MS Flashcards
MS is particular to the CNS or the PNS?
CNS so oligodendrocyte
Comment on the prevalence of MS in relation to the equator
Further north or further south of equator you go, prevalence is higher
First degree relative with MS, what is risk?
3-5%
Identical twin with MS, chance of developing?
1/3
Factors contributing to MS? (3)
Genetics, environment immune response
85-90% patients will have what type of MS?
Relapsing remitting MS (RRMS)
20-50% of RRMS develop what?
Secondary progressive MS (SPMS)
10-15% of patients with MS is what type?
Primary Progressive MS (PPMS)
What is multiple sclerosis and what is the name of its lesions?
Inflammatory demyelinating disorder of the CNS, plaques
Female:Male ratio of MS
3:1 F:M
In what age group do most MS patients initially present?
30s and 40s
List 6 possible clinical features of MS
Pyramidal dysfunction, Optic neuritis, Sensory symptoms Lower urinary tract dysfunction, Cerebellar and brain stem features, Cognitive impairment
List 3 symptoms of pyramidal dysfunction
Increased tone, (velocity dependent)
Spasticity,
Weakness in pyramidal distrubiton
What is weakness in pyramidal distribution?
Weakness in extensors of upper limbs and flexors of lower limbs
Approx 40% of patients with MS present with optic neuritis. Basic presentation of optic neuritis?
Painful visual loss over 1-2 weeks. May present with RAPD
List 5 sensory symptoms of MS
Pain, Paraesthesia, Dorsal column loss, Numbness, Trigeminal neuralgia (very common in MS)
List 7 symptoms of cerebellar dysfunction
Dysarthria, Ataxia, Nystagmus, Intention tremor, Past pointing, Pendular reflexes, Dysdiadokinesis
MS patients with ataxia from cerebellar dysfunction tend to veer towards the contralateral side of lesion. True/false?
False - veer towards same side as lesion
Brain stem dysfunction depends on where lesion is. A lesion of R brainstem could cause both R VI palsy and R VII palsy, how would this present?
Diplopia
Facial weakness
A plaque on the medial longitudinal fasciculus would cause what? What are the symptoms (4)?
Internuclear opthalmoplegia.
Symptoms: distortion of binocular vision, failre of adduction (diplopia), nystagmus in abducting eye, lag
What is an additional very common MS symptom?
Fatigue
Lower urinary tract dysfunction in MS can present as frequency, nocturia, urgency, urge incontinence and retention. What 2 problems cause this?
Increased tone of bladder neck and irritability of detrusor muscle
MS investigations (4)
Blood tests, MRI, CSF, neurophysiology (e.g. EEG)
List 6 DD for MS symptoms
Vasculitis, Granulomatous disorder, Vascular disease, Structural lesion, Infection, Metabolic disorder e.g. B12 and folate deficiency
List specific blood tests for MS to rule out other diseases
PV, FBC, CRP, Renal liver bone profile, Auto antibody screen, Borellia, HIV, syphilis serology, B12 and folate, Vit D
Borellia is the bacteria that causes what disease that can mimic MS?
Lyme disease
PV, FBC and CRP bloods are done to check for inflammation caused by other inflammatory diseases and not MS. True/false?
True
List 2 sequences of MRI for identifying MS
T2 + FLAIR
What is needed for MS diagnosis?
Clinical episode, dissemination in time and place, exclusion of other causes
Oligoclonal bands tend to be present in most MS patients CSF. What is abnormal result?
Unmatched oligoclonal bands in CSF. Unmatched means there aren’t the same ones in the serum
Acute relapse treatment for mild, moderate and severe
Mild: symptomatic treatment,
Moderate: high dose oral steroids,
Severe: admit/IV steroids
List 4 treatments for spasticity
Physio,
Antispasmodics
Botulinum toxin,
Intrathecal baclofen
Give 2 examples of antispasmodics used in MS
Baclofen,
Tizanidine
List 5 treatments for sensory symptoms of MS
Anticonvulsant e.g. gabapentin, Antidepressant e.g. amitriptyline, Tens machine, Acupuncture, Lignocaine infusion
List 4 treatments for lower urinary tract dysfunction in MS
Bladder drill,
Anticholinergics e.g. oxybutynin,
Desmopressin,
Catheterisation
Occupation health nurses, amantadine & modafinil (less), hyperbaric oxygen are all treatment for what symptoms of MS?
Fatigue
What is cannibas licensed for?
Resistant spasticity
Efficacy of MS treatment depends on when treatment is given - true/false?
True
What is first line disease modifying therapy for MS? Which is injectable?
Tecfedira/aubagio (tablets), interferon beta (injectable), glitiramer acetate (injectable)
What is second line disease modifying therapy for MS?
Monoclonal antibody e.g. tysabri, ocrevus, lemtrada,
Fingolimod
What is third line disease modifying therapy for MS?
Mitoxantrone (less as toxic to heart), HSCT (stem cell transplantation)
1st line DMARD used when?
Relapse onset MS
When is second line disease modifying therapy licensed for use in MS? (2)
If tried first line or have very aggressive MS
FBC and liver function monitoring must be done every _ months for patients on tecfedira?
3 months
Interferons and glitiramer acetate decrease relapse rate by how much? They decrease severity of relapses by how much?
Decrease relapse rate by 1/3 and decrease severity of relapses by 50%
What is first line tablet for RRMS? What is approximate relapse rate?
Tecfidera - 44% reduction in relapse rate
Second line tablets for MS are? What is reduction in relapse rate?
Fingolimod/cadrabine, >50% reduction in relapse rate
Monoclonal antibody ocrelizumab targets what site?
Anti CD 20
Monoclonal antibody alemtuzemab targets what site?
Anti CD50
Monoclonal antibody natilizumab targets what site?
Anti integrin
Monoclonal antibodies are licensed when?
In highly active RRMS e.g. patient with rapidly evolving severe RRMS or patients who already tried interferon/glitiramer acetate
Which is best treatment but worst side effect?
Monoclonal antibodies
