Lecture 7: Multiple Sclerosis Flashcards

1
Q

A disorder of the brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbation and remissions), which result from loss of myelin at multiple sites in the CNS, defines what?

A

MS

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2
Q

What are 7 common symptoms of patients with MS?

A

1) Paresthesias
2) Gait disturbances (i.e., transverse myelitis)
3) Weakness
4) Visual loss (i.e., optic neuritis)
5) Urinary difficulty
6) Dysarthria
7) Hemiparesis

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3
Q

What are the 4 major types of MS?

A
  1. Relapsing remitting
  2. Secondary progressvie
  3. Primary progressive
  4. Benign
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4
Q

MS patients with the seconary progressive form of the disease begin their disease process as which form?

A

Relapsing remitting

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5
Q

Which test can confirm the diagnosis of MS?

A

No single test can confirm the diagnosis of MS

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6
Q

How does age of onset affect the prognosis of MS?

A

In general, earlier onset is a more favorable prognostic feature

*However, if really young (i.e., adolescent/early adult) = unfavorable

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7
Q

What are the typical diagnostic features seen with an MRI of the head and CT of the spine in a patient with MS?

A
  • Ovoid lesions of high signal on T2WI in periventricular white matter and spinal cord
  • Acute lesions may enhance
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8
Q

CSF analysis via lumbar puncture will have what diagnostic findings in a patient with MS?

A

Presence of oligoclonal bands and/or increased IgG index/synthesis rate

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9
Q

Which drug is the only approved treatment for patients with the primary progressive form of MS (PPMS) in addition to the relapsing forms of the disease?

A

Ocrevus (ocrelizumab)

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10
Q

Which 2 drugs can be given to treat acute exacerbation in MS?

Why is each drug used?

A

1) High dose corticosteroids: reduces length of exacerbation, but not the overall outcome
2) ACTH (acthar gel) or IVIg used in pt’s who do not tolerate traditional steroid tx.

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11
Q

In terms of clinically isolated syndrome (CIS) what is a monofocal episode as a differential diagnosis for MS?

A

Person experiences a single neurologic sign or symptom that’s causes by a single lesion (i.e., optic neuritis in one eye)

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12
Q

In terms of clinically isolated syndrome (CIS) what is a multifocal episode as a differential diagnosis for MS?

AKA?

A
  • aka Acute Disseminated Encephalomyelitis (ADEM)
  • Person experiences more than one sign or symptom caused by lesions in more than one place (i.e., optic neuritis in one eye plus hemiparesis)
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13
Q

When CIS patients have multiple demyelinating lesions on MRI, they have a __________% chance of developing MS within several years

A

60-80%

*High risk

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14
Q

When CIS patients do not have multiple demyelinating lesions on MRI, they have a ______% chance of developing MS within several years

A

20%

*Low risk

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15
Q

What are some conditions which can mimic MS?

A
  • Autoimmune disease: SLE w/ cerebritis or CNS vasculitis or Polyarteritis Nodosa w/ transverse myelitis
  • Devic’s disease (neuromyelitis optica)
  • B12 deficiency
  • Lymphoma or leukemia w/ CNS involvement
  • Spinocerebellar ataxias
  • Infections: HIV, West Nile, HTLV-1, CMV, Lyme disease, Syphillis
  • Granulomatous disease
  • Metachromatic leukodystrophy, adrenomyeloleukodystrophy
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16
Q

Which 6 drugs/treatments can be used for management of spasticity in patients with MS?

A

1) Baclofen (oral or intrathecal)
2) Tizanadine
3) Diazepam
4) Carbamazepine
5) Botox injections
6) Dantrolene

17
Q

Which 3 drugs can be used for the management of intention tremor in patients with MS?

A
  1. Propranolol
  2. Primidone
  3. Clonazepam
18
Q

Which 2 drugs can be used for the management of urinary urgency (spastic bladder) in patients with MS?

A

1) Oxybutinin
2) Detrol LA

19
Q

Which drug can be used for the management of urinary retention/hesitancy in patients with MS?

A

Bethanechol

20
Q

Which 5 drugs can be used for the management of painful dysesthesias in MS?

A
  1. Carbamazepine
  2. Oxcarbazepine
  3. Gabapentin
  4. Phenytoin
  5. Baclofen
21
Q

Which disease is sometimes considered a “variant” of MS and is characterized by inflammation and demyelination of optic nerves and spinal cord (often long segments of spinal cord) with relative sparing of brain?

A

Devic’s Disease (aka neuromyelitis optica)

22
Q

What is considered a fairly sensitive and specific test for Devic’s disease (aka NMO)?

A

Aquaphorin antibodies in blood and CSF

23
Q

What is the general treatment for Devic’s Disease (aka NMO)?

A
  • Steroids and/or plasma exchange (plasmapheresis)
  • Followed by: immunosupression (i.e., azothiaprine, mycophenolate mofetil, or rituxumab)
24
Q

Which 5 agents are disease modifying/maintenance drugs used in the treatment of MS?

A
  • Interferons
  • Monoclonal antibodies (-mab)
  • Glatirimer Acetate
  • Fingolimod
  • Dimethyl Fumarate