10. Clinical Approach to MS

Question 1

What is a disorder of the brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbations and remissions), which result from LOSS of nerve tract insulation at multiple sites in the CENTRAL nervous system (aka demyelination)?

Answer 1

Multiple Sclerosis

Question 2

Multiple Sclerosis patients can present with any neuro symptoms but MC include paresthesia (tingling), gait disturbance, weakness, visual loss (optic neuritis), urinary difficulty, dysarthria and?

Answer 2

Hemiparesis

Question 3

There are 4 types of MS, relapsing remitting is the MC kinda (50%), primary progressive (15%) has no exacerbations or remissions, Benign MS (15%) may have one flare dx as MS in 25 years, and what type of MS begins their disease process in the relapsing remitting category, and is a steady downhill fall- some pt still have occasional relapses = relapsing progressive?

Answer 3

Secondary Progressive

Question 4

MS is a disorder of the Central nervous system CNS, most patients are dianosed in their 20-30s, it is characterized by periods of exacerbation and remission, no single test can confirm the dx of MS however what can be used to help make the dx?

Answer 4

Multiple studies

Question 5

MS cause is unknown, some genetic susceptibility 5% chance if first degree relative, perhaps childhood illness that sensitizes immune system to attack CNS myelin. It affects women more than men, women have a more favorable course, onset between 15-50, earlier onset is associated with a?

Answer 5

more prognostic feature (unless diagnosed very young- then usually bad)

Question 6

MS is LESS common in tropical/warmer zones as compared to cold climates (Minnesota higher chance than Floridian), pts are usually born during spring months and conceived during the winter, and there is a link with vitamin D. Studies used for diagnosis include MRI of head of C and T of spine where one can see ovoid lesions of high signal on T2WI in the periventricular white matter and in the spinal cord, what might enhance?

Answer 6

Acute/recent lesions may enhance after admin of IV gadolinium

Question 7

It is normal to see ovoid lesions near the lateral ventricles- you know its associated with MS, a lumbar puncture of the CNS fluid should be done, in which you will see increased IgG index/synthesis rate compared to it in the blood, along with what bands?

Answer 7

Oligoclonal Bands in the CSF

Question 8

IMP: MS is diagnosed by multiple lesions over space and time

Answer 8

MEOW

Question 9

Drugs for maintenance in MS are used to decrease the frequency and severity of exacerbations and slow the progression of the disease aka disease modifying meds, which include meds ending in mod and -mab (monoclonal ab) and what?

Answer 9

interferon**

Question 10

Most of the medications ending in mod/mab and with interferon are used in patients with relapsing forms of MS (not primary progressive), except for which drug, which is the only med approved to treat primary progressive MS (PPMS) in addition to relapsing forms of the disease?

Answer 10

Ocrevus (ocrelizumab)

Question 11

medication used to treat an acute exacerbation in MS is high dose corticosteroids such as methylprednisolone 1G IV for 3-5 days which helps with reducing the length of exacerbation, what can be used in patients who do not tolerate steroid treatment?

Answer 11

ACTH gel or IVIg

Question 12

Clinically isolated syndrome CIS can either be one of two episodes. A monofocal episode is when the person experiences a single neurologic sign or symptom thats caused by a single lesion (optic neuritis). What type of episode is aka Acute Disseminated Encephalomyelitis (ADEM) in which the pt experiences more than one sign or symptom caused by lesions in more than one place BUT ONLY ONE TIME?

Answer 12

Multifocal Episode ADEM

Question 13

Patients with clinically isolated syndrome CIS, have a high risk of developing MS, when they have multiple demyelinating lesions on MRI, they have 60-80% chance of developing MS in a few years, a low risk of developing MS is associated with?

Answer 13

lack of multiple demyelinating lesions on MRI (20 still develop MS)

Question 14

Other conditions that can mimic MS include autoimmune disease such as SLE, CNS vasculitis, Polyarteritis Nodosa, Devics disease (neuromyelitis optica), B 12 deficiency, lymphoma, leukemia, spinocerebellar ataxias, vascular malformation, infections *HIV/syphilis, and a granulomatous disease such as?

Answer 14

Sarcoidosis

Question 15

Symptom management treatment is common, note: it is not disease modifying meds… all of the following meds are used for what sx?
baclofen, tizanadine, diazepam, carbamazepine, BoTox, dantrolene

Answer 15

Spasticity

Question 16

Symptom management treatment is common, note: it is not disease modifying meds… all of the following meds are used for what sx?propranolol, primidone, clonazepam

Answer 16

Intention Tremor

Question 17

Symptom management treatment is common, note: it is not disease modifying meds… all of the following meds are used for what sx? Oxybutinin, detrol LA

Answer 17

Urinary Urgency (spastic bladder)

Question 18

Symptom management treatment is common, note: it is not disease modifying meds… all of the following meds are used for what sx? bethanechol

Answer 18

Urinary retention/hesitancy

Question 19

Symptom management treatment is common, note: it is not disease modifying meds… all of the following meds are used for what sx? carbamazepine, oxcarbazepine, gabapentin, phenytoin, baclofen

Answer 19

Painful Dyesthesias (stingy/tingly feeling)

Question 20

Symptom management treatment is common, note: it is not disease modifying meds… all of the following meds are used for what sx? Amantadine, modafinil, armodafinil, bupropion, methylphenidate, pemoline, exercise

Answer 20

Fatigue

Question 21

What disease is aka neuromyelitis optica NMO and is considered a variant of MS, characterized by inflammation and demyelination of optic nerves and spinal cord (often LONG segments of cord), but SPARES the brain, test for NMO/aquaphorin antibodies in CSF/blood to dx, tx is steroids and more commonly plasma exchange with immunosupression (rituxumab MC)?

Answer 21

Devic’s Disease/Neuromyelitis Optica Spectrum Disorder NMOSD