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Neuroconditions 2022 > MS > Flashcards

MS Flashcards

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1
Q

What are the exercise nd physical activity recommendations for people with MS

A

>150 min /week of exercise and or >150 min/week of lifestyle physical activity

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2
Q

What can exercise and PA improve based on moderate evidence?

A

improve strength, mobility, fatigue, and QOL(participation)

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3
Q

What are the guidelines for exercise 2-3xweek to improve aerovic capacity and muscular strength that effects gait and monbility?

A

aerobic/endurance: 60-80% max HR, 30-60 minutes
resistance exercise: 2-3 sets at 8-15 RM for major muscle groups

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4
Q

what is relapse with MS and how to treat

A

treated acutely with steroids
more conservative with exercise and therapy

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5
Q

What is pseudo relapse

A

periods of where patients feels decline in function but no new brain activity or lesions: most often due to other factors like UTIs or other sickness
more common than actual relapse

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6
Q

How do you educate with tone management

A

spasticity – stretching may improve gait temporarily
PF and knee extensors/hip flexors 3x60 sec

educate
stretching ater sitting/driving for longer periods
avoid being sednetary longer periods
exercise in intervals

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7
Q

What medicine helps with spasticity

A

baclofen

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8
Q

What is the dosing for MS resistance training

A

2-3 sers at 8-15 RM (form fatigue)

higher intensity 80% of IRM (3x7-10 reps) 
max intensity (4 sets of 4 reps at 85-95% of I RM 
lower intensity 1 set 30 , 3 sets of 15 at 20-30% of I RM`
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9
Q

What can aerobic exercise do for people with MS

A

increase VO2 max

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10
Q

What are the dosing for aerobic training for MS

A

at least 30 min/day 3 days/wk; 60-80% HR max
consider intervals for fatigue
monitor effort level (modifed Borg or HR monitor)

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11
Q

What is intermittent walking program?

A

intermittent rest can manage pperformanace fatuge
resting every 2 minutes during 6mwt compared to continuous walking
bout of exercise throughout day

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12
Q

What is mS>

A

chronic often ddisabiling disease that attacks the central nervous syste. Thought to be an autoimmune disease

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13
Q

What is the prevalence/ incidnec of MS

A

global prevalence >2.5 million, US adults ~750,000

most common neurological condirion in young adults (late teens to 35)

women 2.5-2.8 x great than men

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14
Q

How do you diagnose MS

A

multiple facetos are needed to diagnose MS capturing dissemination in space and time

clinical exam: neurological exam for sings of UMN involvement

Medical hx: hx of past events consistent with MS

MRI images: start with brain, then spinal cord

lab tests: ex: CSF

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15
Q

What dose the 2017 McDonald critera allow for?

A

MS diagnosis with the first MRI

dissemination in space: lesions in 2 of 4 areas

oerventricular

brainstem

juxtacortical

spinal cord

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16
Q

What are the 4 areas lesions can take place in for MS

A

perventricular

brainstem

spinal cord

juctacortical

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17
Q

What type of MRI is used in MS

A

T2 weighting

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18
Q

What are the typical findings with t2 weighting MRI

A

multiple T2/flair whie matter lesions

lesions >3mm

often periventricular of juxatcortical

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19
Q

What do FLAIR lesions result from

A

gliosis (sclerosis), inflammation, demyelination, edema (rare)

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20
Q

Can T2 lesions correlate disability?

A

no, T2 lesions correlate poorly with disability

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21
Q

What are the typical findings with T1 MRI?

A

T1 weighting highlights myelin

dark= loss of acson

T1 hypointense lesions= black holes

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22
Q

What finding in a MRI correlates with disability?

A

black hole burden correlates with diability found with T1

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23
Q

What can an MRI of brain show for people with MS?

A

Depending on the type of MRI utilized can show black holes, lesions, and atropthy

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24
Q

What can an MRI of the spinal cord show for people with MS

A

short (<3 segment) spinal cord lesions. acutely show cord swelling and later atrophy of cord if damage is permanent

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25
What can cerbrospinal fluid show in MS
elevated level of protein in CSF indicates abnormal immune response oilgoclonal IgG bands in CSF increased IgG index (\>.68)
26
What are the four types of diagnoses for MS
relaspins remitting primary progressive secondary progressive progressive-relapsing
27
What do osymtpoms of MS depend upon
location of the lesion
28
What are the initial symptoms of MS?
limb weakness-40% decreased vision/optic neuritis- 22% tingling and unusal sensations such as electrical , itching or sunburned/ paresthesias -21% double vision/ diploplia -12% dizziness/vertigo- 5% urinary bladder urgency, frep, hesitancy- 5% pyramidal signs, (hyperreflexia, clonus, spasticity posterior column sensory deficits (vibration \> proprioception), cerebellar (intention tremor, dysmetria)
29
What is optic neuritis?
demyelination of optic nerve painful vision loss -- usually peaks in days/weeks, recovers usually in first month-6 motnths other signs and symptoms-- decreased color vision (red desaturation), field loss, central scotoma, relative afferent pupil defect
30
What are the prognosis for MS?
50% will require aid to walk within 10 years 50% will develop cognitive deficits 50-80% wont be working in 10 years loss of lifetime earning loss of productivity
31
What are good prognositic factors for MS?
optic neuritis at onset sensory onset little disability at 5 years replasping/remitting ful recovery from attacks few OCB at diagnosis
32
What are bad prognositic factors for MS
cerebellar dysfunction motor symptoms at onset high attack rate progressive course African Americans baseline MRI with multiple lesions
33
What are the causes of MS?
MS is a multifactorial disease caused by the interplay of environmental, genetic, and immune factors
34
Where is the highest risk of MS in the worls
northern europe, northern US, canda, southern australia, new zealan
35
Where in the world is the lowest risk of MS
asia, south american, uncahrted regions (\<5 per 100,000)
36
What is the main environmental risk of MS
Vitamin D sun expposure decreases with higher latitudes, by increasing Vitamin D intake, higher the dose the fewer relapses
37
What is the genetic susceptibility for MS
MHC association: HLA-DR2 for those of northern european descent 1: 1000 iin general population 1: 100 with first degree relative 67% with an identical twin
38
What kind of disease is MS
T cell mediated disease
39
What classifies a T cell mediated disease
overproduction of inflammatory cytokines t cells (thymus gland)-- cross BBB, and attack myeline B cells (humoral-- can present antigen to T cell
40
What do new drug therapies try to target?
T and B cells, MS responds well to drugs that act on the immune system
41
What are the acture pharmacolocgical management of MS
corticosteroids, plampheresis, cyclophosphamide
42
What are maintenance disease modifying pharmacological managmant of MS
interferons anti-neoplastic agents glatiramer acetate monoclonal antibodies
43
What is an acute relapse in MS
a flare, (relapse, attack, bout, episode, exacerbation): \>= 1 symtpom form MS with objective neurological deterioration lasting over 24 hours in the absence of fever and flollowing a neurologically stable perior of \>30 days.
44
What do steroids do for symptoms of MS
decrease inflammation side effect: anxiety, trouble sleeping, high SBG, worsen stomach ulcers
45
What does plasmaphereis do for MS
similar to dialysis side effects: hypotension, blood clots, and infection
46
What medicine is used for sever relapses
cyclophosphamide (cehmotherapy)
47
What is the difference between the escalation approach and the risk appropriate appproach
esccaltion approach= may undertreat early, over treat later risk appropriate= may match disease activity better
48
What happend if there is a relapse during pregnancy?
corticosteroid use is probably safe to use to treat relapses in the second and third trimestes, but disease modyfing medication stop
49
What is used to mangment the symtom of fatigue
alpha adrenergic receptio agonissts (Amantidine and Modafinil)
50
What is used to maagment spasticity for MS?
bacloffen (oral and intrathecal)
51
What is the most improant function fo people with MS?
walking
52
53
What types of things should you screen for for people with MS
memory/cognition - difficulties w/ dual taksing are associated with falls and gait issues bladderl/ bowel -- mod-servere bladder dysfunction associated with increased falls cardiovascular-- autonomic dsfunction can impair CV autonomic function -- Gi, sexual, sudomotor intergumentary -- AFOs, WCs, etc.
54
What should you include in an exam for MSk and neurologic?
strength and motor function somatosensation ocular motor function coordination tone (spasticity)
55
56
What is the gold standard scale?
EDSS-- Kurtzke expanded disability statuse scale
57
What is the MS edge
overall review of 63 outcome measures that cover a range of body structure and function, activity, and participation and the utility of those outcome measures for patients with MS.
58
What participation outsomes would you use for MS
MS-Walking scale 12 dizziness handicap inventory modified fatigue impact scale steps/physical activty
59
What is a good way to measure physical activity for people with MS
Accelerometers and pedometers ,easures the total activity and sednrary time validity: cut off of 3,279 stpes.day= fully ambulatory less stpes may predict fall risk
60
What is the MS walking scale
12-item questionarrie measure of walking related limitation, the higher the score the more imparied 0-24= independent 25-49= gait disability 50-74 une mployment
61
What are the cutoff and discriminates for the 6MWT and the DGI
6MWT mild 603 m moderated 507 m sever 389 m DGI \<19 for falls
62
What is an outcome measure for gait speed in MS?
timed 25 foot walk measure of gait speed-- 2 trials are averaged norm= \<4 sec \>6 sec= occupational changes \>8 sec= Medicare diability, dependence with ADLs, gait assistance
63
What outcome measure discriminates between people with MS and healthy controls
TUG MS 10 (1.7 sec) control 8.71 (1.04)
64
What is the computerized dynmaic posturography sensory organization test
measure of central sensory integration of balance that has 6 conditions reliable in people with MS across 7--10 days responsive to change affter vestibular rehab
65
What s the modifited fatigue impact scale for participation for MS
measure of fatigue perception, 21 items higher scores= more limitations due to fatigue cut off indicating moderate or greater fatigue impact= 38

Neuroconditions 2022 (14 decks)

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