CBL - MS Flashcards
What are the signs of optic neuritis? [3]
- red desaturation
- relative afferent pupillary defect on one eye
- optic disc pallor on one eye implying optic atrophy
What is Hoffman’s sign? [2]
- upper motor neurone (UMN) sign
- parallels the extensor plantar sign in the lower limb
- +ve when there is flexion of the ipsilateral thumb after tapping the nail bed of the 3rd finger
What are the upper motor neurone (UMN) signs that can be seen in the limbs? [6]
- increased tone in a spastic pattern
- weakness
- hyper-reflexia
- clonus
- extensor plantars
- positive Hoffman’s sign
What parts of the nervous system does MS usually affect and what clinical signs would be present due to a defect in each of these areas? [4]
-
optic nerve
- optic neuritis
-
brainstem
- ataxia
- swallowing problems
- eye movement problems
-
spinal cord
- bladder problems
- constipation
- limb weakness
-
white matter hemispheric regions
- motor problems
- sensory problems
What finding in the CSF would indicate MS? [1]
What other condition can this finding also be present in? [1]
presence of oligoclonal bands in CSF (but not in the blood)
can also indicate sarcoidosis
What is the difference between a diagnosis of MS and a diagnosis of clinically isolated syndrome? [2]
- MS is diagnosed when there are 2 neurological lesions which are disseminated in space and time
- Clinically isolated syndrome is diagnosed when there is a single presentation of optic neuritis with a normal MRI
What is VERS and what does it show? [2]
- visual evoked responses
- measures the speed at which impulses travel along the optic nerve
- if delayed, this indicates optic neuritis
The McDonald criteria for MS requires dissemination in space, with a lesion in at least 2 of what locations? [4]
- periventricular (around the ventricles)
- juxtacortical (at the grey:white matter junction)
- infratentorial (e.g. cerebellum)
- spinal cord
What are the disease modifying treatment options for relapsing remitting MS? [7]
First line treatments
- Injectable treatments
- beta interferons
- glatiramer acetate
- Oral treatments (immunosuppressants)
- dimethyl fumerate
- teriflunomide
Second line treatments
- fingolimod (stronger oral agent)
- atalizumab (monoclonal antibody)
Third line treatments
- alemtuzumab (powerful monoclonal antibody) that essentially resets the immune system and can eliminate MS relapses
Dimethyl fumerate:
- mechanism of action? [2]
- side effects? [3]
- mechanism of action:
- suppresses immune system
- reduces lymphocyte counts
- side effects:
- flushing
- GI side effects
- potentially serious infections
What are the treatment options for progressive MS? [3]
SYMPTOM CONTROL
- fatigue
- if disease related, modafinil or amantadine may help
- urinary symptoms
- storage dysfunction:
- anti-cholinergic agents (oxybutynin)
- botox
- emptying dysfunction:
- self-catheterisation
- tamsulosin
- storage dysfunction:
- spasticity
- physiotherapy
- drugs include gabapentin, benzodiazepines etc.