211 Multiple Sclerosis

Which statement regarding MS is false?

• It is an immune mediated disease

• T cells attack Myelin on CNS & optic nerve

• Scar tissue formed on the myelin is called sclerosis

• The cause is genetic

Answer explanation

The cause of MS is unkown

Which of the following places a pt at risk for MS? (Select all that apply)

• If pt lives close to the equator

• If the pt is a man

• Someone who is 20-40 years old

• Pt is infected Epstein Barr Virus & Rubella

• Smoking

Answer explanation

Contributing factors:

- Genetic predisposition

- Environmental exposure

- Pt live far away from the equator not close

- Women, not men are more prone

- 20-40 year olds

- Epstein Barr & Rubella virus exposure

Smoking

Which type of MS is Mitoxantrone (Novantrone) treatment not used for

• Relapsing Remitting

• Secondary Progressive

• Primary Progressive

• Progressive Relapsing

Answer explanation

Antineoplastic Novantrone: suppresses T cells and others thought to attack the myelin. Has more serious SE; administered IV q 3 months 

For secondary progressive or worsening MS. NOT for RR

1) Relapsing Remitting (most common); 2) Secondary Progressive (what RR progresses to); 3) Primary progressive (diseases progresses slower); 4) Progressive relapsing (no remissions, steadily worsens & progresses faster)

Which of the following are early symptoms of MS? (Select all that apply)

• Visual disturbances

• Emotional changes

• Sexual dysfunction

• Dizziness & verticgo

• Numbness

Answer explanation

Early Symptoms

Visual disturbances (Blurred, Diplopia, Patchy blindness, Total blindness)

Fatigue & Weakness

Dizziness, vertigo

Numbness & Loss of balance/ coordination difficulties

Pain

Sexual dysfunction 

Which of the following are later symptoms of MS? (select all that apply)

• Cognitive & psychosocial

• Ataxia

• Loss of balance/ coordination difficulties

• Bladder dysfnction

• Speech & swallowing problems

Answer explanation

Later symptoms of MS:

Spasticity of extremities

Cognitive & psychosocial problems: memory loss, decreased concentration

Ataxia (impaired coordination of movement)

Tremor

Emotional changes

Bladder dysfunction

“MS hug”

Partial/ complete paralysis

Speech/ swallowing problems

Which of the following are secondary complications of MS? (Select all that apply)

• UTI

• Diarrhea

• Pressure Ulcers

• Pneumonia

• Osteoarthritis

Answer explanation

Complications are: Constipation NOT diarrhea

Osteoporosis NOT oesteoarthritis

UTI, Constipation, muscle atrophy, pneumonia, depression

What are the 3 criteria in order to make an MS diagnosis?

Evaluate responses using AI:

OFF

Answer explanation

1) Find evidence of damage in at least two separate areas of CNS (brain, spinal cord, optic nerve)

2) Find evidence that damage occurred at least 1 month apart               

3) Rule out other possibilities

Which of the following diagnosis assesses for oligoclonal bands (caused by IgG), which indicates MS?

• Neuro Exam

• MRI

• Analysis of CSF

• Evoked potential tests

Answer explanation

Evoked potential tests - Looks at electrical conduction

A combination of diagnosis results is often necessary to come to a MS diagonsis.

Which statement is false regarding children who get diagnosed with MS?

• 2-5% people have symptoms before 18

• Often experience mental status changes

• Higher late of relapse

• Progresses more quickly

Answer explanation

Juvenile MS progresses more slowly

Which of the following medications reduce the frequency and duration of relapses and number & size of plaques in pts with MS? (Select all that apply)

• Interferon beta Mxs

• Glatiramer Acetate (Copaxone)

• Teriflunomide (Aubagio)

• Mitoxantron (Novantrone)

• Prednisone (Deltasone)

Answer explanation

Immunomodulators reduce frequency and number & size of plaques. The following Mxs are:

- Interfereron beta 1a (Rebif); -- 1b (Betaseron); -- 1-a (Avonex)

- Glatiramer acetate (Copaxone)

- Teriflunomide (Aubagio)

-Dimethyl fumarate (Tecfidera)

Corticosteroids: used for exacerbations: Prednisone (deltasone)

Antineoplastic: suppresses T cells & others that attack myelin. Mitoxantrone (Novantrone)