Demyelinating disorders

Question 1

what is the most common demyelinating disorder

Answer 1

multiple sclerosis

Question 2

what is the secondary metabolic demyelinating disorder called

Answer 2

central pontine myelinosis

Question 3

what kind of condition is multiple sclerosis

Answer 3

autoimmune

Question 4

are men or women more likely to get MS

Answer 4

women

Question 5

when do people usually present with MS

Answer 5

30/40s

Question 6

which part of Britain has the highest incidence of MS

Answer 6

Orkney

Question 7

what deficiency is associated with MS

Answer 7

vitamin D deficiency

Question 8

is MS a disease of white matter or grey matter

Answer 8

white matter - bc only white matter contains axons (covered in myelin sheaths)

Question 9

what is the pathological appearance of white matter in MS

Answer 9

glassy/translucent/brown appearance

Question 10

which inflammatory cells are present in MS (most significant one)

Answer 10

oligoclonal IgG bands

Question 11

which eye symptom is common (20%) in MS

Answer 11

unilateral optic neuritis - painful vision loss, exacerbated by eye movements

Question 12

what down below symptom is common in MS

Answer 12

lower urinary tract dysfunction - nocturia, urgency, incontinence

Question 13

what motor and sensory symptoms occur in MS

Answer 13

spasticity and weakness

numbness and pain

Question 14

can someone get pregnant if they have MS

what would happen during pregnancy

Answer 14

yes

relapses actually get better

Question 15

what is the Uhthoff phenomenon in MS

Answer 15

symptoms get worse during increase in heat - eg during exercise or shower

Question 16

what are the 2 types of MS

dependent on presentation

Answer 16

relapsing and remitting

progressive

Question 17

is there loss of sphincter tone in MS

Answer 17

yes

differs it from MND

Question 18

what investigation do you do for MS diagnosis

what do you see

Answer 18

MRI - see ‘white finger’s in sagittal plane

Question 19

apart from MRI, what other investigation do you do for MS

Answer 19

lumbar puncture electrophoresis - looking for oligoclonal IgG bands

Question 20

treatment of exacerbation of MS

Answer 20

PO steroids (IV and admit to hospital if bad)

Question 21

symptomatic treatment for MS if tired

Answer 21

amatidine

Question 22

symptomatic treatment for MS if spasticity

Answer 22

baclofen

Question 23

symptomatic treatment for MS if sensory problems eg neuropathic pain

Answer 23

amitriptyline

Question 24

symptomatic treatment for MS if lower urinary tract dysfunction

Answer 24

catheterization

Question 25

first line disease modifying drugs for MS

Answer 25

interferon beta (immunoglobulins)

Question 26

second line disease modifying drugs for MS

Answer 26

monoclonal antibody (esp if relapsing and remitting)

Question 27

third line disease modifying drug for MS

Answer 27

mitoxantrone (esp if progressive)

Question 28

what condition causes bilateral severe optic neuritis

Answer 28

neuromyelitis optica

Question 29

what is the genetic predisposition to MS

Answer 29

HLA DR2 (though may be idiopathic)

Question 30

is MS curable

Answer 30

no

hence need disease modifying drugs to slow down disease process