MS

Question 1

What is MS?

Answer 1

• Chronic autoimmune, T cell mediated inflammatory disorder of the CNS in which there are multiple plaques of demyelination within the brain and spinal cord, occurring sporadically over years

Question 2

When does MS usually begin?

Answer 2

In early adulthood (20-40y/o)

Question 3

What are the three types of MS?

Answer 3

1. Relapsing and Remitting (80%)
2. Secondary progressive MS
3. Primary Progressive MS (10-15%)

Question 4

Briefly describe the pathophysiology of MS?

Answer 4

• T lymphocytes cross the BBB
• Destruction of myelin sheath
• Resulting in impaired conduction of nerve signals
• Myelin will initially regenerate but over time it doesn’t and the condition becomes irreversible

Question 5

What do the plaques in MS typically occur?

Answer 5

• Perivenular (around the veins)

Question 6

What sites in the CNS are the plaques most likely to occur around?

Answer 6

• Optic nerves
• Around ventricles of the brain
• Corpus callosum
• Brainstem and cerebellar connections
• Cervical cord (corticospinal tract and dorsal columns)

Question 7

What risk factors are associated with MS?

Answer 7

• Females > males
• Race (more common in white populations)
• More common the further from the equator you go (rare in tropical countries)
• HLADR2 positive - genetic factor (tissue type)

Question 8

What is Uhthoff’s phenomenon?

Answer 8

When MS symptoms worsen on heat exposure due to the myelin not performing as well in the heat

Question 9

What is Charcot’s neurological triad or MS symptoms?

Answer 9

• Dysarthria
• Nystagmus
• Intention tremor

Question 10

What symptoms may occur from plaques in the sensory pathway?

Answer 10

• Tingling
• Paresthesia
• Lhenmittes sign

Question 11

What symptoms may occur from plaques in the autonomic nervous system?

Answer 11

• Bowel and bladder dysfunction

- Sexual dysfunction

Question 12

What symptoms may occur from higher order activities?

Answer 12

• Loss of concentration

- Depression and anxiety

Question 13

What investigations would you do in MS?

Answer 13

• MRI scan brain and cord
• Lumbar puncture
• Electrophysiology (visual evoked potential studies)

Question 14

What test is considered diagnostic in MS?

Answer 14

MRI scan of the brain and spinal cord

Question 15

What is the life expectancy in someone with MS?

Answer 15

5 - 10 years below average

Question 16

What is the treatment for someone with MS?

Answer 16

No treatment for the condition but measures can be taken to help with the relapses

• Encourage a stress-free life as possible since a reduction in stress can reduce number of new lesions
• If poor diet and sun exposure then give vitamin D
• Smoking cessation

Question 17

What treatment is there for an acute relapse?

Answer 17

IV methylprednisolone for less than 3 days can help shorten acute relapse - use steroid sparingly and aim to use less than twice a year

Question 18

What treatment is there for frequent relapses?

Answer 18

• Anti-inflammatory cytokines (can help reduce relapses by 30% in active relapse-remitting MS and can reduce lesion accumulation)
• Disease modifying agents

Question 19

What treatment would you use in symptomatic treatment?

Answer 19

1. Spasticity - all antispasticity can result in weakness
   - physio
2. Gabapentin (blocks breakdown of GABA)
3. Urinary urgency and frequency - intermittent self cathterisation (over 100mls)
4. Incontinence - alpha-blocker (adrenergic) drugs eg doxazosin