MS Flashcards
What is MS?
an inflammatory demyelinating disorder of the CNS
What are the clinical features of MS?
pyramidal dysfunction; optic neuritis; sensory symptoms; lower urinary tract dysfunction; cerbellar and brainstem features; cognitive impairment
What are teh features of pyramidal dysfunction seen with MS?
increased tone- velocity dependant; spasticity; weakness of extensors of upper; flexors of lower
What is seen with optic neuritis?
painful visual loss that lasts for 1-2 weeks and is associated with RAPD
What sensory symtpoms are seen with MS?
pain; parasthesia; DC loss of proprioceptio nand vibration; numbness; trigeminal neuralgia
What features are seen with cerebellar dysfunction?
ataxia; intention tremor; nystagmus; pendular reflexes; dysdiadokinesia; dysarthria
What is seen with brainstem dysfunction?
diplpopia; facial weakness
Where is the problem in internuclear ophthalmoplegia?
medial longitudinal fasciulus
What happens in internuclear ophthalmogplegia?
distortion of binocular vision; failure of adduction- diplopia; nystagmus in abducting eye and lag
What are the symptoms of lower urinary tract dysfunction with MS?
frequency; nocturia; urgency; urge incontinence and retention
How is a diagnosis of MS made?
at least 2 peisodes suggestive of demyelination with dissemintation in time and place
What is the purpose of doing blood tests in suspected MS?
to rule other things outj rather than rule in
Why is PV; FBC and CRP done?
to rule out vasculitis or sarcoid- high eosinophils
Why are autoantibodies done?
to rule out sarcoid and vasculitis
What viruses are tested in patients with suspected MS?
borellia; HIV; syphilis
What is seen in the CSF of patients with MS?
matched oligoclonal bands
What are the treatments for pyramidal dysfunction?
PT; OT; antispasmodic agent
What are the treatments for spasticity?
PT; oral- baclofen; tizanidine; botulinum toxin; intrathecal baclofen/phenol
What probem can oral baclofen cause?
postural hypotension
What are hte treatments for sensory symptoms in MS?
anticonvulsant eg gabapentin; antidepressant- amitriptyline; tens; acupuncture; lignocaine
What are the problems in MS that cause lower urinary tract dysfunction?
increased tone at bladder neck; detrusor hypersensitivity; detrusor sphyncteric dyssensergia
What happens with detrusor sphyncteric dyssenergia?
both the detrusor and sphincter contract at the same time so pt wants to pass urine but can;t
What are the treatments for lower urinary tract dysfunction?
bladder drill; anticholinergics eg oxybutynin; desmopressin; catheterisation
When is desmopressin used?
for short periods eg for travel
What are teh treatments for fatigue?
amantadine; modafinil if sleepy; hyperbaric oxygen
What are the first line therapies for disease modifyuing therapy?
interferon beta; glitiramer acetate; tecfedira
What are hte second line disease modifying therapies?
mocolonal antibody; fingolimod
What is the third line disease modifying therapy?
mitoxantrone
What is the method of delviery of interferon beta and copaxone?
injectable sc or im
What is the efficacy of interferon beta and copaxone?
decrease relapses by 1/3rd and decrease severity of realpses by 50%
What drug is the first line in relapsing remitting MS?
tecfidera
When are monoclonal anitbody treatments indicated in MS?
pts with rapidly evolving severe relapsing remittting MS or with high disease actvitiy despite treatment with an interferon
What are the problems with fingolimod?
cardiac issues; llmphopenia; HT; PML
What drugs are associated with PML?
tecfidera and all second line therapies
What drug has the highest risk of PML?
tysabri
What increases your risk of PML?
being JC virus positive
What type of MS is mitoxantrone used for?
relapsing progressive MS
What is the main problem with mitoxantrone?
cardiac toxicity and malignancies
