Multiple Sclerosis Questions and Answers Graded A

Multiple Sclerosis Questions and Answers Graded A Multiple Sclerosis (MS) Disease of the CNS characterized by the occurrence of random patches of inflammation with demyelination called plaques'/lesions. Occurrence age 15-45 yrs. Includes exacerbations and remissions. Relapsing-Remitting, Secondary Progressive, Primary Progressive, Progressive-Relapsing List the 4 variations of Multiple Sclerosis: Relapse-Remitting Acute episodes of worsening neurological function followed by partial or complete recovery w/ no disease progression b/w relapses. -85% of patients begin with this variant. Secondary Progressive Initial period of relapses and remissions followed by progression of the disease w/ or w/o exacerbations. -90% of pts. with relapsing-remitting will later develop this variant unless treated. Primary Progressive Slow but steady worsening of disease from onset w/ NO remissions or relapses. Requires documented worsening over one year. -10% of patients. Progressive-Relapsing Steady worsening of disease from onset with a later exacerbation, no remission. -Rarest variant of MS. Time factors for Dx of MS 1. Two or more episodes of exacerbation each lasting more than 24 hours and separated by no less than one month or; 2. Slow progression extending over at least 6 months. Signs of MS Spasticity, increased DTR, +Babinski reflex, dysmetria (over/under shooting), tremor, nystagmus, diplopia (double vision), impaired vibratory or position sensation, Ataxia, poor BAL and coordination, hyperpathiea (hypersensitivity to sensory stimuli) -Abducen (CN VI) palsy (cannot ABD eye past midline) Trigeminal Neuralgia Facial pain secondary to lesion of Trigeminal nerve (CN V). Lhermette's Sign Electric shock-like sensations down the back & posterior LE when flexing neck, (Slump Test). Dysmetria Overshooting &/or undershooting; poor judgment of distance. Sensory SxS of MS Anesthesia, loss of vibration sense & proprioception (dysethesia) Tight or constricting sensation, Lhermitte's phenomenon, trigeminal neuralgia (tic douloureux). Motor SxS of MS Monoparesis, paraparesis, or hemiparesis. UMN signs common (spasticity, hyperreflexia), including Babinski's sign. Gait ataxia, tremor (intention or rubral), or limb dysmetria may also occur. Vision SxS of MS Optic neuritis, diplopia, nystagmus, scotoma (blind spot). Autonomic SxS of MS Bladder urgency, hesitancy, retention, or incontinence (collectively termed 'neurogenic bladder'). Constipation and neurogenic bowel also occur. Sexual dysfunction. Brainstem SxS of MS Dysarthria, dysphagia, vertigo, facial weakness/numbness, trigeminal neuralgia. Cognitive SxS of MS Depression, anxiety, cognitive dysfunction, fatigue (early sign of MS) -better to exercise in the MORNING. Diagnostic Tests Neuro-imaging (MRI useful for prognosis), CSF evaluation, and electrodiagnostic tests. -No single test is able to definitively diagnosis MS at this time. Uthoff's Sign Worsening of neurologic Sx in MS after periods of exercise and/or increased body heat; due to nerve conduction failure. Steroids Drug used to ease severity of MS symptoms. Disease Modifying Drugs (DMD) Drugs used to slow progression, & reduce episodes of MS. -Avonex -Betaseron -Rebif -Novantrone -Copaxone Favorable prognosis Female, young at onset, low disability at 2&5 yrs., normal MRI at presentation, complete recov. from 1st episode, low relapse rate. Dysphagia Difficulty in swallowing. Cerebellar Dysarthria/Scanning Speech Disorder that results in jerky, uncoordinated movements of the SPEECH musculature; caused by lesions in the cerebellum; Slow, slurred prolonged syllables with inappropriate pauses. Dysdiadochokinesia Inability to perform rapid, alternating movements. Fatigue; afternoon Most common complaint of MS pt's. 15-45 yrs Primary age range affected by MS. Vertigo A movement/perception disorder that can be due to MS lesions in the Brain Stem. Frenkel's Good coordination exercises to use with MS. Pt education Teaching energy conservation techniques, precautions for sensory loss & skin integrity. 3 wks Excacerbations tend to last about 5 yrs Average interval between exacerbations initially Charcot's Triad Combination of intention tremor, scanning speech/cerebellar dysarthria & nystagmus make up. Exacerbating factors Temperature, stress, trauma, exercise, infections and fatigue are examples of. Spasticity Relaxation exercises, prolonged icing, slow rocking and pressure at tendon insertion are use to decrease.