MS Flashcards
What is the clinical presentation of MS?
- Disease of young people: most people present with this condition in their 20s and 30s
- More common in females (3:1)
- Relapsing and Remitting course
- Optic Neuritis:
-> subacute visual loss
-> pain on moving the eye
-> colour vision impaired
O/E:
-> initial swelling of optic disc
-> optic atrophy later on
-> relevant afferent pupillary defect - Cerebellum:
- > vertigo
- > nystagmus
- > ataxia
- Brainstem:
- > Diplopia
- Spinal cord:
- > bilateral motor + sensory symptoms: UMN limb signs, hyperaesthesia
- > bladder involvement
What are the different courses of MS?
- Relapses = focal disturbance of function*
- Nb. some pt.s experience progressive disablement, others don’t*
- Relapsing/Remitting (RRMS) = 85%
- > relapses
- Secondary Progressive (SPMS)
- > relapses, then progressing to loss of strength and disability
- Primary Progressive (PPMS) = 10-15%
- > progressively getting worse from outset
- > often presents in 5th-6th decade
- > bladder and spinal symptoms
How is the diagnosis of MS made?
- Evidences of demyelination separated in time and space
- May be clinical:
- > 2 relapses involving different areas of the CNS, months or years apart
- > Poser’s criteria
- or MRI-based diagnosis:
- > Macdonald criteria: areas of demyelination on MRI (black holes on MRI)
- Other tests:
- > Lumbar puncture: oligoclonal bands
- > Relevant blood tests: ie. serology, autoantibody screen
- > CXR: ?sarcoidosis
What are the poor prognostic signs of MS?
- Older male
- Motor signs at onset
- Many relapses early on
- Many MRI lesions (black holes)
- > axonal loss
What is the differential diagnosis of MS?
- depends on clinical features and whether and on whether it is a first relapse or progressive disease*
- ADEM - Acute Disseminated Encephalomyelitis
- Other causes of demyelination: NMO
- Other autoimmune conditions: ie. SLE
- Sarcoidosis
- Vasculitis
- Infection: ie. Lyme disease, HTLV-1
- Adrenoleucodystrophy
What is the differential diagnosis of Optic Neuritis?
- MS (!!)
- NMO -> Neuromyelitis Optica
- Sarcoidosis
- Ischaemia Optic Neuropathy
- Toxic/drugs/B12 deficiency
- Wegener’s Granulomatosis
- Local compression
- Leber’s hereditary optic neuropathy
- Infection: TB, HIV
What is the differential diagnosis of Myelitis?
- Inflammation
- > MS (!!)
- > NMO
- > SLE
- > Sarcoidosis
- Infection (or post-infection)
- > HIV, HTLV-1, HSV, TB, Borrelia, Mycoplasma
- Tumour
- Paraneoplastic process
- Stroke
What is the treatment of MS relapse?
- Look for underlying infection (!!)
- oral pred
- symptomatic treatment
- general health and diet
- MDT approach
What are the disease-modifying treatments (DMTs) for MS?
Reduce relapse rate -> but NOT a cure!
- Interferons (IFN-1B, IFN-1a):
- > Beta-interferons (1st line)
- Monoclonal antibodies
- > Alemtuzumab, Natalizumab (2nd line)
- Non-immunosuppressives:
- > Glatiramer acetate (1st line)
What is the main side-effect/complication of disease-modifying treatments (DMTs) for MS?
Progressive Multifocal Leukoencephalopathy (PML)
-> due to immunosuppression
What is the symptomatic treatment of MS?
treat the symptom, not the “MS symptom!”
• Spasiticity:
- > muscle relaxants
- > antispasmodics
- > physio
• Dysaesthesia
-> amitriptyline, gabapentin etc.
• Urinary
- > anticholinergic Rx
- > bladder stimulator/ catheterisation
• Constipation
-> laxatives
• Sexual dysfunction
-> Sildenafil (viagra)
• Fatigue
-> graded exercise, medication
• Depression
-> CBT, medication
• Cognitive
-> memory aids, etc
• Tremor
-> aids/medication
• Vision/ oscillopsia
-> carbamazepine
• Speech/ swallowing
-> SALT
• Motor/ sensory impairment
-> MDT
