3: Multiple sclerosis Flashcards
What is multiple sclerosis?
Inflammatory demyelinating disease of the CNS
Multiple sclerosis is more common in (men / women).
women
3:1
At what age do people tend to develop multiple sclerosis?
30s - 40s
Multiple sclerosis is an ___ disease.
autoimmune
What does “disseminated in time and place” mean in relation to multiple sclerosis?
Lesions have to have developed
in different areas of the CNS
at different times
What is pyramidal dysfunction?
Problems affecting the pyramidal tracts i.e the corticospinal tract and corticobulbar tract
What do the
a) corticospinal tract
b) corticobulbar tract
control?
a) Voluntary movement
b) Movement re: cranial nerves
Pyramidal dysfunction causes (motor / sensory) symptoms.
motor symptoms
What are some examples of pyramidal dysfunction caused by multiple sclerosis?
Increased muscle tone
Muscle spasm
Weakness
Tremor
What is optic neuritis?
Inflammation of the optic nerve
What eye problems are caused by multiple sclerosis?
Optic neuritis (inflammation of optic nerve)
Nystagmus
Diplopia
What is the main complaint of optic neuritis?
Painful visual loss
What sign will you see on examination of the eyes of a patient with optic neuritis?
Relative afferent pupillary defect
swinging light test
What sensory symptoms do patients with multiple sclerosis complain of?
Pain
Tingling (paraesthesia)
Numbness
People with multiple sclerosis may lose their sense of proprioception and vibration.
Which sensory pathway is responsible for these?
DC/ML pathway
Which nerve is affected if a patient with MS complains of facial pain?
Trigeminal nerve (CN V)
Which part of the brain, controlling coordination, is affected in MS?
Cerebellum
MS causes cerebellar symptoms.
What is Charcot’s triad of MS?
Dysarthria (slurred speech)
Tremor
Nystagmus
Which cranial nerves are affected if an MS patient complains of
a) diplopia
b) facial weakness?
a) CN III, IV or VI
b) CN VII
Patients with MS will complain of constant ___.
fatigue
Which investigations are used to diagnose MS?
Neuro exam
MRI scan (to pick up lesions)
Lumbar puncture (to examine CSF)
Blood tests (for autoantibodies and to rule out other diseases)
What are the Mcdonald criteria for diagnosing MS?
TWO episodes of symptoms suggesting demyelination
“Dissemination in time and place”
Why is the CSF examined in patients with suspected MS?
‘Oligoclonal bands’ in the CSF is highly predictive of MS
MS can ___ causing acute exacerbations.
flare
How are mild exacerbations of MS treated?
Symptomatic treatment
Baclofen and physio referral for motor symptoms
Gabapentin and amitriptyline for neuropathic pain
Why aren’t normal analgesics e.g paracetamol used in the symptom management of MS?
Not effective for neuropathic pain
How are moderate exacerbations of MS treated?
Oral steroids
Immunosuppressant remember
How are severe exacerbations of MS treated?
Admission to hospital
IV steroids
Which anti-spasmodic drug is used to relieve motor symptoms of MS?
Baclofen
Which AHPs are involved in the management of motor symptoms of MS?
Physiotherapist
Occupational therapist
Which drugs are used to manage the sensory symptoms of MS?
Gabapentin
Amitriptyline
Which class of drug is used to treat urge incontinence caused by MS?
Name an example?
Antimuscarinic
Oxybutynin, Tolterodine
Which illegal drug has been proven to give symptomatic relief in MS?
Cannabis
Which drugs are used to help control
a) motor
b) sensory
symptoms of MS?
a) Baclofen (muscle relaxant)
b) Gabapentin (anticonvulsant), amitriptyline (antidepressant)
Does symptomatic treatment halt the progress of MS?
No
MS progresses in (the same way / different ways) in individual patients.
different ways
Which three immunosuppressants can be used first-line in the treatment of MS?
Interferon beta
Copaxone
Tecfidera
just memorise this like the MSK one
