3: Multiple Sclerosis Flashcards
Define multiple sclerosis
Chronic auto-immune condition characterised by demyelination of central nervous system
What age does MS occur
20-40 years
In which gender is MS more common
Female (3:1)
What is the stereotype for MS
Young Female
In which ethnicity is MS more common
White
What is a genetic RF for MS
HLADR2
What are three environmental RF for MS
- Infection: EBV, HHV6
- High Latitude
- Vitamin D Deficiency
What infections increase risk of MS
EBV, HHV6
What are the 4 types of MS
- Primary progressive
- Relapsing-Remitting
- Secondary progressive
- Progressive -relapsing
What. % of MS is relapsing remitting
85
Explain relapsing-remitting MS
Attacks cause disability, then recovery in-between attacks. Individual nerve fully gains level of full function
Explain secondary progressive
Starts as relapsing-remitting and then attacks become continuous = secondary progressive
What is primary progressive
One continuous attack from the start
What is progressive-relapsing
Constant immune attack with worsening episodes super-imposed
What is a general symptom of MS
Lethargy
What are visual symptoms of MS
- Optic Neuritis
- Marcus Gunn Pupil
- Intranuclear ophthalmoplegia
- Uhthoff’s phenomenon
What is typically first manifestation of MS
Optic Neuritis
How does optic neuritis present
Loss of colour vision
What is Uhtoff’s phenomenon
Visions/Symptoms MS worsen in the head
What causes intranuclear ophthalmoplegia
Damage to medial longitudinal fasiculus
Explain intranuclear ophthalmoplegia
(Defect right eye)
- When looking right eye movements normal
- When looking left. Left eye can abduct. The right eye is unable to adduct. Difference in eye position causes diplopia
What pupil is present in MS
Marcus gunn
Explain marcus gunn pupil
RAPD:
During swinging light test.
Damage to afferent of affected eye
When shining light into affected eye will paradoxically dilate, opposed to constrict, as consensual reflex from other eye is stronger
What are 3 sensory symptoms associated with MS
- Lhermitte’s sign
- DCP
- Bilateral trigeminal neuralgia
What is Lhermitte’s sign
Electric shock type pain down the spine on flexing the neck
What motor symptoms are present in MS and why
Spastic weakness
Hyper-reflexia
Spasticity
Upgoing plantar
= due to UMN lesion
What are other signs of MS
- Urinary incontinence
- Sexual dysfunction
- Intellectural deterioration
What is Devic Syndrome
Transverse myelitis and optic atrophy
How does transverse myelitis present
Transverse myelitis (Loss Motor, Sensory and vision below lesion)
What causes Devic syndrome
Anti aquaporin 4 antibodies
What is Charles Bonnet Syndrome
When individual looses vision - develops very vivid hallucinations
What is pulfrich effect
Unequal eye latencies - causes straight lines to appear curved. Commonly presents as disorientation in traffic
What is argyll-robertson pupil
Small irregular pupils that can accommodate but do not respond to light
What criteria is used to diagnose MS
McDonal Criteria
What is required to diagnose MS using McDonal Criteria
Two lesions disseminated by space and time
What is criteria for ‘attacks’
1h duration
30d between attacks
What investigations are ordered for MS
Visual evoked potentials
MRI
LP
What is seen on visual evoked potentials
Delayed transmission
What is seen on MRI in MS
periventricular plaques
What is seen on LP in MS
Oilgoclonal bands
What lifestyle advice is given for MS
Smoking cessation
Reduce stress
Regular exercise
What is given for acute attacks in MS
Oral prednisolone
Explain oral prednisolone in MS
Helps reduce length of attacks it does not help an individual return to baseline
What are 4 disease modifying therapies in MS
- B-interferon
- Glatamir acetate
- Natalizumab
- Fingolimod
What is MOA of natalizumab
a4b1 integrin antagonist
What is MOA of fingolimod
sphingosine-1-phosphate receptor modulator
What should all patients starting natalizumab be offered before and why
JC virus test. As it can be re-activated on treatment with natalizumab
What causes progressive multifocal leucoencephaloapthy
JC virus
How is fatigue managed in MS
Amantadine
CBT
How is spasticity managed in MS
Baclofen
Gabapentin
- Botox
- Cannabis
- Physio
How is bladder dysfunction assessed in MS
Bladder USS
If residual volume is more than 500ml what is offered
Intermittent self-catheterisation
If residual volume is less than 500ml what is offered for bladder dysfunction
Anti-cholinergic
How is oscillopsia managed in MS
Gabapentin
