MS Flashcards
What is MS?
Inflammatory demyelination episodes affecting whole CNS. Progresses to relapsing remitting disease, and on to axonal loss and progression.
What is the cause of MS?
Inappropriate immune respose to T and B lymphcytes
Why is the peripheral NS not affected?
Myelin is produced by schwann cells so protected
How does incidence vary?
Geographical location- children adopt the risk of the area they move to
Males or females present earlier?
Females
Average age of presentation?
20-40 y/o
Primary progressive is a later onset
Optic presentation of MS
Optic Neuritis: Diplopia Preorbital and retro-orbital pain exascerbated by movement Decreased acuity Central Scotoma (blind spot) Pupil doesn't constrict on swinging light test Swollen, pink optic disc (usually mono symptomatic)
Brainstem presentation of MS
Diplopia Dysonjugate eye movements Limb and gait ataxia (foot drop- need splints) Titubation Tremor Dysarthria Vertigo Nystagmus Dysphasia
Spinal Cord Lesion Presentation MS
Lhermitte’s Phenomenon
Pyramidal spastic weakness- clasp knife
Bladder, bowel and sexual dysfunction
Cerebella lesion MS
Ataxia and intention tremor
Other presentations of MS
Dementia Euphoria Facial Pain Emotional lability Bladder urgency and frequency Uhthoff's
How is MS investigated?
Clinical- no diagnostic test
Oligoclonal bands of IgG in CSF
Slow evoked potentials on EMG
MRI shows lesions around ventricles
What is required to diagnose MS and what are the criteria called?
MACDONAL CRITERIA=
2 lesions disseminated in space and time (over 1 month apart)
MRI with gadolinium contrast can stage plaques
Treatment of MS
- Reduce Stress
- IV methylprednisolone in relapses to shorten
- Interferons (betaferon) decreases freq of relapses
also
Monoclonal antibodies (Natalizumab)
Baclofen for spasticity (or Botox, Tizanidine, Dantrolene)
Oxybuytnin for bladder (or B agonists or alpha blockers)
Amitriptyline for depression
Neurological rehab and physio
Support groups
MS nurse
OT
