MS Flashcards
What is MS?
Inflammatory demyelinating disorder of the CNS
Plaques disseminated in time and place
Are women or men more commonly affected by MS?
Female: male = 3:1
What are the different clinical courses of MS?
Relapsing remitting; 90%
Secondary progressive
Progressive relapsing
Primary progressive
What are the clinical features of MS?
Pyramidal dysfunction Optic neuritis Sensory symptoms Lr urinary tract dysfunction Cerebellar and brain stem features Cognitive impairment
What are the symptoms of pyramidal dysfunction in MS?
Increased tone Spasticity Weakness Extensors of upper limbs Flexors of lower limbs UMN LESION
What are the symptoms of optic neuritis?
Painful visual loss on eye movement
RAPD
Central scotoma
How long will optic neuritis last in MS?
1-2 weeks
What sensory symptoms are associated with MS?
Pain Paraesthesia Dorsal column loss; proprioception and vibration Numbness Trigeminal neuralgia
What cerebellar symptoms are associated with MS?
Dysarthria Ataxia Nystagmus Intention tremor Past pointing Pendular reflexes Dysdiadokinesis
Will cerebellar problems be contra or ipsilateral?
Ipsilateral
What brain stem dysfunctions are commonly seen in MS?
Diplopia; CN6 palsy
Facial weakness; CN 7 palsy
What causes internuclear ophthalmoplegia?
Medial longitudinal fasiculus
What will be seen in INO?
Distortion of binocular vision
Failure of adduction; diplopia
Nystagmus in abducting eye
Lag
What lr urinary tract dysfunctions are assoc with MS?
Increased tone of bladder neck; retention
Irritability of detrusor muscle; frequency, nocturia, urgency, incontinence
What is used for fatigue management in MS?
Amantadine
Modafinil if sleepy (?)
Hyperbaric oxygen
Fatigue management via occupational therapists
How is MS diagnosed?
At least 2 episodes suggestive of demyelination
Dissemination of plaques in time and place
Alternative diagnoses excluded
What scans are done for the diagnosis of MS?
MRI - T2 weighted
FLAIR
CT ALWAYS BEFORE LP PERFORMED
Neurophysiology
What is the DDx of MS?
Vasculitis Sarcoid (tend to have pulmonary and skin involvement along with arthralgia and uveitis) Vascular disease Structural lesion Infection; HIV, syphilis, lyme disease Metabolic disorder; B12/folate
What blood tests are routinely performed in the work up of potential MS?
PV, CRP, FBC U+Es, eGFR LFTs Auto-antibody screen Borrelia (lyme), HIV, syphilis B12 and folate Vit D
What is seen on CSF of those with MS?
Oligoclonal bands in 90+% of cases
What is the treatment of an acute relapse of MS?
Mild - symptomatic
Moderatie; oral methylprednisolone 500 mg for 5 days
Severe; IV methylprednisolone 1000 mg for 3 days
What are some common adverse effects of MS?
Osteoporosis Pancreatitis Diabetes Hypertension Psychosis AVN of hip
What is the symptomatic tx for pyramidal dysfunction?
Physio
Occupational therapy
Anti-spasmodic agents
Don’t always want to get rid of spasticity; if muscles very weak, the spasticity of them will be the only thing allowing the patients to stand up and walk
What are the anti-spasmodic agents used in spasticity?
PO; baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/ phenol
What are the treatments for the sensory symptoms assoc with MS?
Anticonvulsant e..g gabapentin Anti-depressant; amitriptyline Tens machine Acupuncture Lignocaine infusion
What is the treatment for lower urinary tract dysfunction?
Bladder training
Anticholinergics; oxybutynin
Desmopressin
Catheterisation
What are the 1st line disease modifying drugs used in MS?
Interferon beta; avonex, rebif, betaseron, extavia
Glitiramer acetate
Tecfidera, aubagio
What are the 2nd line disease modifying drugs used in MS?
Monoclonal Ab; tysabri, ocrevus
Fingolimod, cladrabine
What are the 3rd line disease modifying drugs used in MS?
Mitoxantrone, lemtrada
HSCT (stem cell transplantation)
What is a very serious side effect associated with tysabri?
If the patient is infected with JC virus; can activate and cause PML
What is PML?
Progressive multifocal leukoencephalopathy; fatal disease characterized by progressive inflammation of the white matter of the brain at multiple locations
What is the mode of action of tysabri?
Prevents leucocytes entering the BBB and therefore prevents autoinflammation
