Chapter 2: Multiple Sclerosis

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Chapter 2: Multiple Sclerosis
2015-03-10 20:41:43
Multiple Sclerosis
NPTE: Chapter 2
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  1. Definition
    Chronic, progressive, demyelinating disease of CNS
  2. Etiology
    • Unknown
    • Most likely viral, autoimmune
  3. Characteristics
    • Affects mostly young adults
    • Demyelinating lesions (plaques) impair neural transmission, cause nerves to fatigue rapidly
    • Variable symptoms 
    • Variable course with fluctuating periods -- exacerbations and remission progressing to permanent dysfunction
  4. Precipitating/Exacerbating Factors
    • Infections
    • Trauma
    • Pregnancy
    • Stress
  5. Transient Worsening of Symptoms
    • Adverse reactions to heat
    • Hyperventilation
    • Dehydration
    • Fatigue
  6. Categories
    • Relapsing-remitting 
    • Primary-progressive
    • Secondary-progressive
    • Progressive-relapsing
  7. Relapsing-Remitting MS
    • Characterized by relapses with either full recovery or some remaining neurological signs/symptoms and residual deficit on recovery
    • Periods between relapses characterized by lack of disease progression
  8. Primary-Progressive MS
    • Characterized by disease progression from onset
    • Without plateaus or remissions or with occasional plateaus and temporary minor improvements
  9. Secondary-Progressive MS
    • Initial relapsing-remitting course
    • Followed by progressing at variable rate
    • May also include occasional relapses and minor remissions
  10. Progressive-Relapsing MS
    • Progressive disease from onset
    • Without clear, acute relapses that may or may not have some recovery or remission
    • Commonly seen in those who develop disease after 40 years of age
  11. Diagnostic Tests
    • LP/CSF
    • Elevated gamma globulin
    • CT/MRI
    • Myelogram
    • EEG
  12. Examination
    • History: symptoms, disease progression, functional deficits
    • Cognitive/behavioral status: mild-mod cognitive impairment common, also euphoria, emotional dysregulation
    • Communicaiton: dysarthria and scanning speech, dysphagia
    • ROM, deformity: associated with disuse/inactivity
    • Sensation: paresthesias, hyperpathia (hypersensitivity to sensory stimuli), dysthesias, trigeminal neuralgia, Lhermitte's sign 
    • Vision: diplopia or blurred vision, optic neuritis, scotoma (blind spot), nystagmus
    • Skin integrity
    • Muscle tone, DTRs: spasticity and hyeprreflexia (pyramidal tract lesions)
    • Muscle strength and control: paresis common, spasticity
    • Coordination: ataxia, intention tremors, dysmetria, dysdiadochokinesia 
    • Balance: vestibular involvement, vertigo, dizziness, unsteadiness, paroxysmal or sudden onset of symptoms 
    • Gait: ataxic
    • Fatigue: number 1 complaint, common with high levels of activity or as day progresses
    • Respiratory status
    • Functional status: FMS, ADLs
  13. Lhermitte's Sign
    • Electric shock-like sensation through the body
    • Produced by flexing neck
  14. Standardized Tests and Measures
    • Expanded Disability Status Scale (EDSS)
    • Minimum Record of Disability (MRD)
    • Modified Fatigue Impact Scale
  15. Medical Management
    • Immunosuppressant drugs: treat acute flare-ups and shorten duration of episode 
    • Interferon drugs: slow progression of disease, decrease symptoms 
    • Symptomatic management of spasticity: baclofen, diazepam, baclofen pump, phenol block surgery
    • Symptomatic management of urinary problems: anticholinergic drugs
  16. PT Goals, Outcomes, and Interventions
    • Monitor changes associated with disease progression: signs of UTI, respiratory infection (common causes of death)
    • Restorative goals: intensive, time-limited rehab designed to improve/stabilize pt status after relapse
    • Functional maintenance goals: manage effects of progressive disease and prevent/minimize indirect impairments associated with disuse and inactivity
    • Maintain ROM, prevent contracture
    • Maintain skin integrity
    • Improve respiratory function
    • Improve sensory awareness
    • Improve strength/motor control/coordination
    • Improve postural control and balance
    • Locomotor training
    • Independence in functional mobility skills and ADLs
    • Promote max mobility in home and community
    • Energy conservation techniques
    • Avoid precipitating exacerbations: schedule therapy sessions during optimal times for function, minimize fatigue, schedule rest and moderate exercise, avoid stress/overheating