Question | Answer |
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 |