MS

Question 1

What is MS?

Answer 1

• The most common primary demyelinating disease (primary – idiopathic, presumably autoimmune) of CNS
• Lesions in the white matter
• Central: oligodendrocytes

Question 2

Where do demyelinating lesions of MS occur?

Answer 2

• anywhere in the brain and spinal cord
• constellation of SxS of almost unlimited variety

Question 3

Optic Nerve

Answer 3

• optic neuritis (pain)
• progressive loss of visual acuity (painless)

Question 4

Brainstem

Answer 4

• Diplopia (III, IV, VI)
• Trigeminal neuralgia (V)
• Hemifacial spasm (VII)
• Vertigo, vomiting, nystagmus (VIII)

Question 5

Cerebellum and spinocerebellar path

Answer 5

• Dysarthria, ataxia, abnormal stance and gait

Question 6

Spinal Cord

Answer 6

• UMN weakness, spasticity, clonus, Babinski, sensory loss (dorsal columns and anterior lateral system), bowel and bladder dysfunction

Question 7

Cerebral Cortex

Answer 7

• intellectual impairment, memory loss, emotional changes, depression

Question 8

Temporal patterns of MS

Answer 8

• Relapsing/remitting (most common)
• Primary progressive
• Progressive-relapsing

Question 9

Relapsing/remitting MS

Answer 9

• Most frequent exacerbations followed by less complete recovery than in benign form
• Stable: long periods of quiescence
• Secondary Progressive: fewer remissions with disease progression (more cumulative
  disability)

Question 10

Primary progressive MS

Answer 10

• Insidious relatively late onset and steady progression of symptoms and disability.
• More lesions in SC than brain. Different inflammatory cells.

Question 11

Progressive- relapsing

Answer 11

often diagnosed as primary first, until a relapse occurs

Question 12

5 major clinical subtypes of MS

Answer 12

• relapsing remitting
• primary progressive
• secondary progressive
• progressive relapsing
• clinically isolated syndrome

Question 13

Relapsing remitting MS characteristics

Answer 13

characterized by specific attack
of deficits (relapse stage) with either full or partial recovery
(remitting stage); periods between relapses characterized by lack of disease progression

Question 14

Primary Progressive MS characteristics

Answer 14

characterized by disease
progression and a deterioration of function from onset; may have slight fluctuations but specific attacks do not occur

Question 15

Secondary progressive MS characteristics

Answer 15

characterized by an initial
relapsing remitting stage followed by a change to a
progressive course with steady decline in function and
impairments increase with or without specific attacks

Question 16

Progressive relapsing MS characteristics

Answer 16

characterized by steady
deterioration in disease from onset with occasional attacks-
but time between attacks has continuing progression

Question 17

Clinically isolated syndrome MS characteristics

Answer 17

first episode of
inflammatory demyelination in the CNS that could become MS
if additional activity occurs/progression to RRM

Question 18

Risk factors of MS

Answer 18

• female for likely for RRMS
• equal for PPMS
• Age 20-30 for RRMS
• Age 40-50 for PPMS

Question 19

Etiology of MS

Answer 19

unknown, likely viral or autoimmune
- May have a precipitating/exacerbating factors- infection,
trauma, pregnancy, stress

Question 20

characteristics of MS overall

Answer 20

Demyelinating lesions (plagues) impair neural
transmission, causing nerves to fatigue rapidly

Question 21

Where are lesions common?

Answer 21

pyramidal tract, dorsal columns, optic nerve, periventricular areas of cerebrum, cerebellar peduncles

Question 22

Falls in MS

Answer 22

• Progressive MS classification is a significant risk factor
• use of mobility aid is a significant risk factor
• consider spasticity, gait disturbances, continence, and fear

Question 23

Fatigue in MS

Answer 23

• Common but a separate entity –> physiologic basis unknown, different fro fatigue experienced by healthy individuals
• no correlation between severity of fatigue and involvement or severity of fatigue and depression

Question 24

heat sensitivity

Answer 24

• internal sources or external sources

Question 25

Uhthoff Symptom/ Phenomenon

Answer 25

* Increase or presence of neurological symptoms (vision, reflexes, sense) in response to a heating condition. * Range of body temperature that could bring on neurological symptoms (.18 F – 4.14 F)

Question 26

Expanded Disability Status Scale

Answer 26

0: normal neurologic function 1: no disability with only minimal signs 2: minimal disability 3: moderate disability 4: relatively severe disability 5: disability affects full daily activities 6: assistance required to walk and work 7: essentially restricted to WC 8: restricted to bed or WC 9: bedridden and unable to communicate effectively eat/swallow 10: death

Question 27

MSQoL-54

Answer 27

structured, self-report questionnaire that the patient can generally complete with little or no assistance. * It may also be administered by an interviewer. However, patients with visual or upper extremity impairments may need to have the MSQOL-54 administered as an interview.

Question 28

Interventions

Answer 28

Guides by an understanding of the type of MS, location of the plagues, general stages of the disease process, impairments, and functional limitations present

Question 29

View on exercise

Answer 29

* regular exercise is essential to preservation of function in this population by minimizing effects of immobility. * Regarding influence on fatigue and relapse: Exercise therapy can be prescribed in people with MS without harm. Exercise may reduce self-reported fatigue and does not seem to be associated with a significant risk of MS relapse

Question 30

Aerobic Training

Answer 30

* Autonomic regulation issues --> Usually a function of advancing disease * Cardiorespiratory response * It is likely that maximal aerobic capacity in persons with MS is partially influenced by the level of neurological impairment --> Those with greater impairment sustain exercise for a shorter period of time, achieve a lower maximal exercise intensity and a lower oxygen uptake.

Question 31

Precautions

Answer 31

* Strengthening and aerobic training can be safely performed in MS population * Those with minimal impairments have best exercise tolerance and get best benefit * Probably submaximal exercise for stable persons with MS * Many unanswered questions * Prevent over-fatigue and overheating

Question 32

Preventing over-fatigue and overheating

Answer 32

* Aquatic therapy? * Cooling suits * Core body temperature changes throughout the day * Try exercising in the morning * No information on exercise during exacerbations * Don’t want to see increases in neurological signs/ symptoms * Complaints of exercise – related fatigue or Uhthoff symptoms should resolve within an hour following cessation of activity or exposure.

Question 33

Medical Management

Answer 33

* Immunosuppressant drugs- treat acute attacks and shorten episode * Steroids * Interferon drugs- slow disease progression * Symptomatic management- tone reducing, bladder

Question 34

Physical Therapy Goals

Answer 34

* Monitor changes in disease progression, attacks/change in status * Rehab Goals- Focused on restoring function * May receive intense therapy- RRMS- restore function * Ongoing therapy needs- as disease progression occurs may need bouts of therapy to address new problems in function, maintain current level of function, address equipment needs

Question 35

Energy Conservation

Answer 35

* Need to have an idea on level of fatigue and impact of fatigue throughout day * Pacing, optimal scheduling, consideration of weather, use of devices * Psychological support