Clinical Approach to Multiple Sclerosis (Hon) Flashcards
Multiple Sclerosis is a disorder of the brain and spinal cord that results from?
Loss of myelin at multiple sites in the CNS
What are the four types of MS?
1) Relapsing remitting
2) Secondary progressive
3) Primary progressive
4) Benign
Which type of MS is the most common?
Relapsing remitting
Most MS patients are diagnosed at what age?
20s and 30s
MS is generally characterized by periods of?
Exacerbation and remission
Which sex does MS affect more?
Which sex generally have a more favorable course?
Around what age does it have a more favorable course?
1) Women
2) Women
3) The earlier the onset (20s)
What studies are used to make the diagnosis of MS?
1) MRI
2) Lumbar puncture
What is found on MRI with MS?
Multiple ovoid lesions in the periventricular white matter and in the spinal cord
What is found on lumbar puncture for CSF analysis with MS?
Presence of oligoclonal bands &/or increased IgG
What role does medications have for MS?
Maintenance (To decrease the frequency and severity of exacerbations and slow the progression)
In general, MS is diagnosed by?
Multiple lesions over space and time
In general, medications for MS are used in patients with what form?
Ocrevus (ocrelizumab) is the only drug approved to treat?
1) Relapsing forms
2) Primary progressive MS
What medication is used to treat an acute exacerbation in MS?
Corticosteroids
What condition which can be either monofocal or multifocal can mimic MS?
Clinically Isolated Syndrome
A multifocal episode of Clinically Isolated Syndrome (aka Acute Disseminated Encephalomyelitis) is characterized by?
Patient experiencing more than one sign or symptom caused by lesions in in more than one area
When do Clinically Isolated Syndrome patients have a high risk of developing MS?
When CIS patients have multiple demyelination lesions on MRI
Baclofen, tizanidine, diazepam, carbamazepine, Botox injections, and dantrolene can be used to manage what symptom of MS?
Spasticity
Propranolol, primidone, and clonazepam can be used to manage what symptom of MS?
Intention tremor
Oxybutynin and Detrol LA can be used to manage what symptom of MS?
Urinary urgency
Bethanechol can be used to manage what symptom of MS?
Urinary retention
Carbamazepine, oxcarbazepine, gabapentin, phenytoin, and baclofen can be used to manage what symptom of MS?
Painful dysesthesias
Amantadine, modafinil, armodafinil, bupropion, methylphenidate, pemoline, and exercise can be used to manage what symptom of MS?
Fatigue
Devic’s Disease aka Neuromyelitis Optica is characterized by?
Inflammation and demyelination of optic nerves and spinal cord with relative sparing of brain
What antibodies in the blood and CSF can be tested for with Devic’s disease?
1) NMO (Aquaphorin 4)
2) MOG (Myelin Oligodendrocyte Glycoprotein)
What is the treatment for Devic’s disease?
Steroids and/or plasma exchange followed by immunosuppression
