Ch 12 - Multiple Sclerosis

Question 1

What is Multiple Sclerosis?

Answer 1

AI disease of the CNS characterized by multiple white matter plaques of demyelination in the brain and spinal cord

Question 2

Describe MS relapse and pregnancy.

Answer 2

Pregnancy decreases relapses but then increases after delivery No change in long-term prognosis

Question 3

What is the MC pattern of MS?

Answer 3

85% to 90% begin with relapsing-remitting MS

Question 4

Describe good prognosis factors for MS.

Answer 4

Monosympatic
Sudden onset
Sensory or optic neuritis at onset
Ambulation
Longer and more complete remissions
Low disability

Question 5

Describe poor prognosis factors for MS.

Answer 5

Polysympatic
Rapidly prog onset
Motor, ataxia, tremor at onset
No ambulation
Higher relapse rate
High disability

Question 6

What are the top 3 most prevalent symptoms of MS?

Answer 6

1. Bladder and bowel dysfunction
2. Fatigue ( central in nature)
3. Pain

Question 7

What are the top 3 symptoms affecting ADL’s in MS?

Answer 7

1. Fatigue
2. Balance difficulties
3. Weakness

Question 8

What are common symptoms of MS?

Answer 8

• Optic neuritis, diplopia, nystagmus, internuclear ophthalmoplegia
• Heat sensitivity (Uhthoff phenomenon)
• Cognitive impairment\
• Ataxia, intention tremor, gait dysfunction, slurred speech
• paresthesias, impairment of deep sensation, proprioception
• Weakness and spasticity
• Dysarthria
• Myokymia, deafness, tinnitus, vertigo, vomiting, transient facial anesthesia, dysphagia

Question 9

What is Lhermitte’s sign?

Answer 9

Passive neck flexion causing an electric shock-like sensation radiating to the spine and shoulders d/t inc sensitivity of the myelin to stretch or traction

Question 10

What are the criteria for MS diagnosis?

Answer 10

McDonald Criteria

Question 11

What is meant by “lesions scattered in time and space?”

Answer 11

• Space: at least 2 of MS 4 typical regions of CNS on MRi
• Time: A 2nd clinical attack or a new T2 and/or gadolinium enhancing lesion
• Time between attacks: 30 days
• > 2 attacks with clinical evidence of >2 lesions
• Neurologic deficits in >2 areas, reflecting white matter involvement, at two points in time for >24 hours separately by 1 month

Question 12

What is seen on CSF analysis in MS?

Answer 12

Oligoclonal IgG bands

ABN CSF IgG production

Question 13

What is seen on SSEP in MS?

Answer 13

Most frequent ABN is latency inc or absence of component evoked by tibial nerve stimulation

Question 14

Describe lesions on MRI in MS.

Answer 14

• White matter lesions
• Ovoid-appearing plaques in the periventricular region, corpus callosum, centrum semiovale, or basal ganglia
• Enhancement with gadolinium indicate active disease

Question 15

What is the dose of methylprednisolone in MS flares?

Answer 15

500 to 1,000 mg IV daily for 3 to 7 days with or without an oral taper

Question 16

Which MS symptoms are responsive to steroids?

Answer 16

• Most: Optic neuritis, brainstem, motor, acute pain, bowel, and bladder
• Least: Cerebellar, sensory

Question 17

What worsens fatigue in MS?

Answer 17

Inc temp
Stress
Activity

Question 18

What is the drug of choice for treatment of central spasticity?

Answer 18

Baclofen

Question 19

What is optic neuritis?

Answer 19

Blurred vision, or complete or partial loss of vision

Unilateral eye pain worse with eye movement

Question 20

What is internuclear opthalmoplegia?

Answer 20

Paresis of the medial rectus muscle, resulting in an inability to adduct the eye; this is seen with voluntary lateral gaze

Question 21

Describe cognitive impairment in MS.

Answer 21

IQ usually intact, early

Processing speed is often delayed