MS

Question 1

What are the main ways in which MS can present?

Answer 1

INSULAR

I - Intention Tremor, Intranuclear Opthalmoplegia, Impotence

N - Nystagmus, Numbness, Neuropathic pain

S - Slurred speech, spasticity

U - Urogenital symtpoms, Uthoff’s Phenomenon: symptoms worsen when patients are exposed to heat due to effect on myelin

L - Labile emotions, Lhermitte’s phenomenon: C-spine flexion sends electric shock-like sensations down the spine

A - Ataxia (and vertigo)

R - Retrobulbar neuritis

Question 2

What are the 4 clinical categories of MS?

Answer 2

Relapsing remitting - RR that recovers (not always fully)

Secondary progressive - intially RR that suddenly declines

Primary progressive - progression with no relapses

Progressive relapsing - steady decline with superimposed RR

Question 3

Which conditions may be considered a forme fruste of MS?

Answer 3

Optic Neuritis

Optic Neuritis with Transverse Myelitis

Question 4

What is the role of Interferon beta (Betaferon) in MS?

Answer 4

Reduces progression of disease

Question 5

What investigations should be done in MS and why?

Answer 5

Contrast MRI of brain AND C-spine to confirm MS but also exclude other diagnoses

FBC, LFT, TFT and don’t forget B12!

Question 6

How may you manage the symptom of fatigue?

Answer 6

Amantadine

Question 7

What is a common side effect of interferon beta?

Answer 7

Flu-like symptoms

Question 8

How may you manage the symptom of urinary frequency?

Answer 8

Lifestyle

• avoid caffeine and vitamin waters’
• bladder training

Oxybutynin or Tolterodine

Question 9

How may you manage symptoms of pain and dysaesthesia (unpleasant sensation when touched)?

Answer 9

Gabapentin or Pregabalin

Question 10

How may you manage symptoms of muscle spasticity?

Answer 10

Lifestyle

• Gentle stretching
• Physio, keep active

Baclofen, clonazepam, dantrolene, tizanidine

Question 11

How may you manage symptoms of tremor?

Answer 11

Propanolol, clonazepam

Question 12

What can patients do themselves to help with their condition?

Answer 12

Regular exercise and a low fat diet, staying active as possible

Question 13

What are some complications of MS?

Answer 13

UTI - with neurological worsening
Osteopaenia/porosis - steroid use
Depression - multifactorial
Visual impairment - primary manifestation
ED - treat with sildenafil
Cognitive impairment
Impaired mobility - DMARDs and physio