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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
- Trigeminal neuralgia
- Fatigue, stress, and heat
Areas most affected by Demyelination
- optic nerves
- and tracts
- the cerebrum
- the brain stem
- spinal cord
- The Axons
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
- visual disturbances
- blurring visoin
- diplopia (double vision)
- Scotoma (patchy blindness
- total blindness
The most disabiling symptom
What contributes to fatigue
Pain can lead to what?
additonal sensory manifestations include?
- propioception loss
medication tx of pain
Perimenopausal women have pain related too?
- estrogen loss
- corticosteriod therapy
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?
- Charot Triad
- intention tremors
- clipped speech
- shuffling gait
- increased deeptendon reflexes
- spastic paralysis
- 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?
- Delay progression
- 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
- flulike symptoms
- potential liver damage
- fetal abnormalites
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
- mood swings
- weight gain
- electrolye imbalance
- 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
- Benzodiazepines (valium)
- Tizanidine (Zanaflex)
- Dantrolene (Dantrium)
- History of onset and progression of motor and sensory loss
- factor that intensify symptoms
- neurologic status
- 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
- swallowing mechanisms
- 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
- pressure ulcers
- 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
- use timer
- 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
- speech therapy
- take small bites
- chew well
- use straw with liquied
- eat food of more solid consistancy
- if cranial nerve affecting vision may use an eye patch
- for diplopia
- Prism glasses
- talking books
- Improve physical mobilit
- is free of injury
- attains or maintaind control of bladder and bowel patterns
- in stratiges to imporve speech and swallowing
- compenstes for alter thought process
- demonstrates effective coping stratagies
- adheres to plan for home maintenace managment
- adapt to changes in sexual function