Dysphagia o Bowel incontinence o Constipation Musculoskeletal o Fatigue o

Dysphagia o bowel incontinence o constipation

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DysphagiaoBowel incontinenceoConstipationMusculoskeletaloFatigueoWeaknessoAtaxic Movements oSpasticityoFoot DropNeurooEmotional labilityoScanning SpeechoImpaired judgmentSensoryoBlurred visionoNumbness/ParesthesiaoDiminished sense of temperatureReproductiveoLoss of sensationMales – impotenceDiagnosis of MSSymptomso2 or more episodes lasting 24 hours separated by one monthoExacerbations & remissions with worsening of symptoms over 6 months ORoGradual worsening of symptoms without recovery over 6 monthsLP – CSF shows increase in proteinMRI – lesions visibleoShows lesions that aren’t normally seen on CT scanoActually measures the size of lesionsTreatment of MSDisease Modifying Drugs*S/E: flu-like symptoms 24-48 hrs, but subside within 2-3 monthsDrugs that modify course of the Disease:oAvonex (Interferon beta 1-a)IM Q weekoBetaseron (Interferon beta 1-b)SC Q other DayoCopaxone (Glatiramer acetate)SC QDoRebif (Interferon beta 1-a)SC 3 times a weekoTysabriEvery four weeks by IVInfusion in a registered infusion centerTreatment for ExacerbationsSolu-Medrol (methylprednisolone) oMost commonly used corticosteroids in MSoShortens duration of relapse by its anti-inflammatory effectsPlasmapheresis (Plasma Exchange) oOnly considered for the 10% or so who do not respond to the standard steroidsPlasmapheresisBlood is cycled through a machinePlasma portion of the blood is separated and removedThis removes harmful antibodies – ImmunoglobulinsPlasma is replaced with plasmanate, NSS or albumin. Symptom Treating DrugsBaclofen (Lioresal) – spasticity or diazepamAmitriptyline (Elavil) – pain/paresthesiaBupropion (Wellbutrin) – depression/fatigueOxybutynin (Ditropan) – bladder dysfunctionAtaxia treated with: Neurontin – antiseizure med.Inderal – beta adrenergic blockersKlonopin – benzodiazepines Goals of TreatmentPromotion of physical mobilityAvoidance of injuryAchievement of bowel and bladder continenceImprovement in cognitive functionPromotion of speech and swallowing mechanismsDevelopment of coping strengthsImproved home maintenanceAdaptation to sexual functionCollaborative ManagementPromote mobility / water exercisePromote nutrition Promote rest and comfort measuresEducationoBladder/Bowel trainingoAvoidance of infection2
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Degenerative Neurologic DisordersoAvoidance of heat/humidityMyasthenia GravisOverviewAutoimmune diseaseAntibody mediated destruction of acetylcholine receptors at the neuromuscular junctionCan occur at any ageRisk Factors:Peak incidence in the 20 to 30 age rangeThree times more common in womenClinical ManifestationsInitial Symptoms in 50% of pts.:oPtosis – drooping of upper eyelidoDiplopia – double visionAs disease progresses additional symptoms appear:oDifficulty chewing or swallowingoProximal extremity weaknessoRespiratory muscle weakness (May require mechanical ventilation)o
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  • Fall '19
  • muscle weakness, Myasthenia gravis

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