MS

Question 1

MS Pathogenesis and Types

Answer 1

• Multiple areas of scarring (sclerosis) after repeated immune mediated inflammation
• Relapsing-remitting
• Secondary progressive
• Primary progressive
• Acute attacks are usually followed by periods of remission where remyelination occurs, as disease progresses; remission fails
• Clinically isolated syndrome is first episode
• Radiologically isolated syndrome is asymptomatic but found on scan

Question 2

MS Epidemiology

Answer 2

-Typically presents in white women between 20-40

Question 3

MS Diagnosis

Answer 3

• No single test available
• Diagnosis can usually be made clinically
• McDonald criteria

Question 4

MS Presentation

Answer 4

• Wide range of symptoms and signs
• Visual (ON)
• Eye movement (double vision, symmetrical horizontal jerking nystagmus)
• Facial weakness
• Hearing and balance
• Cognitive symptoms
• Psychological symptoms
• Taste and smell
• Unpleasant sensations
• Paraesthesiae and numbness
• Transverse myelitis
• Autonomic dysfunction
• Horner’s

Question 5

MS Differentials

Answer 5

• HSP
• SLE
• Sarcoidosis

Question 6

MS Ix

Answer 6

• Exclude differentials with bloods
• Electrophysiology can detect demyelination
• MRI (95% have periventricular lesions and over 90% show white matter abnormalities)
• Raised IG concentration and oligoclonal bands (suggests inflammation)
• Protein can be raised

Question 7

MS Management

Answer 7

Relapses
-Treat with methyprednisolone

Relapsing remitting
-Immunomodulators (interferon beta or glatiramer acetate)

Immune therapy for Primary and Secondary Progressive