Demyelinaiton Flashcards
what is MS
inflammatory demyelinating disorder of CNS
pathological feature of CNS
plaques disseminated in place and time
possible risk factors for MS
females
30s-40s
lack of vitamin D - less sunlight?
EBV
what are the types of disease courses for MS
relapsing remitting
primary progressive
secondary progressive
progressive relapsing
what happens in relapsing remitting
one event
fully recovers from it
same with next events
what happens in primary progressive
continually get worse
what happens in secondary progressive
one event
fully recover
second event - don’t fully recover
what happens in progressive relapsing
never fully recover after first event
most common presenting complaint of MS
optic neuritis: change in colour vision rapid impairment of vision pain behind the orbit - exacerbated by eye movements swollen optic nerve
other clinical features of MS
pyramidal dysfunction (arms and legs) - UMN sensory symptoms cerebellar and brain stem features cognitive impairment sensory symptoms - trigeminal neuralgia CN palsies
diagnostic criteria of MS
at least 2 episodes of suggested demyelination disseminated in time and place
investigation for MS
MRI (T2 weighted - lesions appear bright)
CSF - oligoclonal bands in CSF
what tests should be done to rule out other things
bloods - increased plasma viscosity and CRP in MS. look for B12 and folate deficiency
renal liver bone profile
auto antibody screen (autoimmune vasculitis)
serum ACE (sarcoidosis)
borellia, HIV, syphilis serology
how to treat a mild exacerbation e.g. fatigue, tremor, sensory/motor, urinary tract/sexual dysfunction
symptomatically
how to treat moderate exacerbation (e.g. discomfort, mobility issues)
oral steroids
methylprednisolone 500mg for 5 days
how to treat severe exacerbation
admission and IV steroids
1000mg for 3 days
what is given for pyramidal dysfunction
OT and physio input
anti-spasmodic (baclofen, tizanidine)
what is given for sensory symptoms
anti convulsant - gabapentin
antidepressant - amitriptyline
what can be given for urinary tract dysfunction
anticholinergic - oxybutynin
desmopressin
catheterisation if in retention
what can be given for fatigue
OT input
amantadine
modafinil if sleepy
what disease modifying therapies are first line in MS
interferon beta
copaxone (glitiramer acetate) -both injections
tecfidera - first line in relapsing remitting
what is second line disease modifying therapy in MS
monoclonal antibodies (tysabri, lemtrada) - good in relapsing remitting fingolimod (S1P modulator)
what should be tested for in all MS patients and why
JC virus
cant give monoclonal antibodies - risk of multifocal leukoencephalopathy
what is 3rd line in MS treatment
mitoxantrone - progressive relapsing MS
