L5 MS Intro

Question 1

MS defintion

Answer 1

chronic inflammatory progressive disease of myelin in brain, spinal cord, optic nerve, cerebellum
autoimmune disease with genetic component

Question 2

onset of MS

average and percentages

Answer 2

mean onset is 30 y/o
70% 20-40
10-20% after 60

Question 3

MS population

Answer 3

younger adults
F>M
genetic, 1st degree relative
epstein barr exposure, vitamin D/sunshine deficiency, smoking

Question 4

MS pathology of what cells? (2)

Answer 4

oligodendrocytes which form myelin
microglia release inflammatory agents and autoimmune component

Question 5

pathophys of MS

Answer 5

inflammation opens gaps in BBB, T cells, B cells, macrophages enter CNS and start autoimmune process, microglia start releasing pro-inflammatory signals
antibodies created by T cells activating B cells, target oligodendrocytes

Question 6

inflammatory demyelination in MS

Answer 6

caused by depletion of oligodendrocytes which remyelinate cells
damages nerve transmission
reducing inflammation reduces symptoms as remyelination occurs
repeated inflammation leads to irreversible damage and disability

Question 7

plaques in MS

Answer 7

loss of myelin in one area - plaque
associated with axon loss of function
most in SC, then optic nerve and cerebellum
result in brain atrophy

Question 8

gray matter dysfunction in MS

Answer 8

because white matter/axons are affected, gray matter gets less nutrition and associated with more disability

Question 9

epidemiology

Answer 9

3:1 W to M
men have more aggressive version
western european, extreme north/south
migrating from these areas reduces risk
above 45 latitude

Question 10

classifications of MS

Answer 10

relapsing remitting
secondary progressive
primary progressive
progressive relapsing
benign/CIS

Question 11

relapsing remitting MS

Answer 11

85% of cases
unpredictable attacks which may/may not leave permanent deficits but go into remission

Question 12

secondary progressive MS

Answer 12

RRMS that develops into progressive after about 15 years
starts a decline without remission

Question 13

primary progressive MS

Answer 13

gradual worsening of symptoms without remission
doesn’t respond to standard medical Rx
progressive myelopathy

Question 14

benign MS

Answer 14

one occurrence with no reoccurence

Question 15

EDSS

Answer 15

expanded disability status scale
0-9
0-1 no disability
5 disability affecting ADLs
6 assistance to walk
7 wheelchair
8=9 bedbound

Question 16

diagnosis of MS criteria

Answer 16

two lesions in two separate areas of brain, SC, or optic nerve
AND
evidence of two different points in time
AND
rule out other diagnoses

Question 17

diagnose MS - differential

Answer 17

LBP
fibromyalgia
cervical spondylosis
herniated disc
mitochondrial disease

Question 18

diagnose MS - testing

Answer 18

needs multiple tests, no single one
MRI: plaques and lesions
lumbar puncture: elevated protein in CSF during exacerbation
Visual evoked potential: measure electrical activity of optic nerve

Question 19

initial symptoms of MS

Answer 19

20s female
transient
fatigue
double vision
paresthesia/N/T/weakness
LBP
pain in BL LE

Question 20

s/s in MS exacerbation

Answer 20

lasting longer than 24 hours
N/T
fatigue
visual changes
weakness
gait changes
brain fog
tremors
incontinence

Question 21

disease pathway of MS

Answer 21

diagnosis
exacerbation - longer = more damage
remission - no activity
management - reduce flares

Question 22

smoldering model of MS

Answer 22

continuation of disease process even when in remission with reduced symptoms
explains why pts with MS can be in remission but showing more involvement/more lesions developing

Question 23

pseudoexacerbation of MS

Answer 23

less than 24 hours
resolves on its own
brought on by stress, heat, over exertion
s/s: fatigue, brain fog, pain
does not mean there is nervous system damage

Question 24

central MS symptoms

Answer 24

fatigue
cognitive impairments
depression
unstable mood

Question 25

visual symptoms of MS

Answer 25

nystagmus optic neuritis diplopia

Question 26

speech/throat symptoms of MS

Answer 26

dysphagia dysarthria

Question 27

MSK symptoms of MS

Answer 27

weakness spasms ataxia

Question 28

sensory symptoms of MS

Answer 28

pain hypoesthesia paresthesia anesthesia

Question 29

bowel/bladder symptoms of MS

Answer 29

incontinence diarrhea constipation frequency retention

Question 30

fatigue types in MS

Answer 30

primary: damage to axons in brain and spinal cord (muscle fatigue) indirect fatigue; from med/sleep meds, depression neurologic fatigue: spasms, weakness, heat exposure, energy failure

Question 31

correlations with fatigue in MS

Answer 31

stress and increased physical activity associated with more fatigue positive mood associated with less

Question 32

heat intolerance in MS

Answer 32

Uhtoff phenomenon: increased core body temp 70% pts exertion, hot water, weather does not increase disease, does increase symptoms resolves when heat source is removed

Question 33

types of spasms in MS

Answer 33

flexor and extensor, more UE than LE flexor knees bent, extensor scissoring extended legs

Question 34

spasticity in MS | triggers, effects, % who have it

Answer 34

effects function and QoL 84% have spasticity made worse by position changes, noxious stim, physiologic stress, pain, cold weather, tight clothing, increased body temp can lead to contracture, skin breakdown, infection, pain, sleep disturbances, poor hygiene, decreased mobility

Question 35

neuropathic pain types in MS

Answer 35

acute: from sensory neuron demyelination trigeminal neuralgia: stabbing pain in face and jaw, not constant lhermitte sign: stabbing electric shock through the spinal cord chronic: brought on by stress, fatigue, illness, overheating dysesthesias: pain in limbs including N/T pruritis: itching/burning

Question 36

MSK pain in MS

Answer 36

tightness loss of ROM spasticity weakness abn motion compensatory mvmt patterns abn use/loading muscle fatigue

Question 37

sensory impairments in MS

Answer 37

optic neuritis: double vision/blurry/painful visual field loss pupillary deficits dys/an/parathesia vestibular dizziness/vertigo

Question 38

MS problems with postural control | what are the actual problems found on exam?

Answer 38

1. delayed response to postural perturbations 2. increased body sway to quiet standing 3. inability to move outside bos

Question 39

are bowel or bladder problems more common in MS?

Answer 39

both common, bladder more common 35-68% bowel 53-98% bladder

Question 40

disease modifying drugs for MS have what effect?

Answer 40

prevent new inflammatory lesions prevent development of secondary progressive MS prevent loss of neuroprotection and allow more remyelination slows progression but is not a cure

Question 41

clinical isolated syndrome disease course

Answer 41

monophasic episode suggesting MS 30-70% develop MS if they have optic neuritis, 10-85% develop MS 20-45 y/o

Question 42

RRMS disease course

Answer 42

85% cases 20-30 y/o relapse over days/weeks with full/partial remission over months/years

Question 43

secondary progressive MS disease process

Answer 43

75% RRMS develop into this after 15 years

Question 44

primary progressive MS disease process

Answer 44

steady functional worsening after onset of disease 15% later onset