MS Flashcards
MS is an autoimmune reaction against?
oligodendrocytes
In MS, what do you get destruction of?
myelin
are peripheral nerves affected?
no
normally, macrophages cannot easily cross the BBB, but what do they express that allows them to adhere and cross the endothelium?
glycoprotein α4 β1
show up on MRI as white blobs, roughly 2-10mm in size, and can occur anywhere in the CNS, although most commonly occur at the optic nerves, periventricular lesion, brainstem and cerebellar connections?
plaques
what is the most common form of MS?
relapsing remitting (RR)
what is uhtoffs phenomenon?
symptoms worse during increased heat - conduction slows with increased heat
most common presenting symptom?
fatigue/lethargy
what is lhermittes sign?
on flexion of the neck, there is an electric shock sensation down the spine and into the limbs
what are upper motor neurone signs?
spasticity, weakness, brisk reflexes
what do oligoclonal bands show?
there is lots of antibody to something in the CSF - there will be oligoclonal bands in 80% of cases
for diagnosis, you need at least 1 attack and multiple plaques on MRI
y
often used as symptomatic treatment. It is an antagonist of GABA receptor ?
Baclofen
how do you manage urinary incontinence?
oxybutanin or self catheterisaton
a condition affecting the movement of the eyes which is characteristic of MS?
internuclear opthalmoplegia
in INO, when patient looks to left what happens?
let eye is fine, right eye does not go past midline
in INO, when patient looks to right what happens ?
right eye is fine, left eye does not go past midline
what is the definitive investigation in MS?
MRI
in visual evoked potentials, a delayed response indicates what?
there is evidence of some sort of optic nerve lesion
what other conditions can mimic lesion on MRI?
sarcoidosis, SLE, bechets syndrome
what is the severity of the disease like ?
Some patients may be able to live normally for many years, whilst other will becomes severely disabled.
female to male?
f:m 3:1
what pyramidal dysfunction ?
increased tone, spasticity and weakness
weakness in arms and legs?
weakness in extensors in arms and flexors in legs
you get loss of dorsal column. what does this cause?
proprioception and vibration (DEE PEE VEE)
you get pain and paraesthesia
y
what cerebellar defects can you get?
ataxia
what criteria is used for diagnosis?
mcdonalds
to satisfy dissemination in place, you need?
objective evidence of neurological deficits localised in two sepatrate parts of the CNS
for dissemination in time, you need?
onset of neurological deficits separated by at least one month
what are blood tests like in MS?
negative
for spastcity, what can you give?
BT - baclofen or tizanidine. or botulinum toxin
For sensory symptoms, can give?
sense maga
amytriptyline or gabapentin
for urinary symptoms of frequency etc. tx?
Bladder drill, anticholinergics eg oxybutanin,desmopressin and catheterisation
for fatigue?
Amantadine and modafinil (amanmod)
Hyperbaric oxygen
First line therapy
Interferon Beta – avonex,rebif, betaseron,extavia
Glitiramer acetate
Techfedira
Second line therapy
Monoclonal antibodies tysabri, lemtrada, zymbrata
Fingolimod
Third line
mitoxantrone
S1P modulator ?
fingolimod
