Clin: Multiple Sclerosis - Hon Flashcards
disorder of the brain and spinal cord (CNS) characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbations/remissions), which result from loss of nerve tract insulation (myelin) at multiple sites in the CNS
multiple sclerosis
- most pts diagnosed in their 20’s-30’s (W>M)
- no single test can confirm the diagnosis
- unknown etiology, probably some genetic susceptibility (perhaps a childhood illness that sensitizes immune system to attack)
what are the most common symptoms of MS?
- paresthesias
- gait disturbances
- weakness
- visual loss (optic neuritis commonly seen)
- urinary difficulty
- dysarthria
- hemiparesis
- hemisection of cord
- weakness in legs
- sensory disturbance in legs
- hyperreflexia
- positive Babinski sign
Brown-Sequard syndrome
What are the 4 types of MS?
- relapsing remitting (45-50%)
- secondary progressive (20-25%)** these patients begin their disease process in the relapsing remitting category
- primary progressive (15-20%)
- benign (10-15%)
what is the geographic distribution of MS?
temperate zones (further from equator) see a higher incidence - theory has to do with sunlight/vitamin D levels during pregnancy
what studies are used to make the diagnosis of MS?
- MRI of the head, CT of spine
- lumbar puncture for CSF analysis
where would you see ovoid lesions in MS?
MRI of the spine
- in the periventricular white matter and in the spinal cord
what are the typical findings on lumbar puncture of MS patients?
presence of oligoclonal bands and/or increased IgG index/synthesis rate
how is MS diagosed?
BY MULTIPLE LESIONS OVER SPACE AND TIME - know this!
what are the main drugs used for “maintenance” in MS (to decrease the frequency and severity of exacerbations and slow the progression of the disease)
- MAB’s
- interferons
- glatirimer acetate
- dimethyl fumarate
what is the tx for an acute attack of MS (optic neuritis)?
high dose steroids (1g IV daily for 3-5 days)
- reduces the length of the exacerbation, but is not thought to change the overall outcome of it
what is the exception drug approved to treat primary progressive MS (PPMS) in addition to relapsing forms of the disease?
ocrevus
- is the ONLY drug available for PPMS!
what are the ddx of MS?
- clinically isolated syndrome (CIS)
- monofocal episode (single sign/sx caused by single lesion)
- multifocal episode (aka acute disseminated ecephalomyelitis - ADEM) more than one sign/sx caused by lesions in more than one place
when CIS patients have multiple demyelinating lesions on MRI, what is the percent chance of developing MS?
60-80% within several years
when CIS patients do NOT have multiple demyelinating lesions on MRI, what is the percent chance of developing MS?
20%
