Multiple Sclerosis (MS)

fatigue

40% of people with MS state that ____ is the most disabling symptom

D

Lack of Vitamin ___ is being investigated as a potential factor contributing to disease development

strength

Lower body ____ training can improve walking mechanics with significant increase in step length, decrease in double-limb support phase and improved disability scores

optic

MS is a chronic, inflammatory disease of brain, ___ nerve, and spinal cord mediated by immune system

32

MS is most commonly diagnosed between 25-50 with an average age at diagnosis of ____

infectious

Many researchers believe that exposure to an ____ agent may trigger the MS disease process

symptom

Medical management of MS has two major goals: long term management of disease/exacerbations and ___ management

detrusor

Neurogenic ___ muscle overactivity is the most common urological impairment in people with MS

1.0

No disability, minimal signs/symptoms

0

Normal neurological exam findings

cardiotoxicity

Novantrone (mitoxantrone) may have a side effect of ____; risks may outweigh clinical benefits, especially in early course of disease

infusion

Novantrone (mitoxatrone), Tysabri (natalizumab), and Lemtrada (aletuzumab) are all DMAs that are administered via ____

inflammation

One study showed reduced markers of _____ with exercise; indicating that exercise can have a neuroprotective effect and should occur early in course of disease, not only after clinical disability has occurred

10

The Kurtzke Expanded Disability Status Scale (EDSS) quantifies disability in MS, scores range from 0 to ____

infectious

The etiology of MS is largely unknown but likely multi-factorial: combination of environmental, genetic and ____ factors

contraindicated

The flu vaccine is OK, but other live vaccinations may be ____ in people with MS being treated with disease-modifying therapies

injections

The majority of DMAs require ___ however in 2010 the FDA approved the first oral DMA, fingolimod

T2

___-weighted MRIs able to detect both old and new lesions

avonex

____ (interferon beta-1a) is an injected DMA used in patients with RRMS or SPMS that still have relapses and is shown to reduce relapses, slow disability progression, and improve QoL

optic neuritis

____ ____ is the most common problem of the visual system and is often the first symptom of MS, can produce blurry or double vision, painful eye movements, spontaneous nystagmus, etc

sexual

____ dysfunction affects about 40-85% of women with MS and 50-90% of men

visual

____ evoked potentials are the only type proven useful in diagnosing MS

visual

____ evoked potentials, where the subject observes an alternating checkerboard pattern, identifies pathologic transmission along optic nerve pathway

primary, secondary

____ fatigue is caused by effects of demyelination/axonal destruction whereas ___ fatigue results from problems such as deconditioning, infections, sleep disturbances, and poor nutrition, medication side effects, and heat intolerance

smoking

____ increases the risk of developing MS and increases the progression of the disease

depression

____ is present in 26-50% of people with MS with suicide rates significantly higher than in rest of population

ataxia

____ is present in up to 80% of patients with MS and can occur from disturbances in vestibular system, in cerebellum, or from loss of proprioception

Uhthoff

____ phenomenon is a temporary worsening of MS related problems associated with an increase in core body temperature; can be physical exertion or change in environment

bowel, bladder

____ problems (35-68%) and ____ problems (52-97%) are common in MS, with urinary urgency, nocturia, or retention of urine or feces; incontinence of either system can also occur

female

____ sex or longer disease duration are both associated with higher prevalence of spasticity, which is highly correlated with patient-reported disability and poorer quality of life

vestibular

____ system involvement is present in about 20% of patients with MS, presents as dizziness and/or vertigo

progressive-relapsing

____-____ MS is the least common form (5%) and is characterized by a steady worsening of symptoms with intermittent acute flare ups

primary-progressive

____-____ multiple sclerosis is less common, affecting only 10-15% of people with MS and has a slow onset but continuous worsening of neurologic symptoms without relapses or remissions

relapsing-remitting

____-____ multiple sclerosis is marked by temporary relapses lasting 1-3 months; remissions between attacks may be complete or partial with typically no worsening neurological function

relapsing-remitting

____-____ multiple sclerosis is the most common initial presentation of MS (80%)

secondary-progressive

____-____ multiple sclerosis is usually the second phase of RRMS and is characterized by slow, steady, progressive worsening of symptoms

T1

____-weighted MRIs detect active inflammation

cognitive

_____ impairment is present in 40-70% of people with MS with verbal fluency and verbal memory being affected early in the disease process

FLAIR

_____ is an MRI sequence that suppresses the effects of CSF on the image, which can highlight periventricular lesions

progression

Time to onset from RRMS to SPMS phase could indicate speed of ____ of SPMS

18

About 2-10% of all cases of MS are diagnosed before the age of ____

secondary-progressive

Approximately 90% of people with relapsing-remitting MS transition to ____-____ MS after 20 years or around 40 years of age

neurodegenerative

As MS progresses, it becomes less of an inflammatory condition and more ____

neurodegenerative

As disease progresses, inflammation becomes uncommon while demyelination and axonal loss continues, suggests replacement by a ____ disease process

orally

Aubagio (teriflunomide), Gilenya (fingolimod), and Tecfidera (dimethyl fumarate) are all DMAs that are taken ___

injection

Avonex, bestaseron, copaxone, and rebif are all DMAs that are administered via ____

speed

Balance-based torso weighting such as the BalanceWear may increase gait ____ and improve TUG scores

infection

Before diagnosing a relapse, ____ must be ruled out

aquatic

Benefits of ____ therapy include buoyancy (offloads varying amounts of body weight, requires less energy), viscosity (resistance from water to build strength), thermodynamics (total body cooling to offset temperature elevation)

axons

Both white and gray matter are involved; areas of demyelination and damage to ___ interfere with normal conduction of neural signals, leading to disruption of function

oligoclonal

CSF analysis can show elevated levels of IgG antibodies, presence of ____ bands, and certain proteins common with breakdown of myelin

fatigue

Community-based classes on ____ management/energy conservation resulted in immediate post-course improvements in fatigue that were still present at 1 year in a randomized controlled trial

early

DMAs are more effective in ____ stages of the disease as there is more of an inflammatory process involved

relapses

DMAs have been shown to reduce the number and severity of ____, reduce the development of new areas of inflammation, and delay the progression of disability

first

Damage to the optic system is a common ____ symptom in MS

immune

Disease modifying agents (DMAs) are aimed at reducing ____ system dysfunction, thereby reducing damage to neural tissue

heat

Due to ___ intolerance, exercise should incorporate intermittent rest periods that allow heat to dissipate

disability

During a study on the impact of fatigue, individuals with high levels of fatigue also exhibited greater impairments in functional mobility, depression, and physical/mental quality of life, however ____ was not found to be related to level of fatigue

disease modifying

Early after diagnosis with clinical isolated syndrome or MS, it is recommended that people take ____ ___ agents

white

Early in course of disease, focal inflammatory ____ matter lesions are composed of immune system components that produce demyelination, axonal injury, and loss of oligodendrocytes

quality, 6

Highly recommended measures for inpatient and outpatient settings (but not acute): MS ____ of Life (MS-QOL 54) and ____ Minute Walk Test

low

Exercise is beneficial in MS, regardless of type; ___ intensity may be better tolerated with decreased adverse events, number of withdrawals, and increased attendance

cough

Expiratory pressure is important as a strong ____ is necessary for fluid clearance and to reduce risk of aspiration

clinical

Findings with a CSF analysis are not specific to MS and not all individuals with MS have CSF abnormalities; CSF analysis should be considered as part of a larger ____ picture

baclofen

First-line medical treatment of spasticity in MS is ____ or gabapentin

outpatient, dizziness, functional composite

Highly recommended outcome measures for ____ setting only: ____ handicap inventory and MS ____ _____

walking, 9, Berg, Impact, 25, Cognitive

Highly recommended outcome measures for all settings (acute care, inpatient, outpatient) include the 12 Item MS ___ scale, ____ hole peg test, ____ Balance Scale, MS ____ Scale, Timed ____ Foot Walk, and TUG with ____ and Manual Tasks

prednisone

For relapse or exacerbation management, corticosteroids such as ____ may be administered orally or via IV

hereditary

Genetic influence: MS is not considered a ____ disease, but there is a higher risk among those with a parent/sibling with MS

complications

Goals for rehab in patients with MS are to maximize/maintain function and prevent ____ so patient can participate fully in all aspects of life

inspiratory

In MS, ____ muscle training is effective in increasing pulmonary function in those with mild to moderate disability

temporary

In MS, it is surprisingly common to have symptoms including increased fatigue, visual disturbances, increased sensory symptoms, and reduced physical function after exercise; however symptom increase is a ____ phenomena with vast majority resolving in 1 hour

demyelination

In MS, there are lesions of disseminated focal ___ accompanied by variable axon damage and reactive gliosis, leading to scar tissue (plaque/sclerosis)

lumbar

In a CSF analysis, CSF is obtained via a ___ puncture

5

In addition to ambulation, consideration is given to 8 Functional Systems which are scores from 0 to ___ (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral/mental, other)

50

Increased falls are common in MS with ___% reporting falling on or more times in previous 6 months

vaccines

Infectious diseases may trigger an exacerbation- try to minimize risk; although safe to use flu shot, hep B, varicella, tetanus, and BCG ____ but should be delayed during clinically significant relapses

Lhermitte's

Initial clinical presentations include: loss or reduction of vision of 1 eye with painful eye movements, double vision, ascending sensory disturbance and/or weakness, problems with balance, or altered sensation traveling down the back when bending neck forwards (____ sign)

clinical isolated syndrome

Initial neurological episode is typically defined as ___ ___ ___; symptoms must last for 24 hours and can be monofocal or multifocal; if lesions are present on MRI there is a high risk of developing MS

expiratory

Inspiratory muscle training can have a positive effect on ____ pulmonary function measures such as FVC, FEV1, FEV1/FVC and FEF (the ability of a person to inhale impacts their ability to exhale)

medial longitudinal fasciculus

Intranuclear opthalmoplegia is caused by demyelination of the ___ ____ ____ in the brainstem, results in impairment in lateral gaze (affected eye is limited in adduction)

2.0

Minimal disability

multiple sclerosis

Most common inflammatory condition of CNS and primary cause of non-traumatic disability in young and middle-aged adults

gray

Motor, sensory, and cognitive disability that accumulates in advanced stages appears to be associated with cortical ___ matter pathology

primary-progressive, older

Negative prognostic factors include ___-____ MS, ____ age at onset, males, African American, early cerebellar or pyramidal signs (motor, sphincter), smoking, low Vitamin D levels

primary-progressive

People tend to be older when diagnosed with ___-___ MS (late 30s or early 40s) with fewer abnormalities on brain MRI; respond less favorably to standard MS therapies; progressive myelopathy is commonly associated

smoking

People with MS should avoid ____

relapsing-remitting, one

Positive prognostic factors include ____-____ MS and only ___ symptom at onset

3-6

Pregnancy does not increase the risk of progression of disease; relapse rates may reduce during pregnancy, increase ___-___ months after childbirth before returning to normal levels

6

Prognosis: life expectancy is shortened approximately ___ years compared to individuals without MS

obstructive

Pulmonary issues in MS tend to be (obstructive/restrictive) and even in less disabled population, the pulmonary muscles can be weak with both the maximum inspiratory pressure and maximum expiratory pressure decreased

multifocal

Risk of more rapid disease progression include ___ disease at onset, shorter time between 1st and 2nd attacks, frequent attacks in first 5 years

independently

Stages 0-4.5 of the EDSS individuals are able to walk ____

ambulation

Stages 5.0-9.5 of the EDSS are characterized by impairments in ____

fatigue

Studies have shown that exercise does not worsen and possibly improves ____

Uhthoff

The neuroblockade hypothesis may explain ____ phenomenon; rise in temperature decreases nerve conduction in partially demyelinated fibers

farther from

There is a higher frequency of MS in people who live (closer to/farther from) the equator

atrophy

There is less inflammation, but greater amount of brain ___ in people with secondary-progressive MS

CSF

Updated diagnostic criteria for MS includes MRI, visual evoked potentials, and ____ analysis

men

Women are 2-3 times more likely to be diagnosed with MS and ____ are more likely to have aggressive disease progress and worse prognosis