MS Flashcards
What is Multiple sclerosis?
Acquired chronic immune-mediated inflammatory condition of the CNS - affecting both the brain and spinal cord
Believed abnormal immune response to environmental trigger
Demyelination of the myelin sheath causing plaques which disrupt the neural pathway
Acute inflam stage neurones may remyelinate - clinical remission
Present ~last 20s
How does MS present?
(relapsing + remitting course) = worse with HEAT
- Sensation: pain, numbness, tingling
- Motor: UMN signs, weakness, impaired coordination/balance, dysarthria, dysphagia, spasticity, hyper-reflexia, scissoring gait
- Autonomic: diarrhoea, constipation, urinary incontinence
- Cognitive: fatigue, decreased attention span, concentration, memory, judgment
- MH: depression, mood instability
- Ocular: optic neuritis (mono, pain, vision loss), dec acuity, orbital pain, red desaturation, central scotoma, RAPD, optic disk swelling
Outline the 3 main patterns of MS
Relapsing-remitting = most common, repeated neurological relapses, followed by complete/partial recovery, can devel into sec progressive
Primary progressive = symptoms gradually devel, worsen over time without recovery
Secondary progressive = gradual progression, unrelated to relapses after an initial relapsing-remitting course
How should MS be investigated?
Immunoelectrophoresis of CSF = oligoclonal bands of IgG
MRI brain/spinal cord = demyelination plaques
Typical lesion:
- location = periventricular, optic N, brain stem, cerebellar
- character = oval, well defined, >3-6mm
How is a Dx made?
Dx =
2010 McDonald criteria:
1) lesions consistent with inflam process
2) excluding alternative dx
3) lesions devel at diff times, in diff locations
4) progressive deterioration over 1y
How is an acute relapse of MS Mx?
Rule out infection, tx if present
IV methyprednisolone IV Ig, plasma exchange
How is MS generally Mx?
- Immune modulating = B-interferon, glatiramer acetate
- Immunosuppressant = Natalizumab, azathioprine
- Spasticity = physio, baclofen
- Neuropathic pain = gabapentin, pregabalin, carbamazepine
- Depression = CBT, citalopram (SSRI)
- Incontinence = oxybutynin, botulinum toxin
- Swallowing diff = good posture, eat slowly, chew well, alternative liquid/solid, thickeners
- Emotional lability = amitryptiline
- Fatigue = lifestyle modification (exercise, good sleep), amantadine
- Vit D
- Thyroidectomy
How does pregnancy effect MS?
Doesn’t effect fertility
DMT = Copaxone
Is a positive protective influence, with relapse rates going down, especially during 3rd trimester (between 6-9m)
First 3m after the baby is born, your risk of relapse rises
Having MS will not directly affect the pregnancy, labour or giving birth
Most DMTs shouldn’t be taken if you want to breastfeed
What are the indications for the use of beta-interferon as a DMT?
(anti-inflam)
Relapsing MS and a recent relapse and/or if MRI scans show new signs that the MS is active (new lesions)
Secondary progressive MS but still have significant relapses
‘clinically isolated syndrome’ or CIS (a first attack of MS-like symptoms) and a brain scan shows you’re likely to go on to get MS
List some common DMT used in MS and important side effects
Interferon beta = injection site reactions, flu-like sx, headache, myalgia, nausea, pain, fever
1-a glatiramer acetate = immediate post injection reaction, N+V, chills, athralgia, neck/back pain
1-b glatiramer acetate = immediate post injection reaction, N+V, chills, athralgia, neck/back pain
Mitoxantrone = N+V, heartburn, stomach pain, diarrhoea, constipation, headache
Natalizumab = dizziness, nausea, urticaria, shivering
