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Flashcards in MS management Deck (49):
1

MS usually begins

begin the ages of 20-40

2

early course of MS is usually

relapsing/remitting

3

what is the Prevalence of MS in vancouver compared to malta

vancouver 91/100,000
Malta 4/100,000

4

what is the comparative risk for developing MS based on race in USA

White males 1.0
Black males 0.43
Other males. 0.22

5

what are the ratios of male to female cases of MS?

early onset 3 females :1 male

normal range 2 F: 1 M
Late onset 2.4 F: 1 M

6

MS prevalence can be altered by..

a change in environment

age of migration is critical for risk retention

7

according to Sadovnick et al 1993 what are the rates of concordance for MZ, DZ and siblings?

31% MZ, 5% DZ, 5% siblings

8

what components of the Immune system are thought to play a role in MS pathogeneis?

Lymphocytes (B&T)
Monocytes/macrophages

9

what qualities do remyelinating neurons axons have?

uniformly thin, short internodes

10

plaque distribution in the cerebral hemispheres relates to what symptoms

large variety of symptoms but also many silent lesions

11

plaque distribution in the spinal cord leads to what symptoms?

weakness, paraplegia, spasticity, tingling, numbness, lhermitte's sign, bladder and sexual dysfunction

12

plaque distribution in the optic nerves leads to what symptoms?

impaired vision, eye pain

13

plaque distribution in the medulla and pons leads to what symptoms?

dysarthria, double vision, vertigo, nystagmus

14

plaque distribution in the cerebellar white matter leads to what symptoms?

Dysarthria, nystagmus, intention temor, ataxia

15

what are 6 typical symptoms/signs of MS

optic neuritis

spasticity and other pyramical signs

sensory signs and symptoms

lhermitte's sign

nystagmus, double vision and vertigo

bladder and sexual dysfunction

16

what are the symptoms of optic neuritis?

impaired vision and eye pain

17

what are 5 atypical symptoms or signs of MS?

aphasia
hemianopia

extrapyramidal movement disturbance
severe muscle wasting
muscle fasiculation

18

what is the outcome when lesions affect the cranial nerves?

optic neuritis and other cranial nerve symptoms

diplopia and uhthoff's phenomenon

19

what is the outcome when MS lesions affect the motor systems?

spasticity, weakness,temor and ataxia

20

what is the outcome when lesions affect the sensory systems?

many symptoms including lhermitte's sign

21

what is the outcome when lesions affect autonomic systems

bladder, bowel and sexual dysfunction

22

what are the symptoms when the neurobehavioral systems are affected

cognitive problems and depression

23

what qualities are seen on the CSF electrophoresis in MS?

IgG oligoclonal bonds

24

what is one feature of a preclinical phases of MS

radiologically isolated sydrome

25

describe the prognosis of MS

less than 5-10% will have a mild phenotype with no significant disability

More than 30% of patients will develop significant disability within 20-25 years after onset

Life expectancy is shortened only slightly in persons with MS

Survival rate is linked to disability

Death usually results from secondary complications (pulmonary or renal)

Marburg variant is an acute and clinically fulminant form of the disease that can lead to coma or death within days

26

name 6 clinical indicators of poor prognosis

Male gender
Late age at onset
Early motor, cerebellar, and sphincter symptoms
Short inter-attack interval
High number of early attacks
Early residual disability

27

name 4 paraclinical indicators of poor prognosis in MS

Significant MRI disease burden at onset
Evidence of MRI disease activity
Positive cerebrospinal fluid analysis for OCB
Positive evoked potential examination

28

what treatment modalities exist for MS?

IMMUNOMODULATORY THERAPY
Acute repulses
Frequent relapses
Aggressive illness
Progressive illness

MANAGEMENT OF SYMPTOMS

NON PHARMACOLOGICAL TREATMENTS
physiotherapy
occupational therapy

29

what can be useful to hasten recover from acute exacerbations?

Oral or intravenous Methylprednisolone (steroids)

no evidence that this changes the overall disease progression

does not affect outcome but may shorten relapse

30

when should plasma apheresis be used to treat MS?

short term for severe attacks if steroids are contraindicated of ineffective

2011 AAN guidelines ("probably effective") as a second line treatment

31

symptoms management can be used to treat which symptoms

can be pharmacological or non pharma

Fatigue
Spasticity
Bladder problems
Bowel problems
Cognitive dysfunction
Pain
Paroxysmal symptoms
Sexual dysfunction
Tremor

32

patients with MS may benefit from referral to who?

Patients with MS may benefit from referral to
Physiotherapists
Occupational therapist
Speech therapists

33

what should you do when patients have bad prognostic markers?

Treat early
Treat aggressively

34

what is the prevalence of MS?

120-180/100,000 in britain depending on location

35

what do Disease Modifying Therapies (DMTs) aim to do?

reduce the frequency and severity of relapses

36

what is urthoffs phenonomenon?

worsening of neurological symptoms of demyelinating diseases such as MS from overheating

37

what is the definition of a relapse in MS?

24 hours 1 month apart
- where infection is ruled out

38

what are the 2008 sheffield definitions of a clinically significant relapse in MS?

1) Any Motor relapse
2) Any Brainstem relapse
3) A Sensory relapse leading to functional impairment
4) Sphincter dysfunction
5) Optic Neuritis
6) Intrusive pain

39

what is the sheffield 2008 definition of a disabline relapse in MS?

1) Affects the patient’s ability to work

2) Affects the patient’s activities of daily living

3) Affects motor or sensory function sufficiently to impair the capacity or reserve to care for themselves or others

4) Requires treatment/hospital admission

40

do Disease Modifying Therapies have an effect on disease progression?

no but can reduce relapses and relapse related disability

41

how to disease modifying therapies work?

by altering various mechanisms in the immune system to prevent an inflammatory response

ie immune modulators
preventing cells crossing blood brain barrieer ( natalizumab)

keep lymphocytes in the lymph tissue

reduce lymphocyte formation (teriflunomide, azothiprine)

reboot immune system
(bone marrow transplant)

42

describe the evidence from trials for disease modifying therapies

evidence from BENEFIT (betaferon) and PRECISE (copaxone) that they delay time to conversion after clinically isolated syndrome (teriflunomide too)

43

describe the four common first line DMTs in MS and how their effect

interferon beta 1a IM
interferen beta 1b SC
interferon beta 1a SC
Capaxone (galtimarmer acetate)

all 4 reduce relapses by about a third

make relapses milder

interferons may have some effect on slightly slowing disease progression

44

what are some potential side effects of interferons?

skin site reactions
flu like symptoms
leucopenia
anaemia
thrombocytopeinia
liver dysfunction
potentially teratogenic
can cause depression ( and suicide)

45

what some of the newer DMDs?

ORALS
teriflunomide
dimethylfumarate

NON ORAL
fingolimod
natalizumab
alemtuzumab

46

what sort of stem cell treatments are already used to tream MS?

autologous (self) bone marrow transplants

47

how can vitamin d be used as a DMT?

diet supplementation

may act altering DRBI*1501

study in 132 hispanic people found that lower vitamin d experienced more relapses

48

in terms of efficacy which drug is weakest and which is strongest?

laquinimod weakest

mitoxantrome strongest


49

which DMTs are least and most convenient?

vitamins , anticonvulsants, and drugs such as teriflunomide are the most convenient (oral)

IV are least convenient such as natalizumab and mitoxantrone