MS Flashcards
what is multiple sclerosis
autoimmune inflammatory demyelinating disorder of the central nervous system
- chronic
- degenerative
- immune mediated
what are plaques
inflammatory areas
what does dissemination in time and space mean
plaques are found at different times in different places
does this disorder affect the PNS
no, it only affects the CNS
males/females are more affected by MS
females
what is the epidemiology and RF of MS
F>M 30-40s those who live further away from the equator genetics EBV HHV 6 vit D deficiency
what are the 4 clinical courses of MS
relapsing remitting
secondary progressing
progressive relapsing
primary progressive
define relapse/exacerbation
new symptoms / significant worsening of existing symptoms lasting more than 24 hours with preceding 30 days of clinical stability
list the clinical features of MS (6)
Pyramidal dysfunction Visual symptoms Sensory deficits Lower urinary tract dysfunction Cerebellar and brainstem dysfunction cognitive impairment and fatigue
describe pyramidal dysfunction in MS
hypertonia and spasticity
hyper reflexia
weakness of upper limb extensors and lower limb flexors
describe visual disturbances in MS
optic neuritis
internuclear ophthalmoplegia
what is optic neuritis
painful visual loss because of inflammation of the optic nerve
RAPD seen
describe sensory deficits in MS
pain paraesthesia "water trickling" sensation numbness DCML loss trigeminal neuralgia
describe lower urinary tract dysfunction in MS
frequency urgency urinary incontinence urinary retention nocturia
describe cerebellar and brainstem dysfunction in MS
DANISH symptoms
diplopia + facial weakness from CN palsies
describe internuclear ophthalmoplegia
impaired:
ipsilateral adduction
contralateral abduction nystagmus
how is a diagnosis of MS made
at least 2 episodes suggestive of demyelination
dissemination in time and space
alternative diagnoses excluded
what investigations are carried out to diagnose MS
history and clinical examination MRI CSF neurophysiology blood tests
what is MRI looking for
T2 weighted MRI to look for dissemination in time and space
what do you look for in CSF
oligoclonal bands
what blood tests are done
FBC CRP LFT U+E PV bone profile Ab screen borellio HIV syphilis serology B12 folate Vit D
what are differential diagnoses of MS
vasculitis granulomatous disorders vascular disease structural lesion infection metabolic disorder
3 approaches to management of MS
acute exacerbation
symptomatic treatment
disease modifying therapy
steps in management of acute exacerbation
mild - symptomatic treatment
moderate - PO steroids
severe - IV steroids
give examples of symptomatic treatment for pyramidal weakness
PT + OT
anti-spasmodics
botox, intra thecal baclofen
give examples of symptomatic treatment for sensory symptoms
anticonvulsants antidepressants TENS machine acupuncture lignocaine infusion
give examples of symptomatic treatment for LUT dysfunction
reduce caffeine
anti cholinergics - oxybutynin
desmopressin
catheterisation
give examples of symptomatic treatment for fatigue
amantadine
modafinil if sleepy
hyperbaric oxygen
how many lines of therapy are there in disease modifying therapy
1st, 2nd and 3rd
list first line disease modifying therapy
Tecfidera PO
Interferon B and Glitiramer acetate - SC + IM
which drug is 1st line after RR MS
tecfidera
list 2nd line disease modifying therapy
Fingolimod and Cadrabine - PO
Tysabri
what kind of drug is tysabri
monoclonal antibody
what disease can tysabri cause
progressive multifocal leukoencephalopathy PML
list 3rd line disease modifying therapy
Mitroxantrone and Lemtrada
HSCT - horizontal stem cell transplant
