Clinical Approach to Multiple Sclerosis

Question 1

What are the 4 types of MS?

Answer 1

Relapsing remitting (45-50%)

Secondary progressive (20-25%), but begin in relasping and remitting type

Primary progressive (15-20%)

Benign (10-15%)

Question 2

At what age are most patients diagnosed with MS?

Answer 2

In their 20s-30s.

Question 3

What geographic “zone” has an increased incidence of MS?

Answer 3

Temperate zone; less common in the tropical zones.

Question 4

What are a couple favorable prognostic clues about MS?

Answer 4

Women tend have a milder course

Earlier onset is associated with a better course

Question 5

Which studies are used to help make a diagnosis of MS?

Answer 5

MRI of head, CT of spine: ovoid lesions of high signal on T2W1 in periventricular white matter and spinal cord. Acute lesions may enhance.

Multimodality evoked potentials (SSEPs, VEPs, BAER)

Lumbar puncture for CSF

Question 6

What are common CSF findings in a patient with MS?

Answer 6

Oligoclonal bands and/or increased IgG synthesis rate.

Question 7

In general, what form of is MS is treated with meds?

Which drug treats primary progressive MS (PPMS) in addition to relapsing forms?

Answer 7

Relapsing forms of MS

Ocrevus

Question 8

What is used to treat acute exacerbation of CIS?

Answer 8

High dose corticosteroids

ACTH or IVIg can also be given on occasion

Question 9

What is considered a Monofocal episode in CIS?

Answer 9

The person experiences a single neurologic sign or symptom that is caused by a single lesion.

Question 10

What is considered a Multifocal episode (Acute Disseminated Encephalomyelitis (ADEM))?

Answer 10

The person experiences more than one sign or symptoms caused by lesions in more than one place.

Question 11

What suggests a high risk of developing MS in a CIS patient?

Answer 11

When CIS patients have multiple demyelinating lesions on MRI, they have a 60-80% chance of developing MS in the next few years.

When CIS patients do not have multiple demyelinating lesions on MRI, they have a 20% risk of developing MS in the nest few years.

Question 12

What are the major symptoms in MS?

Answer 12

Spasticity
Intention tremor
Urinary urgency (spastic bladder)
Urinary retention/hesitancy
Painful dysthesias
Fatigue

Question 13

What is Devic’s disease (Neuromyelitis Optica)?

What antibodies are found?

What is the treatment?

Answer 13

Inflammation and demyelination of optic nerves and spinal cord with relative sparing of the brain.

NMO (aquaporin) antibodies.

Steroids and plasma exchange followed by immunosuppression.