MS and MND Flashcards
Describe MS
Inflammatory plaques of demyelination in CNS which are disseminated in time and space
Subtypes of MS
Relapsing remitting
Primary progressive
Secondary progressive (secondary to relapsing remitting)
Age of onset in MS and MND
MS: ~30 years
MND: >40 years
Common presentation of MS
Unilateral optic neuritis (20%)
Corticospinal involvement
Urine retention or incontinence
Symptoms worsen with heat
Clinical features of MS (11 points)
Sensory loss Neuropathic pain Spastic muscle weakness Urine retention/incontinence Constipation Sexual dysfunction Dysphagia Optic neuritis Internuclear ophthalmoplegia Cerebellar signs Cognitive decline
Criteria for MS
McDonald:
At least 2 attacks lasting >1 hour and are >30 days apart
AND
Disseminated in time and space (clinical or MRI evidence)
Diagnosis of MS
T2 weighted MRI brain and spinal cord with contrast
LP for oligoclonal IgG bands on electrophoresis of CSF
Visual evoked response
Effect of pregnancy on MS
During pregnancy relapses may reduce
After giving birth relapses may increase for 3-6 months
Frequency returns to previous rate
Management of MS
Lifestyle: exercise, stop smoking, vitamin D supplements
Disease modifying drugs: dimethyl fumarate, monoclonal antibodies (alemtuzumab)
Relapse drugs: methylprednisolone for 3-5 days
Symptom control (bladder, bowel, pain, spasticity)
Treatment for spasticity
Baclofen
Gabapentin
Treatment for tremor in MS
Botulinum toxin injections
Management of urinary symptoms in MS
Self catheterisation if RV >100ml
Tolteridone if RV <100ml
Describe MND
Loss of neurones in: Motor cortex Cranial nerve nuclei Anterior horn of spinal cord (Mixed UMN and LMN signs)
No sensory loss
No sphincter disturbance
What are the 4 different clinical patterns of MND
ALS
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis
What does ALS stand for
Amyotrophic lateral sclerosis
Describe ALS
Loss of motor neurones in motor cortex and anterior horn of spinal cord leading to UMN and LMN signs
Describe progressive bulbar palsy
LMN signs affecting cranial nerves 9-12
Results in difficulty talking and swallowing
Describe progressive muscular atrophy
Anterior horn cell lesion so LMN signs
Distal muscles affected earlier than proximal
Describe primary lateral sclerosis
Loss of neurones in motor cortex so UMN signs
Spastic leg weakness and pseudobulbar (damage to corticobulbar tracts)
Contrast bulbar and pseudobulbar palsy
Bulbar is LMN lesion of muscles of talking and swallowing, pseudobulbar is UMN lesion of muscles of talking and swallowing
Pseudobulbar has increased jaw jerk, slow speech and mood incongruence
What other progressive condition is associated with MND
Frontotemporal dementia in 25%
Diagnosis of MND
No diagnostic test:
MRI excludes structural causes
LP excludes inflammatory causes
Myasthenia antibodies
Disease modifying drugs for MND
Riluzole - NMDA antagonist
Symptom management for MND
Salivation - antimuscurinics (glycopyrronium bromide) Dysphagia - blend food, gastrostomy Spasticity - baclofen or gabapentin Alternative communication equipment Non invasive ventilation overnight
Prognosis of MND
50% <3 years
