MS

Question 1

What are the risk factors for MS?

Answer 1

• Women>men
• Europeans
• Age: 20-40yrs
• 1st degree relative with MS
• Reduced vitamin D

Question 2

What are the features of MS?

Answer 2

• Optic neuritis
• Cerebral
• Cerebellar
• Brainstem problems
• Spinal cord
• UMN signs

Question 3

What is L’Hermitte’s sign?

Answer 3

Sudden electric shock like sensation radiating down and up the spinal column, provoked by flexion or extension of the neck

Question 4

What is the typical history of MS?

Answer 4

Separate attacks of inflammation within the CNS at different times and in different places
o History of previous neurological symptoms
o Symptoms that evolve over more than 24 hrs and may persist over several days/weeks then improve

Question 5

What are the different types of MS?

Answer 5

Relapse remitting (RRMS)
o	Attacks (relapses) with complete or partial recovery
o	No progression between attacks (remission)

Secondary progressive (SPMS)
o	Initial relapsing-remitting course followed by progression

Primary progressive (PPMS)
o	Progression from onset, no attacks

Progressive relapsing (PRMS)
o	Progression from onset with attacks

Question 6

What investigations do you do?

Answer 6

• MRI brain/spinal cord with contrast
• Lumbar puncture
• Evoked potentials
• Gadolinium contrast
• Serum Vitamin B12

Question 7

What could an MRI brain show?

Answer 7

• High signal T2 lesions
• Periventricular plaques
• Dawson fingers: hyperintense lesions perpendicular to corpus callosum

Question 8

What could a lumbar puncture show?

Answer 8

Oligoclonal bands in CSF

Question 9

How do you manage a MS relapse?

Answer 9

o High-dose steroids – IV methylprednisolone 1g daily 3 days/ PO methylprednisolone 0.5g 5 days
o PPI

Question 10

What do you need to check before giving treatment for a MS relapse?

Answer 10

• Check there are no signs or symptoms of systemic infection
• FBC, renal function, random glucose and urine dipstick

CI: infection, poorly controlled diabetes or HTN

Question 11

When would you give beta-interferon?

Answer 11

• RR-MS + 2 relapses in past 2yrs + able to walk 100m unaided
• SP-MS + 2 relapses in past 2yrs + able to walk 10m

Question 12

What can alemtuzumab cause?

Answer 12

• Autoimmune thyroid disease,
• Immune thrombocytopenia
• Goodpasture syndrome

Question 13

How do you manage neuropathic pain?

Answer 13

1st line: gabapentin, pregabalin, amitriptyline or duloxetine (GI SE)
o If not working, switch drug instead of adding one

Question 14

How do you manage muscle spasticity?

Answer 14

1st line: Baclofen or gabapentin

Question 15

How do you manage neuropathic bladder?

Answer 15

Oxybutynin

Question 16

What inflammatory conditions can mimic MS?

Answer 16

• Anticardiolipin/Antiphospholipid antibody syndrome
• Devic’s syndrome (neuromyelitis optica)
• Neurosarcoidosis
• Sjogren’s syndrome
• Behcet’s syndrome

Question 17

What questions would you ask in the history to exclude an inflammatory cause?

Answer 17

• Rashes
• Fever
• Arthropathy
• Uveitis
• Weight loss
• Respiratory difficulties