Multiple Sclerosis

Question 1

what are the systems involved with Ms

Answer 1

neuro and immune

Question 2

at what age does ms strike

Answer 2

20 to 40 yo

Question 3

is ms curable

Answer 3

no but it can be slowed down (degenerative)

Question 4

is ms more common in men or women

Answer 4

women > men

Question 5

what member of our faculty does ms research

Answer 5

Dr. Peter Darlington

Question 6

why does Kayla (athlete with ms) fall down in the video

Answer 6

because of fatigue and loss of sensation

she can’t feel her legs bc of swelling, raise in body temp and no more transmission of motor connection

Question 7

what is ms and what does the name stand for

Answer 7

ms is a chronic, progressive disease that leads to increasing disability in most individuals

multiple: many scattered areas of the brain and sc are affected
sclerosis: “sclerosed” or hardened tissue in damaged areas

Question 8

what happens with the immune system in ms

Answer 8

immune system attacks the myelin sheath causing communication problems btw the brain and the rest of the body

Question 9

how can meds help ms

Answer 9

1. speed recovery from attacks

2. modify the course of the disease and symptoms

Question 10

what can be bad about ms meds

Answer 10

they can lower the immune system but the benefits far out-weight the side effects

Question 11

Ms lesions can affect what structures and what can be lost because of it

Answer 11

it can affect the brain and/or the sc

loss of motor control

Question 12

myelin damage and the nervous system

Answer 12

In ms, the protective coating on nerve fibers (myelin) in the cns becomes detached and eventually destroyed. This creates a lesion that may cause numbness, pain ot tingling in parts of the body + loss of motor control.

Question 13

why is it important to know about ms

Answer 13

bc its the most common cns disease among young adults in canada

Question 14

how many canadians have ms and from what ages

Answer 14

55 000 to 75 000 canadians have ms or 166 people/ 100 000

from 20 to 40 yo

Question 15

____ are spent each year on medical expenses and special services. Lost productivity adds to the financial toll.

Answer 15

Billions of dollars

Question 16

average age of clinical onset and average age of dx

Answer 16

30-33 but average dx is 37

Question 17

why is there a delay in the age of clinical onset and the dx

Answer 17

bc symptoms come and go, ms gets mixed up w other conditions and symptoms vary from person to person

Question 18

in ___ , only __ of patients were reported to survive beyond __ years after onset of illness, but a patient can now expect to live ___

Answer 18

1936
8%
20
the average population life-expectancy minus 7 years

Question 19

what are the causes of ms and what is it considered as

Answer 19

unknown

ms is considered an autoimmune disease in which the body’s immune system attacks its own tissues by mistake

Question 20

what do T-cells and monocytes do

Answer 20

they work together to fight invaders bu they can get confused and start to attack the body itself by destroying the myelin sheath

Question 21

what are the factors that increase the risk of ms (8)

Answer 21

• age
• sex (women > men)
• family history
• certain infections (Epstein-barr)
• climate (more common in temperate climate; canada, northern usa, new zealand, southeastern australia and europe)
• certain autoimmune diseases (thyroid disease, type 1 diabetes or inflammatory bowel disease)
• smoking
• race (white northen european descent > asian, african or native american)

Question 22

what are the incidences for inuits, scottish, canada and white/vs/no-white people

Answer 22

inuit; very low
scottish and canada; very high
more white > not white

Question 23

s/s optic n lesion

Answer 23

blurred vision

Question 24

s/s brain stem lesion

Answer 24

dizziness and may cause double vision

Question 25

s/s cerebellum and cerebrum lesion (4)

Answer 25

balance problems, speech problems, uncoordinated mvts and tremors

Question 26

s/s motor n tract lesion (4)

Answer 26

m. weakness, spasticity paralysis, bladder and bowel impairments

Question 27

s/s sensory n tract lesion (4)

Answer 27

altered sensation, numbness, prickling and burning sensations

Question 28

symptoms of ms differ greatly from person to person and over the course of the disease depending on

Answer 28

MS type and location of the lesion within the ns

Question 29

other symptoms of ms

Answer 29

fatigue (78% of patients) | tremor, lack of coordination or unsteady gait

Question 30

ms walking patterns

Answer 30

lack of opposition of arms and legs | usually a stronger and more stable side, will cause the patient to take shorter and faster steps on less stable side

Question 31

what is the course of the disease

Answer 31

exacerbation (flare-up, attacks and relapse) will lead to either remission or myelin becoming inflamed and myelin inflammation can lead to either no scar formation then complete recovery and no loss of function or scar formation which will lead to permanent myelin damage and loss of function

Question 32

what can disease modifying therapies help with and what meds are used

Answer 32

decrease of severity and frequency of relapses | immunosuppressant drugs

Question 33

what is ms classification based on

Answer 33

rate of disease progression and frequency of flare-ups

Question 34

what is relapsing/remitting ms (RRMS) (3)

Answer 34

- most common type - unpredictable but clearly defined relapses during which new symptoms appear or existing ones get worse - in the period btw relapses, recovery is complete or nearly complete to pre-relapse function (remission)

Question 35

what is secondary progressive MS (SPMS)

Answer 35

- some people stay in this stage for a long time - follows a dx of RRMS, over time, distinct relapses and remissions become less apparent and the disease begins to progress steadily sometimes w plateaus - about 1/2 of people with RRMS start to worsen within 10-20 years of dx, often with increasing levels of disability

Question 36

what is primary progressive MS (PPMS)

Answer 36

- will die before they are supposed to - slow accumulation of disability without defined relapses - may stabilize for periods of time, and even offer minor temporary improvement but overall, there are no periods of remission, about 10% of people with MS have PPMS

Question 37

what is progressive relapsing MS (PRMS)

Answer 37

- as severe as primary but with flare ups - rarest course of MS, occurring in only 5% of all MS cases - people with this form of MS experience relapses with or without recovery and steadily worsening disease from the beginning

Question 38

can people with MS train, can exercise be beneficial/harmful?

Answer 38

yes they can train can be beneficial if done correctly can be harmful if too much too fast but overall beneficial > harmful

Question 39

how can the guidelines help

Answer 39

people w MS who have mild to moderate disability who meet the guidelines will have reduced fatigue, improved mobility and enhance elements of health-related quality of life

Question 40

who are the guidelines for

Answer 40

minimal to moderate disability resulting from either relapsing, remitting or progressive forms of MS

Question 41

who can train MS people

Answer 41

KCEPs, qualified exercise professional

Question 42

what can physically inactive MS people do

Answer 42

activities performed at a lower intensity, frequency and duration than recommended may bring some benefits

Question 43

what can be done to meet the guidelines

Answer 43

gradually increasing duration, frequency, and intensity as a progression towards meeting the guidelines

Question 44

guidelines: how often

Answer 44

aerobic: 2 times / week | strength training: 2 times / week

Question 45

guidelines: how much

Answer 45

aerobic: at least 30 min during each workout sesh | strength training: 2 sets of 10-15 reps of each exercise

Question 46

guidelines: how hard

Answer 46

aerobic: -mod intensity pa is usually 5 or 6 on a scale of 10 and causes HR to go up -as a general rule, if you're doing mod-intensity pa you can talk, but not sing a song during the activity strength training: -pick a resistance (free weights, cable pulleys, bands, etc) heavy enough that you can barely, but safely, finish 10-15 reps of the last set

Question 47

guidelines: how to

Answer 47

aerobic activities: - upper body exercises; arm cycling - lower body exercises; walking, leg cycling - combined upper and lower body exercises; elliptical trainer strength training activities for upper and lower body: - weight machines - free weights - cable pulleys other types of exercises that can bring benefits: -aquatic exercises

Question 48

what are special considerations concerning MS vs exercise (5)

Answer 48

- lower level of fitness; cardiovascular, muscular strength and endurance (decreased balance) - fatigue - heat intolerance (higher than 0.5°) - depression - exercise does not trigger periods of exacerbation when properly managed

Question 49

Effects of exercise on people with ms

Answer 49

increase aerobic capacity, m. strength and endurance, quality of life, independence in ADL