multiple sclerosis Flashcards
1
Q
what is multiple sclerosis?
A
- chronic, inflammatory demyelinating and neurodegenerative disease of the central nervous system
2
Q
what are the 3 types of disease that MS is described?
A
- heterogenous
- multifactorial
- immune mediated
3
Q
what is multiple sclerosis caused by?
A
- caused by complex gene- environment interaction
4
Q
what is the pathological hallmark of MS?
A
- accumulation of demyelinating lesions that occur in the brain and spinal cord’s white and gray matter
5
Q
what does multiple sclerosis not affect?
A
- doesn’t affect the PNS
6
Q
what is the estimated prevalence of MS in Europe for the past three decades?
A
- 83 per 100,000
7
Q
what gender are more likely to develop multiple sclerosis?
A
- females
- female: male ratio is around 2:0
8
Q
what countries have higher rates of multiple sclerosis?
A
- Northern countries
9
Q
how many people live with MS in Europe?
A
- more than 1,000
10
Q
what is the percentage increase of people living with MS over the last 3 years?
A
- more than 35% increase
11
Q
what is the estimation of the number of MS individuals in the UK?
A
- over 130,000 people
12
Q
how many people are newly diagnosed with MS each year in the UK?
A
- nearly 7,000 people are newly diagnosed each year
13
Q
what percentage of MS individuals are women?
A
- 73%
14
Q
what are the 4 primary disease courses of multiple sclerosis?
A
- clinically isolated syndrome
- relapsing- remitting MS
- secondary progressive MS
- radiologically isolated syndrome
15
Q
what does clinically isolated syndrome refer to?
A
- refers to the first episode of neurological symptoms
16
Q
what is clinically isolated syndrome caused by?
A
- caused by inflammation and demyelination in the CNS
17
Q
how long must the episode last in clinically isolated syndrome?
A
- must last at least 24 hours
18
Q
what is the relation of CIS to MS?
A
- CIS can be a precursor to MS
- but not all individuals with CIS go onto developing MS
19
Q
how does an MRI show an increased likelihood of person progressing from CIS to MS?
A
- MRI showing brain lesions similar to those in MS increases the likelihood of progression to MS
20
Q
what are the common symptoms of clinically isolated syndrome? (3)
A
- headaches
- gait problems
- verbal disturbances
21
Q
what is the most common disease course?
A
- relapsing remitting MS
22
Q
what is relapsing- remitting multiple sclerosis characterised by?
A
- characterised by clearly defined attacks of new or increasing neurological symptoms (relapses) followed by periods of partial or complete recovery (remissions)
23
Q
what percent of MS patients are initially diagnosed with RRMS?
A
- 85% are initially diagnosed with RRMS
24
Q
does the disease progress in the remission phase?
A
- disease does not appear to progress during the remission phase
25
how is relapsing- remitting multiple sclerosis modulated?
- modulated through medication
26
what is secondary progressive multiple sclerosis?
- neurological function worsens
- disability accumulates from the onset of symptoms without early relapses or remissions
27
how many people with MS are diagnosed with SPMS?
- about 15%
28
what is the hardly recognised course of MS?
- radiologically isolated syndrome
29
what is RIS used for?
- used to classify individuals with MRI- detected brain or spinal cord lesions consistent with MS but without past or current neurological symptoms
30
what does a graph showing progressive relapsing MS show?
- shows steady decline since onset with super- imposed attacks
31
what does a graph of secondary progressive MS show?
- initial relapsing remitting multiple sclerosis that suddenly begins to decline without periods of remissions
32
what does a graph of primary progressive MS show?
- steady increase in disability without attacks
33
what does a graph of relapsing- remitting multiple sclerosis show?
- unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
34
what are the three prominent pathological features of progressive multiple sclerosis?
- global brain atrophy
- slowly expanding lesions
- predominantly microglia/ macrophage- mediated inflammatory response
35
what is neurodegeneration in MS driven by?
- driven by complex interplay between compartmentalised neuroinflammation, oxidative stress, iron toxicity and mitochondrial dysfunction
36
when does neurodegeneration in MS occur?
- occurs as early as the radiologically and clinically isolated syndrome starts
37
what do CNS injuries have the potential to do?
- potential to affect everything
38
what does MS specifically affect? (2)
- optic nerve
- any tissue within the brain and spinal cord
39
what are the symptoms like in people with MS ?
- widespread
- heterogenous (different across multiple individuals)
40
what are the 11 common symptoms of multiple sclerosis?
- fatigue
- weakness
- spasticity
- sensory impairments
- pain
- bladder dysfunction
- disorders of emotions
- tremors
- incoordination or ataxia
- dysarthria
- dysphasia
41
what does a clinical assessment for MS involve? (2)
- neurological examination
- medical history
42
what is signs of neurological impairment and history of symptoms suggestive of?
- suggestive of CNS involvement
43
what is the most sensitive non- invasive test for detecting MS- related brain and spinal cord changes?
- magnetic resonance imaging
44
what does MRI help with?
- helps to identify lesions/ scars (sclerosis) typical of MS
45
what does CSF stand for?
- cerebrospinal fluid
46
what dos CSF analysis involve?
- lumbar puncture (spinal tap)
47
what do you analyse from the lumbar puncture?
- presence of oligoclonal bands (unique proteins) in the CSF, which are not found in the blood supports the diagnosis of MS
48
what is an evoked potential test?
- test that measures the brain's electrical activity in response to stimuli
49
what can evoked potential tests detect?
- can detect demyelinated lesions along nerve pathways that are too small or in locations not detected by MRI
50
what is the point in blood tests when diagnosing MS?
- important to rule out other diseases with similar symptoms e.g., lyme disease or certain autoimmune disorders
51
what does the McDonald Criteria integrate?
- clinical presentation with MRI findings
52
what did the 2017 revision of the McDonald Criteria allow for?
- earlier and more accurate diagnosis by incorporating specific MRI criteria that can substitute for a clinical relapse in determining disease dissemination in time
53
what are the two main things that the McDonald criteria involves?
- dissemination in space and time
54
what does dissemination in space refer to?
- how the lesions evolve across structures
55
what does dissemination in time refer to?
- how the lesions progress in time
56
what are the two outcome measures used to measure disease severity?
- functional systems score (FSS)
- expanded disability status scale (EDSS)
57
what are the three main medical management of multiple sclerosis?
- disease modifying therapies
- management of acute relapses
- symptomatic treatment
58
what do disease modifying therapies reduce?
- reduce relapsing frequency and severity
- slow disability progression
- limit new disease activity
59
what are some examples of drugs used in disease modifying therapies?
- interferon beta preparations
- glatiramer acetate
- natalizumab
- figolimod
- ocrelizumab
- cladribine
60
what does the choice of DMT depend on? (4)
- disease course
- drug effectiveness
- side effects
- patient preferences
61
how do you manage acute relapses?
- anti- inflammatory medications
- high dose corticosteroids
- plasmapheresis
62
what are exacerbations of MS usually treated with?
- usually treated with high- dose corticosteroids such as intravenous methylprednisolone
63
what does symptomatic treatment involve?
- pharmacological and non- pharmacological treatments including medication and therapy
64
what impairments are assessed in multiple sclerosis? (5)
- fatigue
- cognition
- balance
- gait
- upper extremity
65
how do you assess fatigue?
- modified fatigue impact scale (MFIS)
- fatigue scale for motor and cognitive function
66
what are the common cognitive deficits? (7)
- learning
- memory
- information processing speed
- executive function
- planning
- organisation
- initiation
67
how do you assess cognition?
- paced auditory serial addition test (PASAT)
68
how do you assess balance?
- anticipatory response challenges and reactive balance strategies
- perturbation response
- BESTest
- miniBESTest
- TUG
- BBS
69
how do you assess gait?
- speed
- distance
- quality (observation gait)
- gait cycle
- step length
- step width
- cadence
- single- leg support
- double- leg support
- 6MWT
- TUG
70
how do you assess upper extremity?
- box and blest test (BBT)
- nine hole peg test (NHPT)
71
how do you manage fatigue?
- energy conservation programs show strong evidence for managing MS- related fatigue
72
what rehabilitation interventions manages fatigue in neurological conditions? (3)
- physical activity
- cognitive education programs
- energy conservation strategies
73
what are sensory interventions to manage fatigue? (3)
- vestibular rehabilitation
- exercise - based sensory integration interventions
- vibration
74
what shows the most promising intervention for treating fatigue?
- balance exercises
- cognitive behavioural therapies
75
what medical management is used for spasticity?
- antispasticity medications
- baclofen
- tizanidine
- gasapentin
- dantrolene
- tolperisone
- benzodiazepines
- sativex oromucosal spray
76
what may be required in selected cases for the medical management of spasticity?
- botulinum toxin
- intrathecal baclofen
77
what interventions can be used for spasticity?
- ROM
- stretching
- orthotics (braces and splints)
78
how do you manage pain? (6)
- pharmacological management
- posture
- movement
- sitting
- orthotics
- supportive equipment/ adaptive equipment
79
what do balance exercises prevent and enhance?
- prevents falls and enhance walking stability and posture control
80
what are the benefits of coordination exercises?
- reduces energy requirements
- increases continuity of movement
81
what are Frenkel exercises improve? what does it involve?
- improve movement coordination
- involves slow repetitions of each movement stage, gradually increasing in complexity
82
what are the three phases of sitting up?
- withdrawing feet
- bending trunk forwards
- straightening legs while getting
83
what are some balance exercises?
- balance based torso weighting
- balance and eye- movement exercises in persons with MS
84
what should you consider balance in?
- consider balance in different postural settings
- sitting, wheelchair use, walking aid
85
what is the main management of balance?
- core stability exercises
- task oriented training
- conventional balance training
- effectively improve balance in ataxic MS patients
86
what are the 6 interventions for balance?
- mobility
- aerobic and strength training
- task specific training
- torso weighting
- mobility assistive devices
- orthotics
