunction

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4
Q

What are nodes of Ranvier?

A

The periodic gap in the insulating sheath (myelin) on the axon of certain neurons that serves to facilitate the rapid conduction of nerve impulses.

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5
Q

What is the action potential?

A

An explosive release of charge between a nerve cell (neuron) and its surroundings

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6
Q

What is Saltatory conduction?

A

The propagation of action potentials along myelinated axons from one node of Ranvier to the next node, increasing the conduction velocity of action potentials

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7
Q

Why does demyelination occur in MS?

A

The blood brain barrier breaks down causing an autoimmune response. This causes the macrophages and antibodies to attack the myelin around neurons, which cause plaque formation and reduce saltatory conduction.

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8
Q

What are the 4 types of MS?

A

Relapsing Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Primary Progressive MS (PPMS)
Progressive Relapsing MS (PRMS)

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9
Q

What is Relapsing Remitting MS?

A

Episodes of acute worsening with recovery and stable course between relapses.

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10
Q

What is Secondary progressive MS?

A

Gradual neurological deterioration with or without superimposed relapses. Typically develops from RRMS

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11
Q

What is Primary Progressive MS?

A

Gradual, nearly continuous neurological deterioration from onset of symptoms

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12
Q

What is Progressive Relapsing MS?

A

Gradual neurological deterioration from onset of symptoms with subsequent superimposed relapses.

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13
Q

Which is the most common type of MS?

A

Relapsing remitting, 85% of cases

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14
Q

What causes MS?

A

Genetic
Infection
Environment

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15
Q

What are risk factors of MS?

A

Vitamin D deficiency under 15
Childhood obesity
Cigarette smoking

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16
Q

What gender is more likely to have MS?

A

Female, 2.5:1

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17
Q

What is the average age of onset?

A

25-35 years

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18
Q

How is MS diagnosed?

A

The revised McDonald Diagnostic Criteria

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19
Q

What are the most common initial symptoms of MS

A 
Visual/oculomotor (49% of cases)
Weakness/sensory disturbance in one or more limbs (40%)
Incoordination (23%)
Genitourinary/bowel dysfunction (10%)
Fatigue
Heat intolerance
20
Q

What determines which symptoms are seen in a person with MS?

A

The location of the affected nerve fibres.

21
Q

What are the 5 categories of symptoms of MS?

A
  1. Sensory
  2. Motor
  3. Visual
  4. Cognitive and communicative
  5. Psychological
22
Q

What are sensory symptoms of MS?

A 
Numbness
Tingling
Pins and needles
Tightness
Pain
Hypersensitivity
23
Q

What are motor symptoms of MS?

A 
Increased muscle tone in affected limbs
Spasticity
Exaggerated deep tendon reflexes
Clonus
Muscle weakness
Dysphagia
24
Q

What is clonus?

A

Clonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons.

25
Q

What is dysphagia?

A

Difficulty swallowing

26
Q

What 3 impairments are caused by impairment of cranial nerves?

A

Impairment of smell
Impairment of visual pathways
Uhthoff’s phenomenon

27
Q

What is Uhthoff’s phenomenon?

A

The worsening of MS symptoms when the body gets overheated, whether it be from hot weather, exercise, fever, or saunas and hot tubs

28
Q

How is vision impaired by cranial nerve impairment?

A 
Impairment of oculomotor pathways
Optic neuritis
Partial or complete loss of vision
Double/blurred vision
Pain
Nystagmus
29
Q

What are signs of impairment of cerebellar pathways in MS?

A 
Dysmetria
Dysdiadochokinesia
Decomposition of complex movements
Action tremor in head and limbs
Truncal ataxia
Scanning speech
30
Q

What is dysmetria?

A

Improper measuring of distance in muscular acts

31
Q

What is Dysdiadochokinesia?

A

The inability to perform rapid alternating muscle movements eg. pronation/supernation.

32
Q

What is an action tremor?

A

A tremor that occurs with the voluntary movement of a muscle

33
Q

What is truncal ataxia?

A

A wide-based “drunken sailor” gait characterised by uncertain starts and stops, lateral deviations and unequal steps

34
Q

What is scanning speech?

A

A type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force.

35
Q

What are signs of impairment of the genitourinary system?

A

Sexual dysfunction, eg. muscular control, altered sensation

Bladder issues eg. urgency and incontinence.

36
Q

What are signs of cognitive and communicative issues in MS?

A

Memory loss
Difficulty with complex ideas
Reduced attention span
Slurred speech

37
Q

What are signs of psychological impairment in MS?

A

Depressed
Euphoric
Impulsivity
Emotional lability

38
Q

What is emotional lability?

A

Rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur.

39
Q

What is the prognosis of MS?

A

Difficult to predict, however life expectancy is reduced by 5-10 years compared to age matched normal.

40
Q

How many relapses do patients with RRMS have per year?

A

1-2

41
Q

True or false; most patients with RRMS convert to SPMS 10-20 years from onset?

A

True

42
Q

What % of patients are unable to work after 10 years with MS?

A

50-80%

43
Q

How is MS treated?

A

Immunomodulatory therapy (IMT) and drugs to relieve and modify symptoms.

44
Q

What does immunomodulatory therapy do?

A

Aims to modify the underlying immune disorder and its response

45
Q

How are MS relapses managed?

A

Corticosteroids and high dose IV methylprednisolone

46
Q

How are symptoms of MS managed?

A

Botox for spasticity
Pain medication
Sexual problems - viagra
Depression and fatigue - Fluoxetine

47
Q

What is the role of Allied health in MS care?

A 
Management of activity limitations
Treatment of complications
Minimise the impact of condition on activity and participation in life.
Maintenance of life roles
Addressing specific symptoms.

Clinical Medicine - OT (35 decks)

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