MS Flashcards
What is MS?
Autoimmune condition involving demyelination in the CNS
The immune system attacks the myelin sheath of the myelinated neurones
Who does MS typically present in?
Young women (under 50)
What cell provides myelin in CNS?
Oligodendrocytes
What cells produce myelin in PNS?
Schwann cells
What does MS affect
CNS (oligodendrocytes)
What is the pathophysiology of MS?
Inflammation and immune infiltration cause damage to the myelin, affecting the electrical signals moving along the neurones.
What can be seen if a patient presents with an MS attack?
Often other demyelination lesions throughout the CNS
What can occur in early disease?
Re-myelination
What happens in later stages of disease?
Re-myelination is incomplete and symptoms gradually become more permanent
What is a characteristic feature of MS?
Lesions vary in location
This means that the affected sites and symptoms change over time
“Disseminated in time and space”
What can influence the cause of MS?
Multiple genes
Epstein–Barr virus (EBV)
Low vitamin D
Smoking
Obesity
What is the most common presentation of MS?
Optic neuritis
What is optic neuritis?
Demyelination of the optic nerve and presents with unilateral reduced vision
Develops over hours to days
What are the main feaitures of optic neuritis/
Central scotoma (an enlarged central blind spot)
Pain with eye movement
Impaired colour vision
Relative afferent pupillary defect
How is optic neuritis treated?
High-dose steroids
How can MS be diagnosed?
MRI can show typical lesions
Lumbar puncture can detect oligoclonal bands in the CSF
How can relapses be treated?
Steroids
-500mg orally daily for 5 day or
-1g IV daily for 3-5 days
What are symptomatic treatments
Exercise to maintain activity and strength
Fatigues treatment
Neuropathic pain treatment
Depression management
Urge incontinence management
Spasticity management
Oscillopsia management
How is fatigue managed?
amantadine, modafinil or SSRIs
How is neuropathic pain managed?
amitriptyline or gabapentin
How is depression treated?
SSRIs
How is urge incontinence treated?
antimuscarinic medications (e.g., solifenacin)
How is spasticity managed?
baclofen or gabapentin
How is oscillopsia managed?
gabapentin or memantine
