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57 Cards in this Set
- Front
- Back
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what is MS
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chronic inflammatory demyelinating disease
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what is the main characteristic of MS
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demyelinating lesions, plaques, widely dispersed throughout CNS
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what are plaques
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demyelinating lesions in CNS in MS
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____, ____, and ____ are present in the acute demyelination in MS
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1) myelin breakdown products
2) edema 3) chemotaxis of lymphocytes |
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sometimes the myelin can be restored in MS patients, but if not what happens
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microglial cells migrate to the lesion phagocytize the debris and produce fibrils that result in glial scar or plaque
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what ultimately replaces the myelin sheath in MS patients
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fibrous scarring--- Plaque
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what do the lesions for MS typically look like
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- symmetrical
- scattered throughout the white matter |
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lesions for MS are particularly found where
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- cerebrum
- cerebellar peduncles - brainstem - corticospinal and dorsal spinal cord |
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what does MS do to the motor system
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affects UMNs --> spasticity
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does MS have sensory issues
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yes- becasue affects CNS
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how common is MS
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50/ 100,000 (1:4,000)
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what is the age for MS
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20-40
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what is the sex for MS
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women to men = 2-3: 1
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do men or women get the more progressive form of MS
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men (but women more likely to get MS)
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race for MS
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- predominantly white populations
- blacks have 1/2 the risk |
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environment for MS
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higher frequency the further you get from the equator
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at what age does the risk with environment for MS stay the same
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15 (doesn't matter where you travel after this point)
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genetics for MS
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slight correlation - but possibly also related to enviromnent
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what is the etiology for MS
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- actual cause unkown
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what are the theories for causes for MS
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- infectious origin (like GBD)
- immune-mediated pathogenesis - some combo- genetic predisposition |
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what is a possible protective factor for MS
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vitamin D--> may explain the equator factor
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what could cause exacerbation of MS
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- infiltrates of T cells and macrophages around acute lesions further interfering with conduction (gradually subside)
- abnormal response to common viruses |
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what are the types of MS
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1) relapsing-remitting
2) primary-progressive 3) secondary-progressive 4) progressive-relapsing |
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what is relapsing-remitting MS
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- clearly defined attacks of worsening neuro function
- relapses followed by partial or complete recovery periods during which no dz progression occurs |
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what is primary progressive MS
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- slowly worsening neuro function from the beginning, no distiinct relapses or remissions
- rate of progression may vary with occasional plateaus and temporary minor improvements |
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what is secondary progressive MS
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- initially presents as relapsing-remitting, but then begins to worsen more steadily with or without occasional flare-ups, remissions or plateaus
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what is progressive relapsing MS
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steadily worsening disease from the beginning, but with clear attacks of worsening fxn along the way
- may or may not experience some recovery following these periods but the disease continues to progress without remission |
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_____ is 85% of MS
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relapsing remitting
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______ is 10% of MS
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primary progressive
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______ is 5% of MS
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progressive relapsing
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____% of people with relapsing-remitting MS develop this form ______ within 10 years
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50% ppl with relapsing remitting develop secondary-progressive within 10 years
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_____ MS is followed by _____ MS
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relapsing-remitting MS followed by secondary-progressive MS
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what is the survival after onset of MS
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35 years after onset
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what is the prognosis for MS
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death does not occur from the disease itself
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74% of MS survive _____ post dx
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25 years post dx
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when do 50% of MS patients need a walker
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15 years post dx
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when do 50% of MS patients need a wheelchair
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20 years post dx
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at what point can most MS patients no longer work
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10 years post dx
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what gives a better prognosis for MS (6)
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1) younger at onset
2) only 1 symptom during 1st year 3) sensory/visual symptoms at onset 4) acute onset of initial symptoms with complete and rapid remission 5) brief length of most recent exacerbation 6) minimal corticospinal and cerebellar signs after 5 years |
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if younger than _____ there is a better prognosis for MS because associated with milder strain
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younger than 35
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____ symptoms at onset give a better prognosis than if ____ symptoms at onset
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sensory/visual symptoms have better prognosis than motor
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minimal ____ and ____ signs after 5 years gives better prognosis
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coritcospinal and cerebellar signs
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what is McDonald Criteria
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multiple signs of neurologic dysfunction involving dissemination in time/space (used for MS dx)
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what results of McDonalt Criteria would be dx of MS
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- 2 or more parts of CNS white matter affected
- 2 or more episodes, lasting more than 24 hours and seperated by more than 1 month - slow or step-wise progression extending over at least 6 months |
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what diagnostic testing can be used for MS dx
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- MRI
- visual evoked potential studies - CSF analysis - Blood tests |
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what is an MRI looking for in MS
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plaques radiating away from ventricles
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what is a VEP used for in dx MS
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testing conduction of nerve, if demyelinated = slow
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what is CSF analysis used for in dx MS
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lumbar puncture looking for oligoclonal bands
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what are the blood tests used for in dx of MS
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not for MS, but can r/o other diseases/infections that decreases optic neuritis
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what are the most common initial complaints of MS
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- visual changes
- sensory symptoms - urinary disturbances |
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what are the other S and S with MS
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- fatigue
- movement disorders - Lhermitte's sign - trigeminal neuralgia - dizziness/vertigo - bowel, bladder and sex disturb. - dysarthria, dysphagia - mental disturbances |
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what is the medical management for acute relapses/exacerbations of MS
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- corticosteroids
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what are the corticosteroids used for tx MS
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- mehtylprednisolone
- dexamethasone - prednisone |
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what are the disease modifying therapies for MS
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- immunomodulation for relapsing-remitting MS
- immunosuppressants |
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what are the immunomodulations used for MS
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- interferon
- glatiramer acetate (copaxone) - natilzumab (tysabril) |
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what are the immunosuppressants for MS
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- thiopurines, methotrexate
- mitoxantrone (novantrone) |
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what are the other experimental approaches for MS
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- plasmaphoresis
- HBO, BMT |
