Multiple Sclerosis/Test 3 Flashcards
Pathophysiology of MS:
- Chronic, progressive, degenerative CNS disorder
- Starts as inflammation then disseminated demyelination and gliosis (scarring) of nerve fibers in the brain and spinal cord
- Random distribution: brainstem, optic nerves, spinal cord, cerebrum
- Formation of plaque
MS is initially triggered by:
a virus in genetically susceptible individuals
- activated T cells migrate to CNS causing blood brain disruption.
- Subsequent antigen-antibody reaction leads to demyelination of axons
Considered a disease of
the young to middle age adults. Onset 15-50. Women are affected more often than men.
Manifestations-
Motor weakness/paralysis of the limbs, trunk or head; diplopia; scanning speech; spasticity of muscles that are chronically affected. Sensory-numbness/tingling, parasthesias, patchy blindness (scotomas), blurred vision, vertigo, tinnitus, decreased hearing, chronic neuropathic pain. Cerebellar signs: nystagmus, ataxia, dysarthria, dysphagia. Bowel and bladder dysfunctions- flaccid bladder
Baclofen:
Acts on the CNS to relieve spasms, cramping and tightness of muscles caused by spasticity in MS
Proper use of Baclofen:
people with MS are usually started on an initial dose of 5 mg every six to eight hours. If necessary, the amount is increased by 5 mg per dose every 5 days until symptoms improve. The goal of treatment is to find a dosage level that relieves spasticity without causing excessive weakness or fatigue. The effective dose may vary from 15 mg to 160 mg per day or more.
Precautions of Baclofen use:
If you are taking more than 30 mg daily, do not stop taking this medication abruptly. Stopping high doses of this medication can cause convulsions, hallucinations, increase in muscle spasms or cramping, mental changes, or unusual nervousness or restlessness. Consult your physician about how to reduce the dosage gradually before stopping the medication completely.
Possible side effects of Baclofen:
Expected: drowsiness or unusual tiredness, increased weakness, dizziness or lightheadedness, confusion, unusual constipation, new or unusual bladder symptoms, trouble sleeping, unusual unsteadiness or clumsiness
-unusual side effects: (immediate medical attention) fainting, hallucinations, severe mood changes, skin rash or itching, symptoms of overdose, sudden onset of blurred or double vision, convulsions, SOB, vomiting.
Etiology of MS:
*Cause in unknown
-possibly autoimmune
Research suggests- Infectious (viral), immunologic, genetic factors
**Higher incident in colder, northern latitude
Clinical manifestations of MS:
- *Remember to correlate symptoms where lesions are:
- Motor symptoms- weakness or a feeling of heaviness in the lower extremities, paralysis, spasticity and hyperrelexia, diplopia, bowel and bladder dysfunction.
- retention, frequency, urgency, incontinences, bladder common symptom
- Neurobehavioral symptoms- emotional lability, euphoria and depression common. Irritability, apathy, poor judgement, inability to problem solve, loss of short term memory r/t demyelination of the white matter in the frontal lobe.
- Optic neuritis
- Impotence
- Sexual dysfunction
- Fatigue (ranges from mild to severe)
MS diagnostic studies:
- *No definitive diagnostic test
- history and physical esp: neuro
- visual, auditory, somatosensory response
- -assess nerve conduction to these areas
- Usually diagnosed by ruling out other neurological causes
- MRI- extremely sensitive to white matter lesions- locating sites of demyelination. Presence of multiple lesions seen over time on MRI (2nd lesion)
- CSF analysis- higher white count, 90% MS patient have a specific protein present. Increase in oligoclonal immunoglobulin G, myelin basic protein. Higher number of lymphocytes and monocytes.
- Evoked responses- decreased nerve conduction from the eye and ear to the brain.
MS is based primarily on
history, clinical manifestations- “DX of exlusion”
- 2 attacks at least 1 month apart
- more than 1 area of damage
Lab tests for MS:
- T4 and immune globulin G (IgG) are increased.
- CSF electrophoresis shows presence of IgG oligoclonal bands, myelin basic protein, higher number of lymphocytes and monocytes.
- Radioimmunoassay: measures the myelin basic protein that is released during the acute attack.
No cure: Goals are: Drug therapy
- Treat the disease process
- Providing symptomatic relief
- Adjust to illness
- Maximize neuromuscular function
- Maintain independence- leading cause of unemployment for MS pt is cognitive impairment, not weakness
- Optimize psychosocial well-being
- Decrease factors that precipitate exacerbations.
For Acute exacerbation: MS
- Steroid use to treat/alleviate the major symptoms of MS
- Short course of high-dose corticosteroids
- Methylprednisolone
- Oral predisone
- Corticotropin (ACTH) IV or IM
