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Flashcards in Chapter 19 Multiple Sclerosis Deck (10):
1

Multiple Sclerosis: MS is a CNS inflammatory disease of unknown etiology (thought to be autoimmune) that is characterized by areas of __________ that are disseminated in __________ and __________. US prevalence is ≈400,000, ranging from 40 to 220/100,000 with ♀:♂ = 2:1 and Caucasian>Asian>African American.

Multiple Sclerosis: MS is a CNS inflammatory disease of unknown etiology (thought to be autoimmune) that is characterized by areas of demyelination that are disseminated in time and space. US prevalence is ≈400,000, ranging from 40 to 220/100,000 with ♀:♂ = 2:1 and Caucasian>Asian>African American.

2

Multiple Sclerosis
Mean onset is ≈__________ years of age. Incidence and death rates are higher in the __________ latitudes, although this differential appears to be decreasing. An important factor appears to be where one lives prior to __________ years of age.

Multiple Sclerosis
Mean onset is ≈30 years of age. Incidence and death rates are higher in the northern latitudes, although this differential appears to be decreasing. An important factor appears to be where one lives prior to 15 years of age.

3

Multiple Sclerosis
Diagnosis and Clinical Features – Definite MS has been classically defined as ≥__________ attacks, separated by ≥__________ month, with clinical, imaging, or laboratory evidence (e.g., ↑ CSF protein with oligoclonal bands on electrophoresis and delayed visual evoked potential [VEP]/somatosensory evoked potential [SSEP] latencies) of ≥__________ lesions. Each attack lasts >__________ hours. Ovoid plaques that are bright on __________ MRI are typically found in the periventricular white matter, cortical–subcortical junction, brainstem, and/ or cerebellum.

Multiple Sclerosis
Diagnosis and Clinical Features – Definite MS has been classically defined as ≥2 attacks, separated by ≥1 month, with clinical, imaging, or laboratory evidence (e.g., ↑ CSF protein with oligoclonal bands on electrophoresis and delayed visual evoked potential [VEP]/somatosensory evoked potential [SSEP] latencies) of ≥2 lesions. Each attack lasts >24 hours. Ovoid plaques that are bright on T2 MRI are typically found in the periventricular white matter, cortical–subcortical junction, brainstem, and/ or cerebellum.

4

Multiple Sclerosis
__________ __________ lesions are relatively specific for MS.

Multiple Sclerosis
Corpus callosum lesions are relatively specific for MS.

5

Multiple Sclerosis
In 2005, revisions were made to the __________ criteria for the diagnosis of MS (see Table 19-1).

Multiple Sclerosis
In 2005, revisions were made to the McDonald criteria for the diagnosis of MS (see Table 19-1).

6

Multiple Sclerosis
Common presenting symptoms include __________ changes, __________ loss, motor changes, and diplopia. Common clinical features include paresthesias, weakness, spasticity, fatigue (may be worsened by heat, __________ phenomenon), bladder and sexual dysfunction, cognitive changes, depression, dysphagia, and neuropathic pain.

Multiple Sclerosis
Common presenting symptoms include sensory changes, visual loss, motor changes, and diplopia. Common clinical features include paresthesias, weakness, spasticity, fatigue (may be worsened by heat, Uhthoff's phenomenon), bladder and sexual dysfunction, cognitive changes, depression, dysphagia, and neuropathic pain.

7

Multiple Sclerosis
Exacerbations are __________ during pregnancy but increased postpartum; __________ is unaffected. Prognosis is worse for males, older age of onset, high lesion burden on MRI at onset, initially polysymptomatic, predominantly cerebellar or motor symptoms, and rapidly progressive symptoms.

Multiple Sclerosis
Exacerbations are fewer during pregnancy but increased postpartum; fertility is unaffected. Prognosis is worse for males, older age of onset, high lesion burden on MRI at onset, initially polysymptomatic, predominantly cerebellar or motor symptoms, and rapidly progressive symptoms.

8

Clinical Categories and Treatment of Multiple Sclerosis:
Relapsing–remitting MS is characterized by acute attacks (1 per month) followed by recovery (within weeks to months) with little or no residual neurologic deficit. Interferon β-1a (Avonex, Rebif), interferon β-1b (Betaseron), and glatiramer acetate (Copaxone) are effective therapies. __________ will develop a __________ __________ course with or without relapses. Interferon β-1b may delay progression of disability in secondary progressive MS (i.e., wheelchair dependence). These two types comprise ≈__________% of persons with MS.

Clinical Categories and Treatment of Multiple Sclerosis:
Relapsing–remitting MS is characterized by acute attacks (1 per month) followed by recovery (within weeks to months) with little or no residual neurologic deficit. Interferon β-1a (Avonex, Rebif), interferon β-1b (Betaseron), and glatiramer acetate (Copaxone) are effective therapies. Half will develop a secondary progressive course with or without relapses. Interferon β-1b may delay progression of disability in secondary progressive MS (i.e., wheelchair dependence). These two types comprise ≈85% of persons with MS.

9

Primary progressive MS (10% to 15%) is characterized by an insidious onset and gradual progression without __________ relapses. It typically presents at around __________ years of age; males and females are equally affected. No proven pharmacotherapy assists treatment.

Primary progressive MS (10% to 15%) is characterized by an insidious onset and gradual progression without acute relapses. It typically presents at around 40 years of age; males and females are equally affected. No proven pharmacotherapy assists treatment.

10

Progressive relapsing MS (5%) is a progressive disease from the onset with superimposed acute relapses with or w/o some recovery.
IV __________, which are a mainstay of acute treatment (e.g., __________ IV 500 mg qd × 5 days or 1 g qd × 3 days), shorten the exacerbation period, but do not change the ultimate extent of recovery. Rehabilitation management includes treatment of __________/__________ spasticity and __________ issues. Fatigue can be addressed with energy conservation techniques and/or pharmaceuticals (e.g., amantadine, pemoline, modafinil, and methylphenidate). Exercise, once considered contraindicated in MS, should be prescribed to help delay secondary disability.

Progressive relapsing MS (5%) is a progressive disease from the onset with superimposed acute relapses with or w/o some recovery.
IV steroids, which are a mainstay of acute treatment (e.g., methylprednisolone IV 500 mg qd × 5 days or 1 g qd × 3 days), shorten the exacerbation period, but do not change the ultimate extent of recovery. Rehabilitation management includes treatment of bowel/bladder spasticity and pain issues. Fatigue can be addressed with energy conservation techniques and/or pharmaceuticals (e.g., amantadine, pemoline, modafinil, and methylphenidate). Exercise, once considered contraindicated in MS, should be prescribed to help delay secondary disability.