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180 Cards in this Set
- Front
- Back
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What is the nature of MS?
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autoimmune disease of the CNS
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What is the hallmark CNS finding in MS?
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white matter plaques of demyelination
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Older MS plaques may become sclerosed due to what 3 processes?
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oligodendrocyte destruction
astrocyte proliferation glial scarring |
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Remyelination is consistent with what disease state in MS?
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remission
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The autoimmune process results in what 3 CNS consequences?
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demyelination
axonal damage brain atrophy |
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MS is the 3rd leading cause of significant disability in what age range?
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20-50
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What is the female:male ratio of MS?
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2:1
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What race is affected predominantly, white or black?
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white
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Who is affected more higher or lower socioeconomic level?
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higher
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What chomosome may be linked to MS?
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6
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What is the incidence range (per 100,000) of MS in the most northern latitudes?
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30-80/100,000
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Pregnancy increases or decreases relapses?
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pregnancy decreases relapses, but after delivery increases relapses
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What is the most common pattern of MS?
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relapsing-remitting
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What is the pattern of MS that starts as relapsing remitting then deteriorates steadily?
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secondary progressive MS
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What pattern of MS remitts completely?
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benign
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What form of MS is marked by progressive worse deterioration with relapses?
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progressive relapsing
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What pattern of MS is marked by few remissions and increasing disability, with progression to death in weeks to months?
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primary progressive
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What is the male:female ratio of primary progressive MS?
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1:1
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What type of MS is rapid and severe?
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malignant
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What age of onset carries a good prognosis?
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<35 years old
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What percentage of MS patients have relapsing remitting?
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85%
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What are the two outcomes of a remission in relapsing-remitting?
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mild disability
return to baseline |
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What type of onset is consistent with a good prognosis in MS?
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sudden
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What two findings at onset are consistent with a good prognosis in MS?
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sensory
optic neuritis |
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What ambulatory status is consistent with a good prognosis?
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ambulatory
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What length remissions are indicative of a good prognosis?
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long remissions
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What gender is a poorer prognosis?
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male
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What age of onset is a poorer prognosis?
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>35 years old
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What 3 symptoms at onset indicate are poorer prognosis?
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motor
ataxia tremor |
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What is triad is seen in advanced MS?
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charcot triad
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What is the Charcot Triad?
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scanning speech
intention tremor nystagmus |
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What are the 3 most prevalent symptoms in MS?
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bladder and bowel dysfunction
fatigue pain |
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What 4 visual disturbance may be seen in MS?
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optic neuritis
diplopia nystagmus internuclear ophthalmoplegia |
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What are 2 cerebellar/basal ganglia symptoms seen in MS?
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ataxia
intention tremor |
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What 3 dorsal column symptoms may be seen in MS?
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deep sensation
parasthesias proprioception |
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What are two corticospinal tract symptoms seen in MS?
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weakness and spasticity
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What 5 frontal lobe dysfunctions are seen in MS?
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cognitive
memory learning impaired emotional responses depression |
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What are 7 brainstem abnormalities seen in MS?
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myokymia
deafness tinnitus vertigo vomiting facial anesthesia dysphagia |
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Ataxia and intention tremor seen in MS originate in what two brain areas?
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cerebellum and basal ganglia
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Parasthesias, memory deficits, learning deficits, and impaired emotional responses are dysfunctions of what brain area?
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frontal lobe
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Weakness and spasticity seen in MS originate in what tract?
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corticospinal tract
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Myokymia, deafness, tinnitus, vertigo, vomiting, facial anesthesia, and dysphagia seen in MS originate in what brain area?
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brainstem
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What 3 MS symptoms most affect the performance of ADLs?
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fatigue
balance difficulties weakness |
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What famous sign is not pathognomonic for MS?
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Lhermitte's sign
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What is Lhermitte's sign?
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passive neck flexion causes an electric shock sensation down the spine and into the shoulders
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Are UMN or LMN signs seen in MS?
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UMN signs
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What are 4 UMN signs seen in MS?
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hyperreflexia
Hoffman's sign Babinski's sign spasticity |
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What 4 environmental /constitutional conditions exacerbate MS?
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fever
heat stress fatigue |
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What 2 infections may exacerbate MS?
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respiratory or urinary infections
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Can a MS diagnosis be made on the basis of clinical signs alone?
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yes
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What 2005 criteria combine clinical and imaging elements in the diagnosis of MS?
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McDonald Criteria
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What is the concept in MS diagnosis that a lesion must occur in different locations in the CNS at different times?
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lesions scattered in time and space
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What further evidence is required to make a diagnosis of MS with 2 or more clinical attacks and 2 objective lesions?
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none
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Is there any pathognomonic test for MS?
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no
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With 2 or more clinical MS attacks and 1 objective lesion, what further requirement is necessary to make a diagnosis?
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dissemination in space by MRI or 2 or more MRI lesions consistent with MS plus positive CSF
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With 1 clinical MS attack and 2 or more objective lesions what additional information is required to make a diagnosis?
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dissemination in time or second clinical attack
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With 1 clinical MS attack and 1 objective lesion, what further information is required to make a diagnosis?
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dissemination in space by MRI or 2 or more MRI lesions plus positive CSF and dissemination in time by MRI or second clinical attack
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With 0 clinical attacks and 1 or more objective lesion, what further information is required to make a diagnosis?
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disease progression for 1 year and 2 out of 3 of the following:
*positive brain MRI *positive spinal cord MRI *positive CSF |
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What CSF 4 values are increased in MS?
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CSF protein
oligoclonal IgG bands IgG WBC |
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What is a primary component of CSF protein in MS?
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myelin
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Presence of what substance in the CSF has the greatest sensitivity for MS?
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oligoclonal IgG bands
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What test combined with MRI has high sensitivity in MS?
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visual evoked potentials
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Visual evoked potentials along with what test has a high sensitivity in MS?
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MRI
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What point is abnormal in visual evoked potentials?
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P100
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What area of the brain is investigated in brainstem auditory evoked response (BAER)?
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pontine area
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What is the MS finding in a brainstem auditory evoked response?
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delay or absence of wave formation due to the demyelinating process
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What is the most common MS abnormality in SSEP?
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latency increase or absence of tibial nerve stimulation
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What 3 NCS studies may be abnormal (decreased) in MS?
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SNAP
CMAP CV |
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What does single fiber EMG show in MS?
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jitter
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Jitter in MS is detected by what type of EMG study?
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single fiber
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What reflex may be abnormal in MS during an EMG study?
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blink reflex
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What are 3 findings on regular EMG in MS?
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fibs, PSWs, facial myokymia
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What test has the greatest sensitivity in MS?
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MRI
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What weighted images on MRI show bright areas of hypersensitivity in MS?
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T2
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What MRI test is the most sensitive indicator of disease activity?
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MRI with gadolinium
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What type of MS lesions enhance in MRI with gadolinium?
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only active lesions
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What test may be positive in MS before onset of deficits?
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MRI enhancement with gadolinium
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What is the most common indicator of MS in CT imaging?
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cerebral atrophy
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What is the mainstay treatment for acute MS attacks?
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methylprednisolone
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What area of the brain is investigated in brainstem auditory evoked response (BAER)?
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pontine area
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What is the MS finding in a brainstem auditory evoked response?
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delay or absence of wave formation due to the demyelinating process
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What is the most common MS abnormality in SSEP?
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latency increase or absence of tibial nerve stimulation
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What 3 NCS studies may be abnormal (decreased) in MS?
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SNAP
CMAP CV |
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What does single fiber EMG show in MS?
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jitter
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Is CT effective in detecting MS plaques?
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no
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What medication and dose range is used in acute MS attacks?
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methylprednisolone 500-1000mg/day x 3-5 days
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What is the most responsive MS symptom to steroid treatment?
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optic neuritis
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What 2 system symptoms are least responsive to steroid treatment?
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cerebellar and sensory
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What are 4 risks of long term steroid use?
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HTN, osteoporosis, diabetes, and cataracts
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Do steroids prevent further attacks or alter disease progression?
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no
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What is Avonex?
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interferon beta 1A
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What is the weekly IM dose of interferon beta 1a?
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30 mcg
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What is the reduction in relapse rate (%) over 2 years with Avonex use?
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29%
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Interferon beta 1a decreases what 3 characteristics of MS?
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disability progression
exacerbations number and size of MRI lesions |
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What is the dosing schedule for Rebif?
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44 mcg subq three times/week
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What is Rebif?
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interferon beta 1a
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What are 3 side effects of Rebif?
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depression
flu symptoms injection site reaction |
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Rebif decreases what 2 characteristics of MS?
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relapse rate
progression of MS |
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What MS metrics does Rebif increase?
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time to first relapse
more relapse free periods |
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What is Betaseron?
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interferon beta 1b
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What is the dose of Betaseron?
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250mcg subq qod
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What is the only MS disease modifying drug that is delivered IM?
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Avonex (interferon beta 1a)
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What is the reduction in relapse rate over 5 years with Betaseron?
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30%
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How does Betaseron affect 4 metrics of MS?
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*delays transition from relapsing-remitting to secondary progressive
*fewer exacerbations *longer time between exacerbations *less severe exacerbations |
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How does Betaseron affect exacerbations in terms frequency, serverity, number
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decrease frequency, severity and number of exacerbations
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What are 2 severe side effects of Betaseron?
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hepatotoxicity
leukopenia |
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What is Copaxone?
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glatiramer acetate
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What is the daily dose of Copaxone?
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20mg subq daily
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What is the reduction of relapse rate over 2 years with Copaxone?
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29%
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How does Copaxone affect MS exacerbation frequency, severity, and number?
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decreases all
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What is Tysabri?
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natlizuamab
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What is the mechanism of action of Tysabri?
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decreases cells crossing blood brain barrier
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What class of medicine is Tysabri?
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selective adhesion molecule inhibitor
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Tyasbri reduces what 2 characteristics of MS?
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relapse rate by 68%
progression to disability |
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A rare progressive multifocal leukencephalopathy in 2005 caused the withdrawal of what medicine?
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Tysabri
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When was Tysabri reintroduced?
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2006
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What immunosuppressive medication results in a modest MS improvement?
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cyclophosphamide
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What immunosuppressive is indicated for worsening relapsing remitting, secondary progressive, and progressive relapsing?
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mitoxantrone
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What are the two main risks of mitoxantrone?
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cardiotoxicity
hepatotoxicity |
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By what percentage does mitoxantrone reduce relapse rate ?
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68%
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What 4 measures of MS does mitoxantrone delay or decrease?
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time to relapse
disability progression relapses size of lesions |
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In MS where is weakness more prominenet, UEs or LEs?
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LEs
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What MS characteristic does exercise improve, conditioning or weakness?
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conditioning
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What 3 activities or environmental conditions worsen MS fatigue?
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heat
stress activity |
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Swimming pool temperature in MS should be set less than what temperature?
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<84 F
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How does heat worsen fatigue in MS?
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delays impulse conduction
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What is the drug of choice to treat spasticity in MS?
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PO or intrathecal baclofen
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What is a lack of harmonious action between muscles during a voluntary movement in which a patient is unable to stop motion at a desired point?
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dysmetria
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What tract/column are most affected in MS?
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spinocerebellar and dorsal columns
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What exercises are use to treat ataxia in MS?
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Frenkel's exercises
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What time of day is MS fatigue better?
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morning
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What are 4 differential diagnoses for MS fatigue?
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anemia, hypothyroidism, medication, and depression
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In what percentage of MS patients is optic neuritis seen?
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25%
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What is optic neuritis?
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inflammatory demyelination of optic nerve
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What is a common visual field defect in optic neuritis?
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central scotoma
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What is the treatment for optic neuritis?
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IV methylprednisolone
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Is optic neuritis usually monoocular or biocular?
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mono
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What are three possible symptoms of optic neuritis?
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decreased acuity
photophobia pain |
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What is internuclear ophthalmoplegia?
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demyelinating lesion of the medial longitudinal fasciculus
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What eye muscle is paretic in internuclear ophthalmoplegia?
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medial rectus muscle
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What eye motion is affected by internuclear ophthalmoplegia?
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eye adduction
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What is an associated finding in internuclear ophthalmoplegia, along with paresis of eye adduction?
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nystagmus
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What direction gaze is affected in internuclear ophthalmoplegia?
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voluntary lateral gaze
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What ocular function is unaffected in internuclear ophthalmoplegia?
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convergence
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What 7 structures make up the pathway for convergence?
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retina, optic nerve, optic tract, optic chiasm, lateral geniculate, bilateral CN III
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What are 2 treatments for internuclear ophthalmoplegia?
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patching and prisms
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What is the most common bladder dysfunction in MS?
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hyperactive (spastic bladder)
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What are two symptoms of a spastic bladder?
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incontinence and dribbling
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What class of medications is appropriate to treat the spastic bladder commonly seen in MS?
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smooth muscle relaxant
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Name 4 (smooth muscle relaxants and anticholinergic) medications used in MS spastic bladder.
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Ditropan - oxybutyinin
Pro-Banthine - propantheline (anticholinergic) Levsin - hyoscycamine Detrol - tolterodine |
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What two medication classes are used to treat a failure to empty bladder?
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external sphincter relaxant
alpha antagonist |
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Name one external sphincter relaxant used in failure to empty bladder in MS?
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urecholine
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Name 2 alpha antagonists used in failure to empty bladder seen in MS?
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Minipress - prazosin
Flomax |
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What is a combination bladder seen in MS?
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detrusor sphincter dyssynergia
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What is the problem in detrusor sphincter dyssynergia?
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bladder contracts and sphincter closes backing urine up to the kidney
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What is the treatment for detrusor sphincter dyssynergia?
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intermittent catheterization
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What medicine class is used between catheterizations in detrusor sphincter dyssynergia?
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anticholinergics
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What is an early bowel dysfunction seen in MS?
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constipation
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Impairment of what 4 cranial nerves can lead to dysphagia in MS?
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CN V, VII, IX, and XII
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What are two finding on swallowing evaluation in MS?
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delayed swallowing and pooling
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A frontal lobe lesion or steriod use can cause what symptom in MS?
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euphoria
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A lesion in what area of the brain can cause euphoria in MS?
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frontal lobe lesion
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What medication used in MS can cause euphoria?
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steroid
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Early in MS is IQ normal or decreased?
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normal
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What intellctual function is affected in MS?
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processing speed
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What is affected more in MS, verbal or performance skills?
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performance skills
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What percentage of MS patients have neuropsychiatric abnormalities?
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70%
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The suicide rate is what multiple of the normal population?
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7.5x
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What memory function is affected in MS?
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short-term
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What mental illness in common in MS?
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depression
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What percentage of patients with MS will have a normal life expectancy?
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85%
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What percentage of patients require ambulatory assistance within 10 years of diagnosis?
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1/3
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What is the most common disability scale used in MS?
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Kurtzke Expanded Disability Status Scale (EDSS)
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How many levels are there on the Kurtzke Disability Scale?
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10 levels
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How many neurologic systems are evaluated in the Kurtzke Disability Scale?
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8
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What rating is bedbound in the Kurtzke Disability Scale?
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8
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What two areas does the Functional Independence Measure test?
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disability and need for assistance
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What area does the FIM not address?
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vision
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What score is normal in the Kurtzke Disability Scale?
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0
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What score in the Kurtzke Disability Scale is severe disability, but ambulatory without aid?
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4
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