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Adult-acquired Neurology - Multiple Sclerosis

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ness37's version from 2018-04-30 10:55

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Question Answer
Defintion Inflammatory, de-myelinating condition (coating that protects nerves) of the central nervous system. Autoimmune disorder, disease of white matter (formation of plagues in white matter of CNS)
Types of MSBenign, relapsing-remitting, secondary progressive, primary progressive
Benign MSMild course, 5-10% of MS patients, sudden onset but absence of relapses (stable disability)
Relapsing-remitting MS80% of case, experience periods of exacerbation (attacks) followed by periods of partial or complete remission (recovery)
Secondary progressive MS50% of cases after 15 years, usually followed by relapsing-remitting course, progressive worsening (accumulation of disability)
Primary progressive MS 20% of cases, slow onset, gradual worsening (without early relapses)
Malignant MS Severe, rapid progression
RelapseThe development of new symptoms or the worsening of existing ones that lasts longer than 24 hours (follows a period of stability)
Symptoms(1) Sensory: Balance and dizziness, fatigue, vision (loss, blurred, double vision) + (2) Motor: stiffness/spasms/spasticity, intention tremor, bladder problems, sexual dysfunction, pain, dysarthria/dysphagia (3) Cognitive: emotions affected (depression), personality changes, difficulty remembering events/to do certain things, concentration and mental speed
Impact70-80% of people will be unemployed 7 years after diagnosis
DiagnosisNo specific test. Based on neurological condition, lumbar puncture (antibodies detected in CSF) EEG, repeated MRIs (spine and brain)
Prognosis Over 80% live 25 years after diagnosis, (life expectancy reduced by 7-8 years), severe disability is a major risk factor for premature death, early age of onset = good remission/better prognosis
CauseNot known, not genetic (but maybe mild genetic susceptibility) more common in places further from the equator (lack of vitamin D?) exposed to Epstein Barr virus in childhood
TreatmentNo cure for MS, corticosteroids used for symptoms during relapse
MDTMS specialist nurse, neurologist, social worker, physio, OT, SLT, Dietician
Implications on speechPresent in 40-50% of people with MS. Ataxic and spastic dysarthria, reduced breath support = reduced speech and endurance, facial paralysis, reduced volume and pitch control harsh/breathy voice quality, hypernasality
Implications on high level language Pragmatic deficit, impaired cognitive flexibility (problems maintaining discourse), reduced inferencing disability
Considerations during assessmentFatigue, visual disturbance, physical disability, mood, cognition, communication needs, AAC
Implications on swallow43% prevalence, secondary symptom of MS, leading cause of mortality (dehydration, malnutrition, aspiration pneumonia)
NICE swallowing guidelinesShould be assessed by SLT, advice given on techniques/food consistencies/diet, specialised seating, NG tube (if having persistent swallowing problems -days) PEG (problems for more than a month)
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