Clinical Approach to Multiple Sclerosis (Hon)

Question 1

Multiple Sclerosis is a disorder of the brain and spinal cord that results from?

Answer 1

Loss of myelin at multiple sites in the CNS

Question 2

What are the four types of MS?

Answer 2

1) Relapsing remitting
2) Secondary progressive
3) Primary progressive
4) Benign

Question 3

Which type of MS is the most common?

Answer 3

Relapsing remitting

Question 4

Most MS patients are diagnosed at what age?

Answer 4

20s and 30s

Question 5

MS is generally characterized by periods of?

Answer 5

Exacerbation and remission

Question 6

Which sex does MS affect more?

Which sex generally have a more favorable course?

Around what age does it have a more favorable course?

Answer 6

1) Women
2) Women
3) The earlier the onset (20s)

Question 7

What studies are used to make the diagnosis of MS?

Answer 7

1) MRI

2) Lumbar puncture

Question 8

What is found on MRI with MS?

Answer 8

Multiple ovoid lesions in the periventricular white matter and in the spinal cord

Question 9

What is found on lumbar puncture for CSF analysis with MS?

Answer 9

Presence of oligoclonal bands &/or increased IgG

Question 10

What role does medications have for MS?

Answer 10

Maintenance (To decrease the frequency and severity of exacerbations and slow the progression)

Question 11

In general, MS is diagnosed by?

Answer 11

Multiple lesions over space and time

Question 12

In general, medications for MS are used in patients with what form?

Ocrevus (ocrelizumab) is the only drug approved to treat?

Answer 12

1) Relapsing forms

2) Primary progressive MS

Question 13

What medication is used to treat an acute exacerbation in MS?

Answer 13

Corticosteroids

Question 14

What condition which can be either monofocal or multifocal can mimic MS?

Answer 14

Clinically Isolated Syndrome

Question 15

A multifocal episode of Clinically Isolated Syndrome (aka Acute Disseminated Encephalomyelitis) is characterized by?

what is the monofocal episode?

Answer 15

Patient experiencing more than one sign or symptom caused by lesions in in more than one area (Optic neuritis in one eye plus hemiparesis)

Single neurologic sign or symptom caused by a single lesion (ex: Optic neuritis in one eye)

Question 16

When do Clinically Isolated Syndrome patients have a high risk of developing MS?

Answer 16

When CIS patients have multiple demyelination lesions on MRI

Question 17

Baclofen, tizanidine, diazepam, carbamazepine, Botox injections, and dantrolene can be used to manage what symptom of MS?

Answer 17

Spasticity

Question 18

Propranolol, primidone, and clonazepam can be used to manage what symptom of MS?

Answer 18

Intention tremor

Question 19

Oxybutynin and Detrol LA can be used to manage what symptom of MS?

Answer 19

Urinary urgency

Question 20

Bethanechol can be used to manage what symptom of MS?

Answer 20

Urinary retention

Question 21

Carbamazepine, oxcarbazepine, gabapentin, phenytoin, and baclofen can be used to manage what symptom of MS?

Answer 21

Painful dysesthesias

Question 22

Amantadine, modafinil, armodafinil, bupropion, methylphenidate, pemoline, and exercise can be used to manage what symptom of MS?

Answer 22

Fatigue

Question 23

Devic’s Disease aka Neuromyelitis Optica is characterized by?

Answer 23

inflammation and demyelination of optic nerves and spinal cord with relative sparing of brain

Question 24

What antibodies in the blood and CSF can be tested for with Devic’s disease?

Answer 24

1) NMO (Aquaphorin 4)

2) MOG (Myelin Oligodendrocyte Glycoprotein)

Question 25

What is the treatment for Devic’s disease?

Answer 25

Steroids and/or plasma exchange followed by immunosuppression