MS Flashcards
what is MS
inflammatory demyelinating disorder of the CNS
what is meant by plauqes
areas of inflammation caused by T-cell mediated response
what are the 4 patterns of MS
Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive
how does demyelination cause symptoms
demyelination heals poorly causing relapsing and remitting Sx
prolonged demyelination causes axonal loss and progressive Sx
how does MS normally present
monosymptomatic unilateral optic neuritis numbness/tingling in limbs leg weakness ataxia
what are signs of pyramidal dysfunction
increased tone
spasticity
weakness
affects extensors of upper limbs and flexors of lower limbs
what is Sx of optic neuritis
painful visual loss
lasts 1-2weeks
most improve (but not always)
associated with RAPD
what is RAPD
condition in which pupils respond differently to light stimuli shone in one eye at a time
what are sensory Sx of MS
pain paraesthesia numbness trigeminal neuralgia dorsal column loss
what is lost in dorsal column damage
proprioception and vibration loss
what are cerebellar dysfunction Sx
ataxia intention tremor nystagmus past pointing pendular reflexes Dysdiadokinesis Dysarthria
what are Sx of brain stem dysfunction
Diplopia = VI palsy
Facial weakness = VII palsy
what ophthalmic condition is almost seen exclusively in MS
Internuclear ophthalmoplegia
what is Internuclear ophthalmoplegia
caused by injury/dysfunction in the Medial longitudinal fasciculus
what are Sx of Internuclear ophthalmoplegia
Distortion of binocular vision
Failure of adduction- diplopia
Nystagmus in abducting eye
Lag
what are Sx of lower urinary tract dysfunction in MS
frequency nocturia urgency urge incontinence retention
what could Sx of lower urinary tract dysfunction in MS be confused with
BPH
what is used to treat fatigue in MS
amantadine
what is needed for a diagnosis of MS
At least 2 episodes suggestive of demyelination
Dissemination in time and place
what would Ddx be in MS
Vasculitis
Granulomatous disorder e.g. sarcoidosis
Vascular disease e.g. stroke
Structural lesion e.g. mass pressing on spinal cord
Infection
Metabolic disorder e.g. folate deficiency
what is the most sensitive test for MS
MRI
why are blood tests done in suspected MS
don’t rule in MS but they rule out other differentials
what blood tests should be done, and come back negative, to ensure it is MS
Plasma viscosity, FBC, CRP
Renal liver bone profile
Auto anti body screen - should be normal in MS
Borellia (lime disease), HIV, syphilis serology
B12 and folate
what in the CSF suggests inflammation
oligoclonal bands of IgG on electrophoresis
what are the 3 categories of management of MS
acute exacerbation
symptomatic treatment
disease modifying treatment
in a broad manner, what is the treatment of acute exacerbation of MS
mild - symptomatic Tx
moderate - oral steroids
severe - admit/IV steroids
what are tx options for pyramidal dysfunction
physio
occupational therapy
anti spasmodic agents
what are anti spasmodic agents
baclofen
tizanidine
Botox
what can be given in severe cases of bed bound patients
Intrathecal baclofen / phenol
what Tx can be given for sensory symptoms
anti convulsant eg. gabapentin
anti depressant eg.amitriptyline
what causes lower urinary tract dysfunction in MS
increased tone at bladder neck
detruser hypersensitivity
Tx for lower urinary tract dysfunction
anti-cholinergics eg. oxybutynin
desmopressin - stops urine production so only given for short period of time, i.e. they have to go on a plane journey
catheterisation
what is the first line therapy for disease modifying treatment
Interferon Beta – Avonex, Rebif, Betaseron, Extavia
Tecfedira
what is second line therapy for disease modifying
Monoclonal antibody – Tysabri, Lemtrada
Fingolimod
what is third line therapy for disease modifying
Mitoxantrone
what treatment is first line in relapsing remitting MS
Tecfidera
when is monoclonal antibody drugs indicated in MS
highly active relapsing remitting multiple sclerosis
what is a deadly SE that needs to be looked for in Tysabri
Progressive multifocal leukoencephalopathy
what are SE of the interferons
flu Sx
depression
abortion
what is the most common pattern of MS
Relapsing-Remitting
what are features of RR MS
episodes of exacerbations/relapses i.e. clearly defined attacks of new or increasing neurologic symptoms
followed by periods of partial or complete recovery (remissions)
no progression of the disease during remission
what are features of Primary Progressive MS
worsening neurologic function from the onset of symptoms, without early relapses or remissions.
what are secondary progressive MS
initial relapsing-remitting course
transition to a secondary progressive course in which there is a progressive worsening of neurologic function
what is progressive relapsing MS
pattern of relapses within primary progressive MS
least common
