MS

Question 1

Definition of MS

Answer 1

MS is a progressive long-term neurological disorder of the CNS that affects the brain, spinal cord and optic nerves
It is an acquired chronic autoimmune-mediated inflammatory disease

Question 2

Prevalence of MS

Answer 2

• 8,000 people living with MS in Ireland
• 100,000 people in the UK
• 400,000 people in the US
• 2.8 million people worldwide

Question 3

Epidemiology of MS

Answer 3

Peak age onset 25-35 years
70% between 21 and 40
Rarely in childhood and after 60 years
* Females > Males (3:1)
* White races mostly

Question 4

Causes of MS

Answer 4

Genetic
environmental - geographic variation
viral - epstein barr virus link
immunological - auto-immune and hypervilisant immune system

Question 5

pathophysiology of MS

Answer 5

interplay between immune system, glial cells and neuron
destroys oligodendrocytes - myelin degenerates - less conduction speed by neuron in CNS
axon is relatively spared but damage of axons seen in later stages of disease

Question 6

Pathology of MS

Answer 6

sclerotic plaques in cortex (grey and white matter), spinal cord and optic nerve
acute lesions are inflammatory mediated by T cells CD4+ and CD8+

Question 7

Investigations of MS

Answer 7

MRI
Visual Evoked Responses
Lumbar puncture
2017 McDonald Criteria for diagnosis of MS

Question 8

Clinical presentation of initial symptoms of MS

Answer 8

• Vague: lack of energy, headache, depression, aches in limbs
• Precise neurological deficit
  Sensory disturbance 40% Neurons
  Retrobulbar or optic neuritis 17% optic
  Limb weakness 12% Spinal cord
  Diplopia 11% optic
  Vertigo, Ataxia, Sphincter disturbance - 20% all

Question 9

motor symptoms of MS

Answer 9

Monoparesis
Hemiparesis
Tetraparesis
* Spasticity (80%)
* Clonus
* Spasms
* Hyperreflexia, positive Babinski’s sign
* Abnormal posture and movement

Question 10

visual symptoms of MS

Answer 10

• Diplopia
• Blurred vision
• Loss of visual acuity
• Sudden onset of optic neuritis without any other CNS signs

Question 11

cerebellar signs of MS

Answer 11

• Hypotonia
• Ataxia
• Intention tremor
• Poor coordination (Dyssynergia/ Dysmetria/
  Dysdiadochokinesia)
• Nystagmus
• Dysarthria (Staccato)

Question 12

Sensations that can be tested for MS

Answer 12

• Position sense / Proprioception
• Vibratory sense
• Pain, Temperature, Touch
• Lhermitte’s symptoms – flexing head → sensory symptoms
  spine or LL
• Paraesthesias & numbness

Question 13

cranial nerve signs of MS

Answer 13

• Visual disturbance
• Vertigo - Brain stem plaque
• UMN signs

Question 14

classification of MS

Answer 14

1. Benign stable condition, mild attacks/and relapse followed with no progression, no permanent disability
2. Relapse remitting multiple sclerosis - stable, greater and longer relapse periods than benign, unpredictable and new symptoms can occur, most common
3. secondary chronic progressive - starts as RRMS but remissions stop and progressive phase continues
4. Primary Progressive - no distincts stages of stable and relapse, just experiences progression of worsening symptoms and disability

Question 15

Prognosis of MS

Answer 15

People with MS die 6 year earlier

Question 16

pharmacological management of MS

Answer 16

Steroids orally or IV
Beta interferons - AVonex, Rebif
Immunomodulators - copaxone, tysabri

Question 17

outcome measures for MS

Answer 17

Oxford
Ashworth
TUG
10MWT
Berg
Extended disability status scale