Four hot topics ms (2)
-
Upload
monique-canonico -
Category
Health & Medicine
-
view
247 -
download
3
description
Transcript of Four hot topics ms (2)
![Page 1: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/1.jpg)
When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.
Henri Nouwen
![Page 2: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/2.jpg)
Four Hot Topics:Balance, Fatigue Spasticity and HeadacheMonique M. Canonico DOAssistant Professor, John A. Burns School of Medicine
2014 Lecture Series- NMSS
![Page 3: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/3.jpg)
![Page 4: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/4.jpg)
Overview
Balance Fatigue Spasticity Headache
![Page 5: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/5.jpg)
Balance
Balance issues may affect over 50% of people living with ms
Study was done in 2008 by Cameron et al Tested by SSEPs Subjects with MS demonstrate differences
in the delay in postural response latencies between their two legs
![Page 6: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/6.jpg)
![Page 7: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/7.jpg)
![Page 8: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/8.jpg)
4 Strengthening and Balance Exercises to Try at Home
1 Heel raises/toe raises: Stand up on tippy-toes and hold for 5 seconds, lower, and then rock back on your heels by lifting your toes up, and hold for 5 seconds. Do this 10 to 15 times. 2 Leg balance: Stand on one leg and hold for up to 30 seconds. Add in challenges like raising your arms to the side or holding overhead to make the exercise more difficult. Repeat this on a variety of surfaces, such as tile, carpet, and standing on a foam cushion to strengthen the connections between physical movement and mental association. 3 Foot exercises: Toes and feet play an important role in balancing. Use your toes to pick up small objects, like marbles or tissues, off the floor. This strengthens the calf and intrinsic muscles of the feet. Do this 5 to 10 times on each side. 4 Balance: Walking in a heel-to-toe pattern forward and backward. Take 5 to 15 steps in each direction. As you train, be aware of your MS symptoms. Challenge yourself but do so in a safe environment
![Page 9: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/9.jpg)
What is a pseudoexacerbation?
![Page 10: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/10.jpg)
There is no evidence whatsoever that exercise in persons with MS can lead to an exacerbation. As a matter of fact, in studies of persons with MS who exercise aggressively there was no higher incidence of exacerbation than non-exercisers.
![Page 11: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/11.jpg)
Gratitude is the fairest blossom which springs from the soul.
Henry Ward Beecher
![Page 12: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/12.jpg)
Tai Chi
Tai Chi is a wonderful approach to balance training. The research has been very, very clear that persons with MS, when they use Tai Chi as balance training that it does improve their balance.
![Page 13: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/13.jpg)
Find a place inside where there's joy, and the joy will burn out the pain.
Joseph Campbell
![Page 14: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/14.jpg)
Fatigue
![Page 15: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/15.jpg)
Fatigue: a complex symptom of MS
• Common disabling symptom
• Up to 75% of MS patients affected
• Worst complaint in 14-40% (50-60% ?) of MS patients
• Lack of physical, mental energy
![Page 16: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/16.jpg)
• Tiredness following ordinary exertion
• Unrelated to effort, especially during relapses
• Transient or chronic, isolated or linked to relapses
• By definition, not a relapse by itself
• Circadian pattern
![Page 17: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/17.jpg)
• Interferes with normal activities
• Major limiting factor in social, familial,
professional activities: ↓ quality of life
• Not restricted to relapsing periods
• Not strictly related to the handicap
based on EDSS
• Intensive inpatient rehabilitation trial ↓
fatigue in MS
![Page 18: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/18.jpg)
![Page 19: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/19.jpg)
![Page 20: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/20.jpg)
![Page 21: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/21.jpg)
Fatigue scales
o FSS (Fatigue Severity Scale, Krupp et al., 1989)
o FAI (Fatigue Assessment Instrument, Schwartz et al., 1993)
o FRS (Fatigue Rating Scale, Chalder et al., 1993)
o FIS (Fatigue Impact Scale, Fisk et al., 1994)
•MFI (Multidimensional Fatigue Inventory, Smets et al., 1995)
o FAMS (Functional Assessment of Multiple Sclerosis, Cella
et al., 1996)
o MFIS (Modified Fatigue Impact Scale, MS Council, 1998)
o FDS (Fatigue Descriptive Scale, Iriarte et al., 1999)
o FSMC (Fatigue Scale for Motor function and Cognition,
Penner et al., 2009)
![Page 22: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/22.jpg)
Non-pharmacological approaches to MS fatigue
• Acknowledgement of this MS symptom
• Learning to manage fatigue (practical arrangements in
daily living, adjustments in professional, familial and
social activities)
• Improvement of sleep
• Strategically timed daytime rest
• Regular physical exercise (avoid physical
deconditioning)
• Behavioral therapy (emotions and coping capacity
influence how fatigue is perceived)
• Recognition of favorable factors (e.g. cooling)
• Avoidance of predisposing factors (e.g. heat)
![Page 23: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/23.jpg)
![Page 24: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/24.jpg)
Treatment of MS fatigue
• Amantadine hydrochloride
– Marked or moderate improvement in 47% MS patients vs.
1% controls (Canadian MS Research Group, 1987)
– RA Cohen & Fisher, 1989: improvement in some aspects of
fatigue (energy level, sense of well-being, perceived attention
and memory, problem solving capacity) in 15/22 MS patients
– 100 mg qd or bd
– Caution: hepatic disease, heart failure, edema, hypotension,
seizures, glaucoma
– Adverse events: livedo retic., nausea, headache, insomnia,
dizziness, nightmares, confusion, edema, orthostatic
hypotension
![Page 25: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/25.jpg)
Treatment of MS fatigue
• 4-aminopyridine (more effective than 3,4-AP), K+
channel blocker (Polman et al, 1994; not confirmed by
Rossini et al, 2001)
– Side effects: headedness, abdominal pain, confusion,
seizures
• Fampridine (4-AP prolonged release, 10 mg; Goodman AD
et al, 2009)
– Improvement of walking ability, speed
– Contra-indications: epilepsy,heartdisorders – Review
process ongoing in Switzerland
![Page 26: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/26.jpg)
Treatment of MS fatigue
• Modafinil 200 mg/day
(Rammohan et al, 2002; Stankoff
et al, 2005; un-/–
Recommendation: 100 mg qd or
bd
– Side effects: agitation,
dizziness, headache, insomnia,
diarrhea, arrhythmia,
hypertension
– Caution: cardiovascular
disease, oral contraceptives
![Page 27: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/27.jpg)
Treatment of MS fatigue
• Aspirin 1.3 g/day (Wingerchuck et al,
1998; 2005)
– Tested vs. placebo in 30 MS patients;
benefit of aspirin measured by the MFIS
and patient preference
• Randomized 3-arm study (Oken et al,
2004) suggests that:
![Page 28: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/28.jpg)
– Participation to either yoga or
exercise class for a 6 month
period reduced the severity of
fatigue compared with a waiting
list control group
![Page 29: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/29.jpg)
![Page 30: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/30.jpg)
Spasticity
![Page 31: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/31.jpg)
Spasticity
stiffness of the limbs resulting from increased muscle tone
Results from demyelination that occurs in nerves that regulate muscle tone. It most frequently affects the group of muscles known as the antigravity or postural muscles, which include the calf muscles, thigh, buttock, groin, and back.
![Page 32: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/32.jpg)
-people with MS who are affected by weakness in the leg muscles, may find mild stiffness helpful in standing and moving. People often experience a worsening of stiffness the more quickly they move their limbs. So, one rule of thumb with spasticity is to move slowly and steadily.
![Page 33: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/33.jpg)
![Page 34: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/34.jpg)
Spasticity
84% are reporting at least some symptoms of spasticity
• 30% are suffering from moderate to severe symptoms
• 1/3 are modifying or discontinuing daily activities because of spasticity
• only 38% are taking medications to control their spasticity (60% DMT)
![Page 35: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/35.jpg)
Spasticity
![Page 36: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/36.jpg)
Spastic Syndromes in MS
Variable distribution- affects both upper and lower limbs
Decreased muscle tone of trunk Changing degree of spasticity depending
on activity, posture and time of day Combined with ataxia
![Page 37: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/37.jpg)
Factors Increasing Spasticity • infections (urinary a.m.)
• pressure sores• pain (even if not perceived by patient)• thrombosis• bladder disturbances, obstipation• fatigue• temperature (heat, cold)• posture (sitting in wheel-chair, supine position)
• emotional stress, anxiety
![Page 38: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/38.jpg)
Tips from Others: Cramps
Muscle cramps can be helped by adding potassium: Melon is a good source.
organic, unfiltered apple cider vinegar made into a drink is also very helpful
Eat bananas and broccoli
![Page 39: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/39.jpg)
Cramps: Tips cont.
Potassium, hydrate with an electrolyte. Gatorade, or Nuun. Hammer makes a product called Endurolytes as well.
Drink healthy teas. Gatorade (as long as the cramps
are not bad), soma for bad cramping Stay hydrated! Pickle juice is great…Old natural
remedy
![Page 40: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/40.jpg)
Cramps: Tips cont.
tonic water. It is the quinine in the tonic water that makes them go away. Diet tonic is horrible, go for the real stuff.
For the Dysesthesias that can involve a girdle band-like pressure, drink any hot liquid. This causes me severe sudden pain and this is the only way that I can get relief but it helps instantly
![Page 41: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/41.jpg)
Cramps: Tips cont.
For bad pain make a massage oil from 2 tea bags and 1/2 cup of canola oil that has been sitting in the sun for a day either out-side or on windowsill. You can use whatever teabags you want. For pain treelike peppermint
![Page 42: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/42.jpg)
Cramps Tips Cont.
Meditate on the muscle that is cramped Deep breathing Ice packs
![Page 43: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/43.jpg)
Meds
Flexeril Robaxin Valium (night) Baclofen Gabapentin dantrolene Magnesium Voltaren cream
![Page 44: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/44.jpg)
Neurotoxin injections
Pros• effect limited to treated muscles • no effect on other muscle groups, no generalized side-effects • well tolerated
Cons ● invasive ● limited to few
muscle groups ● increased
weakness ● transient effect ● high costs
![Page 45: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/45.jpg)
![Page 46: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/46.jpg)
![Page 47: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/47.jpg)
![Page 48: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/48.jpg)
![Page 49: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/49.jpg)
Headache
![Page 50: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/50.jpg)
Headache
Headache is a common problem for people living with multiple sclerosis (MS) - many report suffering from migraine and/or tension type headache. A survey focusing on migraine in people with MS noted that 41% met the study criteria for migraine, compared with about 10% of Canadians in the general population.
![Page 51: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/51.jpg)
MS patients with headache tend to have developed MS at an earlier age, and to have significantly higher rates of relapses and pain-related complaints compared to those who don't have headache. Migraine seems to occur more often in younger people with relapsing-remitting MS, while a smaller proportion of tension-type headache tends to affect individuals who are older, male, and have secondary progressive MS.
![Page 52: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/52.jpg)
Despite the link between MS and migraine, it is not clear if headaches exacerbate MS, or if MS contributes to migraine-like headaches.
![Page 53: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/53.jpg)
Studies comparing MRI scans of MS patients with headache to those with no headache have observed a non-significant association between a greater number of mid-brain plaques and an increased likelihood of headaches, especially headaches with migraine characteristics.
![Page 54: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/54.jpg)
What Type is Your Headache?
Tension Cluster MIGRAINE
![Page 55: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/55.jpg)
Tension
Less common Temporal areas Treat with anti inflammatories
![Page 56: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/56.jpg)
Cluster
100% on ONE side Males older drinkers Night Severe
![Page 57: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/57.jpg)
Migraine
With aura 15% Without aura 85% Usually have one side more common Throbbing 4 hours to many days nausea Light sensitivity Try triptan
![Page 58: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/58.jpg)
Migraine Triggers
Food Wine Smells Sleep deprivation Stress Hormonal changes Vog
![Page 59: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/59.jpg)
MS medications and headache!It is not clear as to whether or not the class of interferon beta (IFNB) medications increase the frequency and duration of headache. Some studies have noted newly devil- oped headaches or an increase in existing headaches in individuals when they begin taking an IFNB for MS, while other studies have seen no difference in headache between patients taking and not taking IFNBs. Studies of headache in patients taking COPAXONE® (glatiramer acetate) or an INFB have suggested that the increase in headache seen with IFNBs compared with COPAXONE® may be due to the different brain pathways used by these drugs.
![Page 60: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/60.jpg)
Migraine Treatment
Herbals
magnesium 800 mg a data
B2 400 mg a day
Butterbur extract
-Triptan for rescue
-Preventives
![Page 61: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/61.jpg)
Review
Balance Fatigue Spasticity Headache
![Page 62: Four hot topics ms (2)](https://reader033.fdocuments.us/reader033/viewer/2022060121/5594395a1a28ab247c8b4695/html5/thumbnails/62.jpg)
Love Story