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?

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)