Approach to MS

Question 1

Multiple Sclerosis

Answer 1

CNS demyelination disorder affecting multiple sites characterized by periods of exacerbation and remission
20-30y most common
F>M
Temperate Zones> Tropical Zones

Question 2

Common symptoms of MS

Answer 2

Paresthesias
Gait disturbance
Weakness

Question 3

4 types of MS

Answer 3

Relapsing Remitting (most common)
Secondary progressive
Primary progressive
Benign

Question 4

What causes MS?

Answer 4

Idiopathic
Some genetic susceptibility related to first degree relatives
2-hit hypothesis from an event or illness in childhood

Question 5

Studies used to diagnose MS

Answer 5

MRI of head, cervical, and thoracic spine looking for ovoid lesions in periventricular white matter

Lumbar puncture looking for oligoclonal bands

Question 6

How do you diagnose MS?

Answer 6

Observance of multiple lesions over space and time

Question 7

Drug examples for maintenance of MS

Answer 7

Interferon

-mabs

Question 8

What is the only drug approved to treat Primary Progressive MS?

Answer 8

Ocrelizumab

Question 9

How do you treat an MS exacerbation?

Answer 9

Steroids

Reduces length of exacerbation, but not damage

Question 10

Clinically Isolated Syndrome (CIS)

Answer 10

episodes of neurological signs that look like MS
Monofocal- 1 neuro sign causes by a single lesion
Multifocal- Acute Disseminated Encephalomyelitis (ADEM)- >1 sign by multiple lesions

Question 11

Diseases that mimic MS

Answer 11

Autoimmune (SLE, Polyarteritis Nodosa) 
B12 def (Megaloblastic Anemia) 
AVMs
Infections
Granulomatous Dz

Question 12

Treatments for the common symptoms of spasticity, intention tremor, Urinary urgency, and urinary retention

Answer 12

Spasticity- Baclofen, benzo, Na blocker, botox
Intention tremor- Propranolol (B blocker)
Urgency- anticholingeric (oxybutinin)
Retention- Cholinergic (bethanechol)

Question 13

Devic’s Disease

Answer 13

Neuromyelitis Optica (NMO)
inflammation and demyelination of optic nerves and spinal cord