MS

Question 1

What are common symptoms of Multiple Sclerosis (MS)?

Answer 1

• Optic neuritis.
• Ascending sensory disturbance and/or weakness.
• Problems with balance, unsteadiness, clumsiness.
• Lhermitte’s symptoms.
• Symptoms may persist for several days/weeks, then improve.
• Bladder, bowel, and sexual dysfunction.
• Ataxia.
• Diplopia.

Question 2

What are Lhermitte’s symptoms?

Answer 2

Altered sensation down the back (+/- limbs) when bending the neck forward.

Question 3

What are the common patterns seen in Multiple Sclerosis (MS)?

Answer 3

• Relapsing-Remitting MS (85%).
-Primary Progressive MS (10-15%)
• Secondary Progressive MS.
• Progressive-Relapsing MS.

Question 4

How is Multiple Sclerosis (MS) diagnosed?

Answer 4

• McDonald Criteria: Establish lesions developed at different times and in different anatomical locations.
• Requires ≥2 attacks or clinical evidence of ≥2 lesions.

Question 5

What investigations should be ordered for Multiple Sclerosis (MS)?

Answer 5

1. Brain MRI (≥3 white matter lesions = 90% sensitivity).
2. Follow-up MRI every 3–6 months after starting treatment and annually if on DMT.
3. Bloodwork:
   • CBC, LFTs, electrolytes, calcium, glucose, TSH, Vit B12, ESR/CRP.

Question 6

What are some differential diagnoses for Multiple Sclerosis (MS)?

Answer 6

• Stroke.
• Seizure.
• Presyncope.
• Vestibular migraine.
• SLE.
• ALS.
• Metabolic (e.g., B12 deficiency).
• Neurosyphilis.

Question 7

How is a relapse in MS defined?

Answer 7

Development of new symptoms or worsening of existing symptoms, excluding infection.

Question 8

What is the treatment for MS relapses?

Answer 8

Treat within 14 days of symptom onset using methylprednisolone 0.5 g daily for 5 days.

Question 9

When should disease-modifying therapy (DMT) be initiated in MS?

Answer 9

If the patient has ≥1 relapse in the last 2 years and ≥2 brain lesions.

Question 10

What are examples of high-efficacy DMARDs used in MS?

Answer 10

• Ocrelizumab.
• Natalizumab.
• Fingolimod.

Question 11

What are examples of moderate-efficacy DMARDs used in MS?

Answer 11

• β-interferon.
• Glatiramer.
• Teriflunomide.
• Dimethyl fumarate.

Question 12

How is fatigue managed in MS?

Answer 12

• Amantadine for MS-related fatigue.
• Magnetic therapy.
• Consider CBT, mindfulness, aerobic exercise, and yoga.

Question 13

How is spasticity managed in MS?

Answer 13

• Baclofen.
• Gabapentin.
• Tizanidine.
• Dantrolene.
• Benzodiazepines.
• Consider medical cannabinoids.

Question 14

How is oscillopsia managed in MS?

Answer 14

• Gabapentin (first line).
• Memantine (second line).