Electric shock-like sensations down the back and back of legs when flexing neck
Extreme sensitivity to touch
2 types of spasticity
Hypertonicity and hyperreflexia
Most common complaint of MS patients
Fatigue, particularly after noon
Charcot's Triad is these three things
intention tremor, scanning speech/cerebellar dysarthria, nystagmus
weird feelings such as pins and needles
overshooting, poor judgment of distance
The name of the lesions caused by MS
MS plaques are located throughout ...
the CNS white matter. They do not affect peripheral nerves
Primary age range affected by MS
Theories of the etiology of MS
infectious origin, autoimmune system origin or a combo of the two (those who have had mono are more likely to get MS)
Risk of MS diagnosis in the general population
1 in 1000
Supportive lab/diagnostic tests for MS include
lumbar puncture, CSF evaluation, MRI, Electrophysiological testing (ex: Visual Evoked Potentials or VEP)
VEP -- Visual Evoked Potentials look for
impaired transmission of the optic nerve
CSF evaluation for MS looks for
elevated levels of IgG antibodies and oligoclonal bands (proteins) and protein byproducts of breakdown of the myelin sheath
a disorder that results in jerky, uncoordinated movements of the speech musculature; caused by lesions in the cerebellum; Slow, slurred prolonged syllables with inappropriate pauses
inability to perform rapid, alternating movements.
the worsening of neurologic symptoms in multiple sclerosis after periods of exercise and increased body heat.
MRIs show abnormalities in this percentage of people who have MS
Criteria for MS diagnosis includes time factors and multiple signs of
neurologic dysfunction involving two or more parts of the CNS, predominantly involving the white matter
The two time factors for diagnosis 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.
Slow progression of neurological dysfunction must extend over at least this time period to be criteria for MS diagnosis
To meet criteria for MS diagnosis, "episodes of exacerbation/worsening" must last more than ___ hours and be separated by no less than ___
24 hours, one month
Like Rheumatoid Arthritis, MS is characterized by ...
exacerbations and remissions
MS prognosis can be estimated by...
the number of exacerbations per year for the first 1-2 years. 1 or 2 episodes indicates good prognosis. 5, not so good.
Typically, MS patients live __ years post-diagnosis
Four types of MS
Relapsing remitting, Secondary progressive (follows relapsing remitting), Primary Progressive, Progressive Relapsing
The most common form of MS is
Relapsing Remitting is characterized by
partial or total recovery after exacerbations
Approximately 85 % of MS patients begin with this form of MS
More than 50% of those with RRMS (relapsing remitting) will develop...
SPMS (Secondary progressive) within 10 years
More than 90% of those with RRMS with develop SPMS within...
The type of MS in which symptoms do not remit
Primary Progressive MS (PPMS)
Approximately 10% of MS patients are diagnosed with...
PPMS (Primary Progressive)
The most rare form of MS, about 5% of cases
Progressive Relapsing MS
This form of MS is slowly progressive with obvious acute attacks along the way and no remission
Progressive Relapsing MS (PRMS)
Female patients with onset before age 35 are associated with
a more favorable course of MS
Sensory symptoms, like numbness, rather than motor symptoms indicate
a more favorable prognosis
5 factors associated with less favorable MS course
Male, onset after age 35, cerebellar symptoms, poor remissions, frequent attacks
2 forms of spasticity
Hypertonicity and hyperreflexia
A movement/perception disorder that can be due to MS lesions in the Brain Stem
When working with an MS patient, aim for the most energy intensive tasks at this time of day
Mild paresis or total paralysis in MS patients is secondary to lesions here
in the motor cortex
Poor coordination can be due to lesions in the
"upper motor" neurons
Visual disturbances occur in this percentage of MS patients at some point
Often the initial symptom of MS is
Sexual dysfunction with MS can be due to direct demyelination or indirect via
depression, spasticity, contractures, bladder and bowel disturbances
Most common behavioral disturbance with MS
Mild to moderate problems with this kind of reasoning are common
Heat, emotional stress, cold or humidity, trauma and strenuous exercise are
Initial interval between exacerbations is usually
exacerbate symptoms for those with MS
Medical management of MS has these two routes
1. Treatment of the acute attacks and 2. Symptom management
Treatment of acute MS attacks includes
high dose intravenous corticosteroids. 3 day course as an outpatient followed by oral steroids if possible
Treatment of spasticity includes these medications
Baclofen, Zanaflex, Dantrium, Valium or Neurotin
Injectable medications for spasticity management
botox, phenol and ethanol (which act as nerve blocks)
UTIs are treated with
Death from MS is usually secondary to...
a respiratory infection or UTI
the frequency and severity of exacerbations and new or active lesions on MRI
Immunosuppressants like Novantrone are used in..
worsening relapse remitting MS and secondary progressive and progressive relapsing MS. Can only be used for 2 to 3 years
Novantrone doses occur ___
once every 3 months
The goal of PT with MS patients is to ...
maintain independence for as long as possible
Good coordination exercises to use with MS
relaxation exercises, prolonged icing, slow rocking and stroking, as well as pressure at tendon insertion help to..
A large part of patient education is teaching...
energy conservation techniques AND precautions with sensory loss