10-10 Multiple Sclerosis

Question 1

What is MS

Answer 1

• Chronic, inflammatory demyelinating disease of the CNS

- “islands of sclerosis” = areas of hardened tissue

Question 2

Charcot Triad

Answer 2

• Intentional tremors
• Stagnant speech
• Paralysis

Question 3

Age of MS onset

Answer 3

• 15-50 years old
• Peak age = 30 years old
• More common in woment (2:1 ratio)

Question 4

Concentration of MS cases

Answer 4

• Highest: Northern US, Europe, Asia
• Medium: Southern US, Europe
• Low: Asia

Question 5

Causes of MS

Answer 5

• Unknown
• Maybe Vitamin D deficiency, smoking
• Autoimmune response to virus or other infectious agent
• Higher risk if family hx - inherited genetics

Question 6

Pathophysiology of MS

Answer 6

• T-lymphocytes attach to and destroy myelin sheath
• Disruption causes demyelination
• Neural transmission is slowed or stopped; nerves fatigue rapidly
• Inflammation, edema, infiltrates surround acute lesion and interfere with nerve conductivity
• Most susceptible areas: Optic nerves, periventricular white matter, spinal cord, cerebellar peduncles

Question 7

Prognosis of MS

Answer 7

• No change in life expectancy with proper maintenance

- After 10 years, few still in work force

Question 8

Diagnosis of MS

Answer 8

• Diagnosed by neurologist

- Neurological tests including CT Scan, MRI, CSF fluid (lumbar puncture)

Question 9

Exacerbations of MS

Answer 9

• Significant decline in functional capacity - sudden increase in clinical signs
• Exacerbating factors are variable - two factors are heat and stress

Question 10

Four categories of MS

Answer 10

• Relapsing-remitting
• Secondary progressive
• Primary progressive
• Progressive-Relapse

Question 11

Relapse vs. Remitting

Answer 11

• Relapse = exacerbation, new or recurrence lasting more than 24 hours
• Remitting - remission (back to baseline)

Question 12

Early Sx of MS

Answer 12

• Minor visua disturbances (ex: diplopia
• Parensthesias progress to numbness, weakness, fatiguability
• May be transient; patient does not seek medical attention with early sx

Question 13

Clinical Manifestations of MS

Answer 13

• Sensory changes
• Pain
• Visual changes
• Motor dysfunction
• Speech/swallowing dysfunction
• Cognitive and affective changes
• Autonomic changes