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Adult Neuro Exam 3 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

what is the pathophysiology of MS?

A

immune-mediated disease that primarily affects the CNS (auto-immune)

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2
Q

what are the “exacerbations” associated with MS?

A

random attacks of inflammation towards the CNS (brain or SC)

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3
Q

What is the etiology of MS?

A

abnormal autoimmune response to some infection or environmental trigger in a genetically susceptible individual

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4
Q

what is the pathophysiology?

A

inflammatory disease DESTROYING areas of myelin in the CNS, primarily white matter

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5
Q

what are the four locations that MS affects?

A
  1. brain
  2. SC
  3. brainstem
  4. CN
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6
Q

with MS, what is a result of the inflammation

A

irreversible damage of axons

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7
Q

what cause the irreversible damage of the axons?

A

scarring or sclerosis

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8
Q

what is the epidemiology of MS?

A

women > men
caucasians > hispanics/AA >asians
prevalent in temperate zones
genetic link

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9
Q

what are the most common s/s of MS?

A
  1. fatigue (88%)
  2. difficulty walking (87%)
  3. B and B (65%)
  4. pain/sensory changes (60%)
  5. visual disturbances (58%)
  6. cognitive problems (44%)
  7. tremors (41%)
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10
Q

what are some cognitive problems associated with MS

A

difficulty with:

  • dual and multi tasking
  • following detailed instructions
  • ST memory
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11
Q

what is the most common emotional instability related to MS?

A

depression

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12
Q

what is the initial presentation of an initial attack for MS?

A
  1. transient
  2. mild
  3. self-limited

don’t know they are having an attack

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13
Q

what are some things associated with diagnosis of MS?

A
  1. clinical attacks
  2. MRI
  3. CSF
  4. positive evoked potentials (nerve conduction testing)
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14
Q

what is the timing of the attacks to be diagnosed with MS?

A

2 attack separated by 30 days

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15
Q

what is the gold standard for diagnosing MS?

A

MRI - lesion dissemination over space and/or time

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16
Q

what level is elevated in CSF with diagnosis of MS?

A

gamma globulin

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17
Q

what are the factors for more positive prognosis

A

female, onset < 35, monoregional, and complete recovery after exacerbation

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18
Q

what are the factors for more negative prognosis

A

male, onset > 35, brainstem symptoms, poor recovery following exacerbation, frequent attacks, AA

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19
Q

what are special issues for PTs with MS?

A
  1. ambiguity of the disease
  2. unpredictability of the disease
  3. covert symptoms
20
Q

what are considered covert symptoms?

A

fatigue, pain, vision, B and B, and paresthesias

21
Q

what are the 4 categories of MS?

A

relapsing-remitting
primary-progressive
secondary-progressive
progressive-relapsing

22
Q

what is the most common form of MS?

A

relapsing-remitting

23
Q

what are some characteristics of relapsing-remitting?

A

defined disease flare-ups with full recovery/minimal residual deficit; periods between disease relapses (remissions)

24
Q

what percentage of patients with relapsing-remitting develop secondary progressive?

A

50%

25
Q

what are characteristics of secondary progressive MS?

A

initial relapsing-remitting course followed by progression with or w/o occasional relapses, minor remissions with some recovery and plateau

26
Q

what is the progression of secondary progressive MS?

A

attack – progressively worse – plateau – another attac

27
Q

what are the characteristics of primary progressive MS?

A

disease progression from onset; without plateaus OR with occasional plateau and temporary minor improvements

28
Q

what are the characteristics of progressive-relapsing MS?

A

progressive from onset; clear acute relapses with or w/o full recovery; periods between relapses characterized by continuing progression

29
Q

what are the 5 categories of treatment for MS?

A
  1. treatment of acute exacerbations
  2. symptom management
  3. disease modification
  4. rehabilitation
  5. psycho-social support
30
Q

what are 5 factors triggering a relapse?

A
  1. unpredictable
  2. infections
  3. physical and emotional stress
  4. heat
  5. last trimester of pregnancy offers a natural protection against relapse
31
Q

what are some tips for acute relapse management?

A

natural improvement over 4-12 weeks; degree of improvement varies, and IV or oral corticosteroids

32
Q

what attempts to end the attack sooner and leave fewer permanent lesions?

A

methylprednisolone followed by oral corticosteroid

33
Q

what are some symptoms to manage?

A

fatigue, pain, depression, bowel and bladder, spasticity, dizziness/vertigo, and intention tremor

34
Q

what are the goals of disease modifying agents?

A

reduce frequency of relapses, progression of disability, and number/volume of brain lesions

35
Q

Avonex

A

treatment of all relapsing forms of MS; weekly IM injection

-can use for a single clinical episode if MRI is consistent with MS

36
Q

Rebif

A

all relapsing forms of MS

-3x/week IM injection

37
Q

Betaseron and Extavia

A

treatment of all relapsing forms of MS;

-every other day subcutaneous injection

38
Q

what is a precaution for betaseron and extavia

A

should not be given to patients with severe and untreated depression due to increased risk of suicide associated with this treatment

39
Q

copaxone

A

treatment of relapsing/remitting MS

-daily subcutaneous injection

40
Q

novantrone (serono)

A

worsening relapsing/remitting MS and for progressive relapsing or secondary progressive MS
-4x/year IV infusion

41
Q

Tysabri

A

relapsing forms of MS

-every 4 weeks IV infusion

42
Q

what are some tests that can be demonstrated during the comprehensive neuro eval?

A

SF-36, Fatigue Impact Scale, MMSE, MMT & Gonio, Modified Ashworth, Vestibular/Ocular Exam, 6MWT, Berg, FIM, Barthel

43
Q

what are some areas that PT could help with treatment?

A

wellness/health, fatigue, weakness, spasticity, balance/vestibular, coordination, sensory problems, ambulation/mobility, ADLs

44
Q

What are issues that need to be addressed when trying to help fatigue management?

A

sleep, poor diet, deconditioning, movement limitations, depression, neuromuscular conditions (more energy consumption by demyelinated axons), body core temp (increasing = slows conduction velocity), emotional stress

45
Q

What is the effect of heat on MS?

A

heat sensitive = aggravate common symptoms (does not cause exacerbation)

  • pool temp <85 degrees
  • cooling garments
46
Q

what are four outcomes measures commonly used with MS?

A
  1. satisfaction with life scale
  2. SF-36
  3. MSQOL-54
  4. Modified Falls Efficacy Scale

Adult Neuro Exam 3 (7 decks)

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