MS Flashcards
What is MS?
Episodes of demyelination in white matter disseminated in space and time
What causes MS?
Autoimmune
Activated T cells cord blood brain barrier and cause demyelination
What are the types of MS?
Relapsing remitting= most common Secondary progressive- relapses and remission lead to eventual progression Primary progressive- no remission Sensory Malignant
What are the risk factors for MS?
Female
20-40yo
Infectious mononucleosis in early adulthood
Latitude- vit D exposure?
What are the good prognostic indicators for MS?
Female
Present with optic neuritis
Long period between 1st and 2nd relapse
Few relapses in first 5 years
What are the bad prognostic indicators in MS?
Male
Older age
Multifocal S+S
What are the early presenting features of MS?
Often optic neuritis- subacute vision loss, pain moving eye and disturbed colour vision
Sensory- ascending numbness, numb extremities, paaresthesia
Motor weakness
What are the ongoing features f MS?
UMN- brisk reflexes, upping plantars, spastic weakness
Cerebellar signs- incoordination, loss of balance, ataxia
Paraesthesia and hyperaesthesia
Incontinence
Cognitive and emotional change
Fatigue- very prominent
What investigations are done for MS?
MRI with contrast- visible lesions of demyelination LP- oligoclonal bands Bloods CXR Visual/somatosensory evoked response
What are the management principles in MS?
Disease modifying
Symptomatic
Relapse improvement
What are the 1st line disease modifying treatments for MS?
Beta interferons
Glatiramir acetate
Teriflunomide
Dimethylfumerate
What are the 2nd line disease modifying treatments for MS?
Natalizumab
Fingolimod
Alentuzumab
What is used to treat relapses in MS?
Oral prednisolone
What is used to treat spasticity in MS?
Muscle relaxants
Anti-spasmodics e.g. baclofen
What is used to treat dysaethesia/hyperaesthesia in MS?
Amitriptyline
