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Pathology F10

Multiple Sclerosis

Multiple sclerosis is a major cause of disability in ________________. young adults
What is the hallmark of multiple sclerosis? sclerotic plaques spread or dispersed throughout the CNS (white matter) that slow or block neural transmission.
How many recognized subtypes of MS are there? four
The highest known prevalence of MS is in what country? Scotland; also common in Scandinavia and Northern Europe
Prevalence of MS in the US? 30-80/100,000 (450,000 people are affected and 10,000 new cases annually)
In MS, a viral infection triggers a cascade of events that results in -destruction of oligodentrocytes (cells producing myelin in neurons) and the myelin -repair produces scars or plaques
What ethnic groups have higher prevalence of MS? -Caucasians have the highest -AA and Japanese Americans also have a high prevalence
ratio of males to females 1:2
Pathogenesis of MS- A the myelin sheath is significantly damaged, whereas the nerve cells and axons are relatively spared
Pathogenesis of MS- B -brain is loosing white matter so it shrinks -occurs early in disease course and is related to physical and cognitive impairments
Which parts of the nervous system are affected in MS? disseminated plaques are found on corpus callosum, optic nerves (which are most susceptible and often the first sign) and the brain stem (swallowing or hearing issues & cranial nerves)
what happens when the oligodendrocytes disintegrate? they try to come back but the myelin produced is not as good
signs and symptoms of MS -87% walking problems (b/c of balance) -65% bowel and bladder problems -60% pain and other abnormal sensations -58% visual symptoms -44% cognitive deficits -41% tremors -Internuclear opthalmoplegia -Uhthoff's sign -UMN lesion -brainstem lesions
internuclear opthalmoplegia is... -pathognomic (if you have this, you have multiple sclerosis) -the nerve fibers that coordinate both eyes in horizontal movements—looking from side to side—are damaged
Uhthoff's sign heat intolerance; fatigue quickly in hot climates (body deteriorates so take precautions)
Clinical Manefestations of MS -Optic symptoms -Sensory changes -Lhermitte's sign -sleep disturbance -neurogenic burning pain is felt in the thorax or legs -back pain
optic symptoms in MS optic neuritis is the first manifestation; visual blurring; diplopia (seeing double); loss of vision in one eye
sensory changes in MS paresthesia (in one extremity, head and face)
Lhermitte's sign if you flex your head, you get an electrical shock down your spine (coughing or sneezing)
What is the most debilitating and common symptom of MS? fatigue
How do you plan a PT appointment for a patient with MS? know when during the day the patient has the most energy; they need a good balance between work and rest
Relapsing-Remitting MS (RRMS) -70% of patients with MS -relapses with full recovery or some residual between each exacerbation -no progression between relapses -about 80% that start with RRMS will go on to develop secondary progressive MS
Primary-Progressive MS (PPMS) 10% of MS patients (very rare) -progresses from onset without remissons or with occasional temporary minor improvements -commonly seen in people who develop MS after 40 years of age -keep getting more and more symptoms
Secondary-Progressive MS (SPMS) -Initially RRMS followed by progression at a variable rate that may include occasional relapses and minor remissions -not having complete recovery and start having losses
Progressive-Relapsing MS (PRMS) -Progressive disease from onset but with clear acute relapses that may or may not resolve -intervals between relapses are marked by progression of the disease
How to diagnose MS -History, clinical finding & lab tests -look at time course & evidence of white matter involvement -neuro exam to rule out other etiologies -tests: CSF, MRI, evoked potentials -McDonald criteria: how to diagnose MS earlier & how to incr time b/w relap
Cerebrospinal Fluid Analysis detection of inflammatory process in NS: -increased mononuclear cell pleocytosis -elevation of total immunoglobins -presence of oligoclonal bands IgG
Commonly used scales for MS *Modified Fatigue Index *Kurtzke Expanded Disability Status Scale -patient's ability to take care of their self -includes mobility
Treatment of MS -no cure -treat symptoms & acute attacks (rest & corticosteroids) -PT, OT & speech (energy conserving & stretching program) -Disease modifying drugs: ABC's, Novantrone IV infusion & artificial interfeurons
Novantrone -mitoxantrone -treatment made for RRMS -lifetime limit of 8-12 doses (generally saved for really bad exacerbations)
Rebif -interfeuron beta-1a -sub-cutaneous injection -treatment for RRMS
Copaxone -Daily SC injection -RRMS -reduces relapse rate
Betaseron -Every other day SC injection -RRMS -reduces relapse rate
Avonex -weekly IM injection -relapsing MS -slows progression
Corticosteroids -used for management of acute relapses -anti-inflammatory -immunosuppression -decrease swelling within CNS -temporarily repair blood-brain barrier
ACTH (adrenocorticotrophic hormone) -medical management of relapses -long-term suppression of immune system
Created by: CWestrick