MS

Question 1

what is the etiology of MS

Answer 1

autoimmune dz induced by viral/infectious agent causes an cytotoxic effect on myelin

Question 2

what is the role of myelin

Answer 2

insulator and saltatory conductor to conserve energy during signal transmission

Question 3

what is the role of oligodendrocytes

Answer 3

myelin production in CNS

Question 4

describe the pathogenesis of plaque formation

Answer 4

demyelinated areas fill with fibrous astrocytes and proliferation of neurological tissue (gliosis) occurs resulting in plaque formation

Question 5

what are the four most predictable areas of plaque formation in MS

Answer 5

1. optic nerve
2. ventricular system
3. SC - particularly the posterior column
4. CB peduncles

Question 6

what is typically a first symptom of MS?

Answer 6

visual changes

Question 7

what are the criteria for dx MS

Answer 7

1. evidence of damage in at least 2 areas of the CNS AND
2. damage occured at at least 2 different times AND
3. r/o other dx

Question 8

what three diagnostic tests are most common in the MS population

Answer 8

1. MRI to visualize plaques in 95% of patients
2. CSF/lumbar puncture will show inc IgG
3. abnormal evoked potential

Question 9

of the three diagnostic tests for MS, which is most useful for diagnosis?

Answer 9

evoked potential

Question 10

what are the three common forms of MS

Answer 10

RRMS (most common)
secondary progressive (SPMS)
primary progressive (PPMS)

Question 11

Most RRMS evolves into what…

Answer 11

SPMS

Question 12

Describe RRMS graphically

Answer 12

stepwise relapses with incomplete recovery

Question 13

Describe SPMS graphically

Answer 13

RRMS developing into a constant attack on the myelin

Question 14

Describe PPMS graphically

Answer 14

constant attack on the myelin

Question 15

What two medications are most implicated in MS treatment

Answer 15

DMARDs early will save patients long term and high dose steroids to reduce the immune response

Question 16

Define a MS exacerbation

Answer 16

New MS symptoms lasting MORE THAN 24 HOURS (usually longer) unrelated to another pathology

Question 17

define Uhthoff’s phenomenon

Answer 17

psudoexacerbation of MS symptoms lasting <24 hours

Question 18

T/F: Uhthoff’s phenomenon is caused by external heat

Answer 18

sort of true: it can be caused by either internal or external heat generation

Question 19

Neurosensory changes are very common in MS patients… What are six common pain presentations

Answer 19

1. tic douloureux - trigeminal neuralgia
2. Lhermitte’s sign
3. burning/aching especially in LE (dysesthesias)
4. hyperpathia - light touch = severe pain
5. headaches
6. chronic neuropathic pain

Question 20

what is Lhermitte’s sign?

Answer 20

neck flexion produces shock down the spine indicative of posterior column involvement of MS

Question 21

visual changes are common in MS… what are six common findings for visual disturbances in MS

Answer 21

1. optic neuritis
2. scotoma
3. marcus gunn pupil
4. nystagmus
5. INO
6. diplopia

Question 22

what is optic neuritis

Answer 22

pain behind eye with blurred vision and usually blindness in one eye

Question 23

what is scotoma

Answer 23

dark spot in the center of the visual field

Question 24

what is marcus gunn pupil?

Answer 24

related to the light reflex, both eyes dilate when a light in shined in the eye

Question 25

what in INO

Answer 25

internuclear opthalmoplegia - lateral gaze palsy in one eye and nystagmus in the other

Question 26

T/F: cognitive and autonomic changes are common in MS patients

Answer 26

true

Question 27

How is fatigue unique to MS patients

Answer 27

Lassitude - physical and mental fatigue associated with CNS pathology and is described as the most common/troubling symptom for patients

Question 28

T/F: rehab is as effective as medication in MS patients

Answer 28

false: rehab is better than meds to manage fatigue in MS patients

Question 29

Higher levels of aerobic capacity in MS patients are associated with (higher/same/lower) levels of fatigue

Answer 29

lower

Question 30

is endurance exercise good for MS patients to improve aerobic capacity?

Answer 30

yes, but it requires a long term commitment according to the literature (1 year)

Question 31

T/F: exercise increases exacerbations of MS

Answer 31

false

Question 32

at what level should you exercise MS patients

Answer 32

submaximally with rest periods to prevent fatigue and overheating

Question 33

What is exercise Rx for MS patients

Answer 33

strength (standard), endurance (10-40 min 2-3x/wk)

Question 34

T/F: balance training is beneficial for MS patients

Answer 34

eh.... some/limited evidence about balance training in MS

Question 35

What are Frenkel's exercises

Answer 35

coordination training with limited support in the literature for MS patients (includes finger to nose, heel to shin, RAM, shooting for targets, dual tasking)

Question 36

T/F: error augmentation is effective for MS patients

Answer 36

false - the CB modulates motor output in an intact system but with CB plaques from MS the patient will be unable to match motor output to sensory input effectively

Question 37

T/F: the evidence supports weighted vests/limbs to combat lacking CB error augmentation in MS patients

Answer 37

the evidence is indifferent and not strong

Question 38

MS specific outcome measures you may want to use

Answer 38

12-item MS Walking Scale; MS-QoL 54