Approach to Multiple Sclerosis

Question 1

Patients with MS can present with many neuro symptoms. List 4.

Answer 1

• Paresthesias
• Gait disturbance
• Weakness
• Optic Neuritis

Question 2

What is MS?

Answer 2

Multiple lesions over space and time

– due to myelin loss in CNS

Question 3

Multiple lesions over space and time

Answer 3

Multiple Sclerosis

Question 4

What is the most common type of MS?

Answer 4

Relapsing Remitting = periods of exacerbation and remission

Question 5

Describe Secondary Progressive MS

Answer 5

Patient begins with Relapsing Remitting MS

–> Steadily decline with occasional relapses

Question 6

Will there be relapses with Primary Progressive MS?

Answer 6

No

Question 7

When do MS patients usually get diagnosed?

Answer 7

In their 20s and 30s

Question 8

Can one single test confirm MS?

Answer 8

NO

Question 9

What causes MS?

Answer 9

Unknown

Question 10

Which sex is affected more commonly with MS and which sex has a more favorable course?

Answer 10

WOMEN for both

Question 11

The ____ the onset for MS, the more favorable course

Answer 11

EARLIER onset = favorable course

Question 12

What types of lesions will be seen on an MRI of the head/cervical/thoracic spine with MS?

Answer 12

Ovoid lesions

Question 13

What are typical CSF lumbar puncture findings with MS?

Answer 13

1. Oligoclonal bands

2. Increased IgG index/synthesis rate

Question 14

What are typical CSF lumbar puncture findings with MS?

Answer 14

1. Oligoclonal bands

2. Increased IgG index/synthesis rate

Question 15

What is MS?

Answer 15

Multiple lesions over space and time

Question 16

Most of the drugs for MS are used in the Relapsing Remitting form. Which one can also be used for Primary Progressive?

Answer 16

Ocrevus

Question 17

What medications can be used to treat an acute exacerbation in MS?

Answer 17

• High dose corticosteroids

- ACTH or IVIg if the patient cannot have corticosteroids

Question 18

What is on the differential diagnosis list when considering MS?

Answer 18

CIS = Clinically Isolated Syndrome

Question 19

What types of episodes are options for Clinically Isolated Syndrome (CIS)?

Answer 19

1. Monofocal episode

2. Multifocal episode

Question 20

Monofocal episode of CIS

Answer 20

SINGLE neuro sign due to a SINGLE lesion

Question 21

Single neuro symptom due to a single lesion

Answer 21

Monofocal episode of Clinically Isolated Syndrome

Question 22

Multifocal episode of CIS

Answer 22

MULTIPLE neuro signs caused by lesions in MULTIPLE places

– but only at a single time (DOES NOT EQUAL MS)

Question 23

Multiple neuro symptoms caused by multple lesions

Answer 23

Multifocal episode of Clinically Isolated Syndrome

Question 24

What is another name for a Multifocal Episode of CIS?

Answer 24

Acute Disseminated Encephalomyelitis (ADEM)

Question 25

If a CIS patient has MULTIPLE demyelinating lesions, what kind of risk do they have for developing Multiple Sclerosis?

Answer 25

HIGH risk

Question 26

If a CIS patient does NOT have multiple demyelinating lesions, what kind of risk do they have for developing Multiple Sclerosis?

Answer 26

LOW risk

Question 27

What is another name for Neuromyelitis Optica?

Answer 27

Devic’s Disease

Question 28

What is Devic’s Disease (neuromyelitis optica)?

Answer 28

Demyelination of optic nerve and spinal cord

Question 29

How do the affected segments of the spinal cord look with Devic Disease?

Answer 29

Long segments of spinal cord demyelinated

Question 30

What will be present in the blood and CSF to diagnose Devic’s Disease?

Answer 30

Aquaphorin (NMO) Antibodies