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585-15
Multiple Sclerosis
| Term | Definition |
|---|---|
| MS | Neurodegenerative disease 1 of most neurologic diseases in YA Demyelination of CNS |
| MS etiology | Slow acting viral infection Autoimmune response of virus Environmental triggers Genetics- 10-20% of people Vitamin D Geographic |
| MS prevalence | 2.5 million people around the world Incidence of 7:100 000 Females x2 likely Onset at 15-50 years 98% Caucasians, N. America & Europe |
| mechanisms of demyelination | Myelin sheath is broken down & chemically degraded which makes inflammation After initial onset, demyelination subsides and leaves sclerotic plaque which disrupts transmission Impaired conduction rate |
| diagnosis of MS | Based on hx, neuro exam, overall picture Symptoms may mimic other disorders of NS Hx of at least 2 attacks w/ 1 month separation Episodes of CNS dysfunction over time or ongoing symptoms greater than 6 months 2+ lesions in CNS w/ no other diagnosis |
| clinical investigations | Imaging- MRI- lesions in brain, loss of brain volume Electro-physical tests- measures speed of nerve impulse conduction in CNS CSF- spinal tap, rise in antibodies (90%) Only provide clinical signs |
| types of MS | Clinically isolated syndrome Relapsing- remitting MS Secondary- progressive MS Primary- progressive MS Benign Malignant |
| clinically isolated syndrome | Earliest form of MS Single episode of symptoms suggested of MS Impacts optic, motor, sensory, cognitive Resolves w/ w/o tx |
| relapse-remitting | Unpredictable relapses/ flares followed by remission Flares sudden, then gradually disappear; OR Relapse full-partial recovery w/ stabilization period Affects 2+- optic, motor, sensory, cognitive May lead to secondary progressive 80% of people |
| secondary progressive | Progressive relapses & minor remissions/ occasional relapses Cont neurological deterioration Sudden relapses w/ poor recovery & shorter remission Affects SC, less cog, cerebellar & optic involvement |
| primary progressive | Less common Gradual decline w/o remission OR may stabilize over time but no remission Continued deterioration & disability Cerebral & spinal involvement Age 40+ |
| progressive-relapsing | Rarest Continued flare ups Steady worsening of symptoms w/ attacks No remission |
| benign | Rare Disease process occurring but w/ little to no disability Fully functional 15 years after onset Doesn't lead to secondary progressive |
| malignant | Rapid progression leading to significant disability or death in short period of time More extreme & progressive |
| motor vs. sensory symptoms | Fatigue, spasticity, weakness, ataxic like, intention tremor, balance & mobility vs. Numbness, pain, altered pain sensation, hypersensitivity |
| cognitive vs. visual symptoms | Memory loss, difficulty w/ complex ideas, reduced attention, concentration vs. Double vision, pain behind eyes, blurred vision, partial blindness, nystagmus |
| psychological vs. body function symptoms | Depressed/ euphoric, impulsivity, lability vs. Speech, bowel & bladder, sexual dysfunction |
| MS specific fatigue | Increased energy is needed for nerves to conduct their impulses Poor sleep, depression, muscle spasms, urinary issues, medication side effects, infections |
| common symptoms in relapsing/ remitting | Spasticity, paresis, spasm Numbness, tingling Optic neuritis, diplopia, nystagmus Ataxia |
| common symptoms in primary progressive | Gait Paresis Sphincter disturbance Sexual dysfunction Cognitive changes- loss of concentration |
| factors that worsen symptoms | Heat/ cold Stress Fatigue Mood Time of day Impact of meds |
| prognosis | 15% who have 1 attack don't have another event Those w/ relapsing have avg 1-2 relapse every 2 years 1/3 of pts need assistance w/ mobility after 10 years 50% very disabled after 15 years ~5% die within 5 years of onset |
| relatively good prognosis if | Sensory/ visual involvement Complete recovery from episodes Younger women |
| relatively poor prognosis if | Motor involvement Older men Frequent/ prolonged relapses Incomplete recovery between |
| management of MS | Medication management Rehabilitation Other |
| medical management | Manage symptoms w/ medications Information to rehab team & GP Disease modifying therapy |
| tx of acute relapses | Bedrest & decreased activity until symptoms subside IV steroids- reduced inflammation in really aggressive manner |
| medications to help | Slow the progression Min symptoms during flares Improve physical and mental function |
| medications used for root cause | Immunosuppressants- prevent relapses Reduce severity & frequency Anti-inflammatories Plasmaphoresis |
| medications for tx of symptoms | Muscle relaxants for spasticity Anticholinergics for bladder Anti-fatigue medication Antidepressants Gabapentin for pain |
| rehab | Management of disability with interdisciplinary team Prevention of disability and maintain QoL Psychosocial support/ intervention |
| diet vs. cannabis | Meatless diets may limit the immune responses vs. Relief of pain, spasm, anxiety, depression, insomnia. Possible negative cognitive function |
| OT role | Understand medical condition & symptoms Complete comprehensive ax to guide intervention Treatments and goals must be flexible & timely Consider impact on client, family, relationships, self esteem |
| early OT | Information and education Link w/ MS support group Provide employment, home, family support ENERGY CONSERVATION |
| later OT | ADL & mobility- energy conservation, env adapt W/c Home management & work evaluation Driving adapts Physical impairment- identify if anything else needs to be done Cog strategies Ongoing support |
Created by:
craftycats_
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