MS and Epilepsy Flashcards
What is Multiple Sclerosis?
A chronic AI progressive neuroinflammatory disease where there is demyelination of axons (Schwann Cells and Oligodendrocytes)
What is the epidemiology, aetiology and PP of MS?
E: 20-40y/o, Rarer in tropics and males
A: Environment, Chance and Genetic predisposition
PP: Genetic susceptibility and environmental trigger -> T cell activated –> B cell and macrophage activated release cytokines IL-1, IL-6 etc and inflammation, demyelination and gradual destruction
Where is an MS plaque found and what are the 3 main features?
1) Inflammation
2) Demyelination
3) Axon Loss
Around blood vessels
Does myelin regenerate with someone with MS?
Yes, but will regenerate thinner and overtime become thinner to point of destruction
What is RRMS?
Recurrent attacks over years at random intervals of MS but no progression in severity
What can affect MS symptoms?
Heat exacerbates symptoms
Cold relieves symptoms
What is chronic MS?
Slow decline in function of symptoms from gradual onset
What are the main S/S of MS?
1) Nystagmus
2) Spasticity
3) Rigidity
4) Bladder and Sex dysfunction
5) Paraesthesia
6) Sensory symptoms
7) Weakness
8) Optic neuritis
What are the 3 general symptoms of MS?
1) Aphasia
2) Hemianopia
3) Muscle wasting
What is the diagnostic criteria of MS?
- > 2 CNS lesions disseminated in time and space.
2. Exclusion of conditions that may give a similar clinical presentation.
What investigations and treatment are used in MS?
I: MRI brain and spinal cord
Lumbar Puncture
T: (Short course steroids to V inflammation)
- Beta Interferon, Natalizumab, Stem Cell transplant, Muscle relaxants for spasticity and other symptom relief
Therapy: Physio, Counselling and Speech
Define epilepsy and seizures?
E: Tendency to have seizures
S: Convulsion caused by discharge of cerebral neurones (Abnormal and excessive excitability of neurones)
What are the main causes of epilepsy?
1) Flashing lights
2) Cerebrovascular events
3) CNS infection
4) Trauma
5) Genetic Predisposition
What is the definition for an epileptic seizure?
Excessive, unsynchronised neuronal discharges in brain causing paroxysmal changes in behaviour, sensation or cognitive processes
What are 5 signs of an epileptic seizure?
1) 30-120s in duration
2) Positive symptoms e.g. Tingling and Movement
3) Tongue biting
4) Head turning
5) Muscle pain
How does a non-epileptic seizure differ?
Mental processes associated with psychological distress cause paroxysmal changes in behaviour, sensation and cognitive processes.
- Situational.
- 1-20 minutes in duration (longer than epileptic).
- Eyes closed.
- Crying or speaking.
- Pelvic thrusting.
- History of psychiatric illness.
What is focal epilepsy?
Seizure/Epilepsy with only one region of the brain involved
- Simple partial seizures with consciousness
- Complex partial seizures without consciousness
- Secondary generalised seizures
What is general epilepsy?
Epilepsy with all regions of the brain
- Tonic
- Clonic
- Tonic-Clonic
What happens in a Tonic-Clonic seizure?
- Sudden onset rigid tonic phase followed by convulsion (Clonic) so muscles jerk rhythmically
- Episode lasts up to 120s and associated with tongue biting and incontinence
What are the main features of an absence seizure?
- Child ceases activity and lasts for few seconds
- Present in childhood
How does carbamazepine work as an AED?
- Inhibits Na+ pre-synaptic channels so prevents pre-axonal firing
What is the treatment for generalised vocalised seizure?
- Sodium Valproate
Teratogenic –> Lamotrigine
What are 4 potential side effects of AED?
1) Cognitive disturbances
2) Teratogenic
3) Heart disease
4) Drug interactions
How are focal seizures treated?
Carbamazepine
