MS Flashcards
What is the pathophysiology of MS?
Demyelination of the white matter of the CNS caused by an autoimmune, T cell mediated response.
Causes still unknown
What is specific about the symptoms in MS?
Disseminated in time and space
i.e. separate episodes which improve
What is the most common type of MS?
Relapsing-remitting
List the different types of MS:
Relapsing-remitting
Secondary Progressive
Primary Progressive
What occurs in optic neuritis?
Usually unilateral
Colour changes
Visual field changes - central scotoma
Lasts usually 1 - 2 weeks
What medication is given in acute phases to improve symptoms?
IV (or oral) steroids
Mehtylprednisalone
List some of the symptoms associated with brainstem demyelination
Diplopia
Vertigo (without tinnitus/hearing loss)
Facial weakness
Pyramidal Signs occur when there is a demyelinating plaque where?
The corticospinal tract
List some pyramidal symptoms:
Increased tone
Spasticity
Weakness
Hyperreflexia
Loss of proprioception is caused by a plaque where?
Dorsal column spinal tract
List some other symptoms common in MS:
Fatigue Water trickling sensation Neuropathic pain Urinary problems Sexual dysfunction Depression / low mood Temperature sensitivity
Should exercise be recommended in patients with MS?
Exercising in swimming pool is best - prevents risk of overheating which can exacerbate symptoms
List some signs/symptoms which suggest plaques in the cerebellum:
Ataxia Intention tremor Nystagmus Past pointing Pendular reflexes Dysdiadokinesis Dysarthria
What investigations should be done for MS?
Mostly diagnosis made on clinical history
Bloods done to rule out other differentials
MRI - will show plaques
What drug is used to manage fatigue in MS and what is its mechanism of action?
Amantadine Hydrochloride
A weak dopamine agonist
What else can amantadine hydrochloride be used to treat?
Parkinson’s
What disease modifying drugs are first line in RRMS
Beta interferon
Alemtuzumab
Glatiramer acetate
Tecfidera
What medication can be used to manage spasticity symptoms
Baclofen
Tizanidine
Botulinum toxin
What medications can be used to manage the sensory symptoms?
Gabapentin
Amitriptyline
Lignocaine infusion
What medications can be given to treat bladder / Urinary tract dysfunction
Oxybutynin
Desmopressin
What is the second line dmd used in MS?
Monoclonal Antibodies
e.g. Tysabri, Lemtrada, Zymbrata
OR
Fingolimod
What disease modifying drug is third line in MS?
Mitoxantrone
How would plaques of demyelination show up on an MRI?
Hyperintense regions
What areas in the brain are most commonly affected by plaques?
Lateral ventricles Corpus callosum Optic nerves & chiasm Brainstem Cerebellum Spinal cord and tracts
What morphology is seen in active plaques?
Perivascular inflammatory cells
Microglia
Ongoing demyelination
What morphology would be indicative of an inactive plaque?
Gliosis & scarring
Little remaining myelinating axons
Decreased number of oligodendrocytes and axons
