Multiple Sclerosis

What is the typical age range for diagnosis of MS?

20-50 years old

Are males or females more likely to be affected by MS?

Females

What climates have higher MS incidence rates?

Temperate climates

What are the four types of MS as defined in 1996?

Relapsing remitting, primary progressive, secondary progressive, and progressive relapsing

Which phenotype name is being used less and less?

Progressive relapsing

What has research shown progressive relapsing MS to be more appropriately classified as?

Primary progressive in active or non-active state

What is clinically isolated syndrome?

The first episode of neurologic symptoms lasting at least 24 hours

What does clinically isolated syndrome suggest?

Inflammation and demyelination

Will all individuals who experience clinically isolated syndrome develop MS?

No

If MRI for suspected clinically isolated syndrome demonstrates damage in two or more areas, what is different?

Criteria are met for MS diagnosis

What is radiologically isolated syndrome?

MRI abnormalities suggestive of demyelination with no clinical signs or symptoms demonstrated (commonly an incidental finding)

What is the conversion rate of radiologically isolated syndrome to clinically isolated syndrome or MS diagnosis?

30% with median time of 5.4 years

The frequency of exacerbations for relapsing remitting MS typically does not exceed ____ per year

1.5 episodes

Number of relapses in the first _______ of diagnosis influences the median onset of progressive disease.

2 years

Which factors lead to a less favorable prognosis with relapsing remitting MS?

Male, onset >40 years old, frequent early relapses, more lesions demonstrated on MRI, motor/brainstem/cerebellar symptoms first

Which factors lead to a more favorable prognosis with relapsing remitting MS?

Female, onset <40 years old, longer time between first and second relapse, fewer lesions demonstrated on MRI

What is the typical timeframe from onset to use of walking aid with primary progressive MS?

Approximately 7-10 years

What is the effect of primary progressive MS on life expectancy?

Reduced by 5-7 years

Which factors lead to a less favorable prognosis with primary progressive MS?

Male, onset >40 years old, frequent early relapses, more lesions demonstrated on MRI, motor/brainstem/cerebellar symptoms first

Which factors lead to a more favorable prognosis with relapsing remitting MS?

Female, onset <40 years old, longer time between flares, fewer lesions demonstrated on MRI

Do the majority of relapsing remitting MS cases progress to secondary progressive MS?

Yes

What is the median age of transition to secondary progressive from relapsing remitting MS onset?

Approximately 19 years

When is the diagnosis for secondary progressive MS often given?

Retrospectively, several years after progression began

Which factors increase risk of transition from relapsing remitting to secondary progressive MS?

Older age at relapsing remitting MS onset, male, spinal cord symptoms, incomplete relapse recovery

What is required for a true relapse?

New inflammatory demyelination

What is a pseudorelapse?

Temporary worsening of symptoms without new lesions or demyelination

What are common triggers of pseudorelapse?

Heat, stress, excess fatigue, illness

What number of attacks and lesions are required to meet McDonald criteria?

2 attacks and 2 lesions

A patient with 2 attacks and 1 lesion demonstrates what according to the McDonald criteria?

Dissemination in space

A patient with 1 attack and 2 lesions demonstrates what according to the McDonald criteria?

Dissemination in time

A patient with 1 attack and 1 lesion demonstrates what according to the McDonald criteria?

Dissemination in space and time

What does a 0 on Kurtzke’s Expanded Disability Status Scale indicate?

A normal neuro exam

What does a 1-4.5 on Kurtzke’s Expanded Disability Status Scale indicate?

Abnormalities in neuro exam with maintained ability to walk unaided

What does a 5-9.5 on Kurtzke’s Expanded Disability Status Scale indicate?

Abnormalities in neuro exam with walking impairments

What does a 10 on Kurtzke’s Expanded Disability Status Scale indicate?

Death due to MS

What is the “MS Hug” or “MS Girdle”

A sensation of pressure around the chest, ribs, or abdomen often described as a BP cuff tightening around the patient or a crushing sensation

What is an appropriate frequency for strength training in patients with MS?

2-3 times per week

What is an appropriate intensity/weight for strength training in patients with MS?

Heavy enough for 10-15 reps with gradual increasing sets

What is an appropriate frequency for aerobic exercise in patients with MS?

2-3 times per week with gradual increases until 30 minutes of continuous activity are tolerated

What intensity (RPE) should aerobic exercise be for patients with MS?

3-5 on the 0-10 scale; patients should be able to recover to baseline status within 2 hours following exercise