192. Multiple Sclerosis

Question 1

What is multiple sclerosis (MS)?

Answer 1

An immune-mediated inflammatory disease leading to the demyelination of axons in the central nervous system (CNS)

MS arises from a combination of genetic susceptibility and environmental triggers.

Question 2

What are the primary agents responsible for the pathogenesis of MS?

Answer 2

Autoreactive lymphocytes

They are thought to be the main contributors to the disease process.

Question 3

What are the common disease patterns of MS?

Answer 3

• Relapsing-remitting MS (RRMS)
• Secondary progressive MS (SPMS)
• Primary progressive MS (PPMS)

These patterns differ in rates of progression and prognoses.

Question 4

How are attacks of MS defined?

Answer 4

Episodes of focal neurologic disturbance lasting no longer than 24 hours after a period of clinical stability.

Question 5

What does Charcot’s neurologic triad consist of?

Answer 5

• Dysarthria
• Nystagmus
• Intention tremor

These symptoms are characteristic of MS.

Question 6

What is dysarthria in the context of MS?

Answer 6

Difficult or unclear speech due to plaques in the brainstem after demyelination.

Question 7

What is nystagmus?

Answer 7

Involuntary and rapid eye movements.

Question 8

What causes painful optic neuritis in MS patients?

Answer 8

Plaques on the optic nerve.

Question 9

What characterizes secondary progressive MS (SPMS)?

Answer 9

Initial relapsing-remitting course with continuous progression even between acute exacerbations.

Question 10

What is the main characteristic of primary progressive MS (PPMS)?

Answer 10

Steady progression of disability throughout a patient’s lifetime.

Question 11

What is the gold standard test for diagnosing MS?

Answer 11

Magnetic resonance imaging (MRI).

Question 12

What are characteristic MRI findings in MS?

Answer 12

Lesions in white matter areas that are hyperintense on T2-weighted imaging and ovoid in shape.

Question 13

What is the recommended therapy for patients diagnosed with MS?

Answer 13

Disease-modifying therapy as soon as possible.

Question 14

Which immunomodulatory agents have shown high effectiveness in reducing MS relapse rates?

Answer 14

• Natalizumab
• Ocrelizumab
• Alemtuzumab

These agents have been shown to decrease relapse rates and slow accumulation of brain lesions.

Question 15

What are some oral therapies for MS?

Answer 15

• Dimethyl fumarate
• Teriflunomide
• Fingolimod
• Cladribine

These therapies come with a risk of severe lymphopenia.

Question 16

What is the treatment of choice for acute exacerbations of MS?

Answer 16

Glucocorticoids.

Question 17

What should be assessed during a preoperative evaluation for MS patients?

Answer 17

Type of MS, acute exacerbation status, current medications, and degree of neurologic damage.

Question 18

What can increase the risk of postoperative ventilation in MS patients?

Answer 18

Perceived compromise of diaphragmatic and intercostal muscle power.

Question 19

What is a recommended initial pain management strategy for MS patients?

Answer 19

Nonopioid, nonsedating analgesic systemic therapy, such as NSAIDs/acetaminophen.

Question 20

What are potential concerns with neuraxial techniques in MS patients?

Answer 20

Local anesthetics may exacerbate MS symptoms due to similarities with oligopeptides in CSF.

Question 21

True or False: Intravenous lidocaine has been associated with worsening MS symptoms.

Answer 21

True.