Clinical classification of MS

Question 1

What % are RR and what % are PP or PR

Answer 1

85% RR

15% PP OR PR

Question 2

What is the first attack in RR MS?

Answer 2

Clinically isolated syndrome -
Onset to peak worsening- days
Recover - may be complete or incomplete

Question 3

3 MAIN initial symptoms

Answer 3

1. Sensory MOSTLY LIMB not face (30-43%)
2. Optic neuritis (14-24%)
3. Weakness - acute (9-40%)

Question 4

If you have a CIS in MS

Answer 4

MAJORITY 50-70% of patients will have multiple lesions on MRI

Question 5

Over time… what happens to MRI burden

Answer 5

Increases - total number of accumulated lesions goes up

Question 6

Over time what happens to MRI activity or the number of attacks?

Answer 6

DECREASES - more attacks earlier

- permanent disability also goes up

Question 7

What does a new relapse or new lesion mean?

Answer 7

Dissemination in time

Question 8

Multiple in MS refers to

Answer 8

Multiple in SPACE AND TIME

Question 9

Common symptoms in MS

Answer 9

• easy fatiguability
• Impaired vision
• brainstem dysfunction
• cerebellar problem
• sensory issues
• Motor - spasticity
• retention/incontinnence urinary

Question 10

Common Physical FINDINGS

Answer 10

1. intelligence not affected - may have memory loss - attention loss - not linked to disability
2 - Optic nerve atrophy, scotoma, RAPD
3 - impaired smooth pursuit, INO, 
4- Dysarthria
5 - emotional lability
6- exaggerated gag and jaw reflex
7- UMN signs
8 - Decreased vibration/prop/two point discrimination
9 - cerebellar

Question 11

Diagnosis of MS IS PRIMARILY

Answer 11

A clinical diagnosis

Question 12

which is more sensitive in MS- cranial or Spinal MRI

Answer 12

CRANIAL MRI is more sensitive

OVER 50 - spinal MRI is more specific

Question 13

Majority of MS lesions are

Answer 13

Clinically silent

Question 14

spiNAL CORD MRI is abnormal in

Answer 14

75% of cases

Question 15

In patients over 50

Answer 15

a spinal mri IS valuable! and more specific

Question 16

Differential DX for MS

Answer 16

1. Sarcoidosis
2. Vasculitis
3. Lupus
4. ADEM
5. HIV

Question 17

When do you question a diagnosis of MS

Answer 17

1. 60
2. all symptoms leading to single site
3. lack of optic nerve, oculomotor, sensory or bladder involvement after many years
4. absence of remission
5. CSF/MRI persistently normal

Question 18

Unfavorable prognosis

Answer 18

1. high relapse
2. short interval to second attack
3. lack of full recovery
4. older age at onset
5. male gender
6. high burden on first MRI
7. early cerebellar involvement
8. motor onset

Question 19

Corticosteroids ARE

Answer 19

NOT EFFECTIVE IN SLOWING OR PREVENTING PRGORESSION