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What is multiple sclerosis
MS is an immune mediated progressive demyelinating disease of the CNS
What is Demyelinaton
Destruction of myelin the fatty and protien materila that surrounds certain nerve fiber in the brain and spinal cords
What is the result of Demyelination
impaird transmissin of nerve impulses
What ages and sex does MS affect
Age 15-50 and it affect women more often than men.
How is the myelin destroyed?
T and B lymphocytes cross teh blood brain barrier they are supposed to check the NCS for antigens and leave. But T cells remain. The immune system attacks causing randomly scatterd plaques of sclerotic tissues
What causes MS
Cause is unknow: environmental exposure at a young age and immunologic causes are implicated.
Where is it most prevelant?
Europe, New Zealand, Southern australia, teh norther USA and southern Canada.
How are genetic prediopositons incicated
By the presence of specific cluster (haplotype) of human leukocyte andtines on the cell walls
Other factors that can increase symptoms
Onset in early adult life,
caucasion living in temperte limates
Fatigue, stress, and heat
Areas most affected by Demyelination
the brain stem
Acute episodes with almost a complete recovery
Steady dgenerative progression without exacerbation
Initally RR followed by steady deterioration later in disease process
Progressive but with periodic acute exacerbations
What % of patients have (RR)
80-85% with each relapse recovery is complete with residual deficits
Signs and Symptoms of MS
varied and multiple reflecting location of he lesion (plaque)
difficultiy in coordination
loss of balance
diplopia (double vision)
Scotoma (patchy blindness
The most disabiling symptom
What contributes to fatigue
Pain can lead to what?
additonal sensory manifestations include?
medication tx of pain
Perimenopausal women have pain related too?
how does Spasticity affect extremites?
muscle hypertonicity of the extremites and loss of teh abdominal relexes from involvment of teh main motor pathways (pyramidal tracts) of the spinal cord.
How is fronal or parietal love involvment seen?
Cognitive and psychosocial problems
Severe cognitive changes with dementia are?
impaird coordination of movements
Involvement of teh cerebellum or basal ganglia can produce?
Objective clinical findings?
increased deeptendon reflexes
impaired bowl and bladder function
cognitive loss in advanced stage
pallor of optic discs blindness
Increaased immunoglobulin G (IgG) levels in the CSF
MRI indicates demyelinatin and presence of MS
Life expectancy for PT with MS?
not dramatically diffrent from those with out MS.
DX of MS is based on?
Presence of multiple plaques in the CNS Observed in MRI.
Electorphoresis of CSF identified sthe presence of?
oligoclonal banding (several bands of imunoglobulin G bonded together) which indicates an immune system abnormality.
What is the cure for MS?
NO CURE EXISTES!!!
Individual TX of MS
indicated to relieve the patient symptoms
provide continuing support
The goal of treatment is?
manage chronic symptoms
treat acute exacerbations
Meds for MS include?
those for modification and those for symptom managment
such as immunomdulatin therapies, immunosuppressive agents.
reduce the frequency of relapse
the duration of relapse
and number and size of plauques
all mes require injection
Interferon beta 1a (Rebif) inerferon 1b (Betaseron) are and admin how?
Avenox is admin how?
IM q wk
Side effects of interferon beta meds
potential liver damage
Glatiramer acetate (copaxone)
Reduces rate of relape in RR
decreases the number of plaques
increases the time between relapses
admin SQ Q D
Side effects are minimal and manageble
may take 6 months for evidence of immune response to appear
the key in treating acute relapse in the RR
shorten duration of relapse
exerts anti-inflammatory effect vy acting on T cells
1 gram is adim IV Q D doe 3 days followed by a oral taper of predenisone.
Side effects include
Admin via IV every 3 months
reduce frequency of clincia relapses in PT with SP or worseing RR
Montior for side effects of cardiac toxicity
Med for Symptom managment?
GABA agonis - tx of spasticity
History of onset and progression of motor and sensory loss
factor that intensify symptoms
Glasgow Coma scale
Planning and goals
The major goals may include
promotion of physical movility
avoidance of of injury
achievement of bladder and bowel continece
promotion of speech
improvement of cognitive function
develpompent of coping skills
improved home maintence management
adaptation to sexual dysfunction
Promote physical mobility by?
Relaxation and coordination exercises promee muscle efficency.
Progressive resistive exercies to strengthen weak muscles.
Walking to improve gait
if muscle groups are iffeversibley affecte other muscle can be trained to compenste.
teach use of assistive device.
minimizing spasticity and contractures?
Severe adductor spasm of the hips wieh flexor spasm of the hips and kness
Warm packs can be applied
no hot baths due to risk for injury secondary to sensorly loss
increaed temp can incre symptoms
Daily exercises for streaching to min contractures
Swimming and bicycleing are useful
weight bearing can relive spasticity in th elegs
PT should not be hurried may increase spasticity
Activity and rest
work to just short of fatigue
strenous exersice not advised due to increased body temp
take short rest periods,preferably lying down
Extreme fatigue may contribute to exacerbation.
Minimize effects of immobility.
effects such as
expiratory muscle weakness
accumulaton of brochial secretions
conduct coughing and deep breathing
teach to walk with feet apart to widen the base of support and increase stability
if positon sense is lost have PT watch feer while walking
gait training with assistive devices
if gait is ineffective may use wheelchair or motro scooter
weighted braclets for movement control
inability to store urine
inability to empty bladder
voiding schedule 1.5-2 hrs and increase time
drink measured amount of fliud Q2hr and void 30 min later
take meds to TX bladder spasticity
intermittent self cath to maintain bladder control
bowel problems include fecal impaction constipation and incontince
Commucnication and swallowing difficulties
take small bites
use straw with liquied
eat food of more solid consistancy
if cranial nerve affecting vision may use an eye patch
Improve physical mobilit
is free of injury
attains or maintaind control of bladder and bowel patterns