MS

Question 1

Environmental associations?

Answer 1

Vit D/Sun exposure, smoking
 Viruses (Canine distemper, Herpes,
EBV)
 Changing sex incidence

Question 2

Genetics associated?

Answer 2

HLA DRB1*1501

52 non HLA disease associated genes

Question 3

T-helper differentiation?

Answer 3

Question 4

patterns of disease course?

Answer 4

Bening (15%)

Relapsing (65%)

Primary Progressive (10-20%)

Secondary Progressive (50%)

Question 5

Relapses?

Answer 5

Symptom or symptoms of neurological dysfunction with or without objective confirmation lasting more than 24hours
Exclude confounding causes of deterioration
Infection, menses, emotional stress, heat etc
In relapsing pattern disease rate = 1-.15 pa
Common sites
optic nerve, spinal cord, brainstem
Relapses decrease in frequency and severity with disease duration

Question 6

Relapse frequency?

Answer 6

Clinical coroborated mean annualised relapse tates (MARR)

Question 7

MS making the diagnosis?

Answer 7

History
Identify relapsing neurological dysfunction occurring at different sites.
Examination
Evidence for involvement of multiple sites within the central nervous system
Paraclinical evidence
MR, CSF, EPs
Exclude other causes

Question 8

McDonald diagnostic criteria?

Answer 8

s

Question 9

conditions ot be excluded?

Answer 9

Question 10

disease heterogeneity?

Answer 10

Question 11

Expanded disability scale status (EDSS)

Answer 11

Question 12

assessment of disease activity?

Answer 12

Relapse frequency and severity
Rate of change in disability
Early fixed disability: esp motor, cerebellar, cognitive
MRI: T2 Lesion load, gadolinium enhancing lesions, atrophy

Question 13

HCDMT treatment criteria?

Answer 13

Relapsing remitting disease
Independent mobility (preferably EDSS <5.5 ie 100m)
At least two clinically significant relapses in last 2 years
Secondary progressive disease
Able to walk >10m with or without assistance
At least two clinically significant relapses in last 2 years
Any increase in disability due to slow progression over the last two years has been minimal
All
Age >18 years
There are no contraindications

Question 14

relapsing ms treatment?

Answer 14

Route 1
Symptomatic control, steroids during acute events
Route 2
Established DMTs
Tier 1 Interferon beta 1a/1b, Glatirimer acetate
Tier 2 Fingolimod
Tier 3 Natalizumab, Alemtuzumab
Route 3
Experimental treatments including, BG12, Laquinimod, Teriflunamide, Rituximab, Dacluzimab etc)

Question 15

Consequences of treatment?

Answer 15

Question 16

Symptomatic treatment?

Answer 16

Fatigue
•Vertigo
•Spasticity and muscle spasms
•Psychological difficulties
•Bladder and bowel dysfunction
•Sexual dysfunction
•Ataxia and tremor
•Cognitive impairment