Multiple Sclerosis Flashcards
MS definition
Life long inflammation of brain and spinal cord.
Remissions and exacerbation
Spinal nerves
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccyx
Four major types of MS
Relapsing-remitting
Primary progressive
Secondary progressive
Progressive-relapsing
Relapsing-remitting
Classic.
Develop and resolve
Primary progressive
Steady and gradual deterioration without remission
Secondary progressive
Begins with relapsing-remitting then becomes steadily progressive
Progressive-relapsing
Frequent relapses with partial recovery, but never a return to baseline
Most often seen in
Cold climates
European ancestry
20-40 years
Women’s twice as often
Medical history
Ability to move Progression? Aggravating factors- fatigue, stress, cold Behavior changes- mood, judgement Family history
Assessment of neuro
\+babinski Tinnitus Tremors Slurred/slowed speech Unstable gait Dysphagia Dysarthria Scanning- long pauses between words
Assessment of visual
Blurred vision
Diplopia
Scotomas(peripheral)
Nystagmus
GI assessment
Bowel and bladder dysfunction
A reflexive bladder
Sexual assessment
Impotence
Decreased libido
Sensory assessment
Parasthesia
Facial pain
Decreased temperature sensation
Interferon-beta
Immunomodulators
Given sub Q- self administer
Glatiramer acetate
Synthetic protein
Sub Q
Teaching: avoid crowds, rotate site, infection, draw it up
Natalizumab
Binds to WBC to prevent further damage.
IV form controversial for side effects.
Metabolized in liver
Builds up in body
Patients receiving natalizumab are at high risk for
Progressive multi focal leukoencephalopathy (PML)
An opportunistic viral infection
Fingolimod
1st oral immunomodular approved for tx of MS
Causes bradycardia especially in first 6 hours
Immunosuppressive therapy
Combo of cytocan and solu-medrol
If having flare up
Treatment of bladder dysfunction
Anticholinergics
PT
ROM exercise
Stretching and strengthening
OT
Fine motor
Diagnosis
CSF
Increased protein
Slight increase WBC
CSF electrophoresis increase in myelin basic protein and IgG
