MS + MND ? Flashcards
key features that point towards a diagnosis of MND
- asymmetric limb weakness
- mix of lower AND upper motor neuron signs
- sparing of ocular muscles
- wasting of small hand muscles
- fasciculations
absence of sensory signs
diagnosis of MND
clinical (more diagnosis of exclusion?)
nerve conduction studies =** normal** motor conduction (excludes neuropathy)
EMG = reduced no. of action potentials with increased amplitude
MRI - to exclude cervical cord compression + myelopathy
types of MND
amyotrophic lateral sclerosis (ALS)
primary lateral sclerosis
progressive muscular atrophy
bulbar palsy
management of MND
riluzole
resp care - NIV (BiPAP) used at night
nutrition - percutaneous gastrostomy tube (PEG)
riluzole
for MND
prevents stimulation of glutamate receptors
- used mainly in ALS
prolongs life by about 3 months
amyotrophic lateral sclerosis
50% of px with MND
typically;
- LMN signs in arms
- UMN signs in legs
primary lateral sclerosis
UMN signs only
progressive muscular atropy
LMN signs only
affects distal muscle before proximal
carries best prognosis !
progressive bulbar palsy
palsy of tongue, muscles of chewing/swallowing + facial muscles
–> due to loss of function of brainstem motor nuclei
caries worst prognosis :(
visual sx in MS
optic neuritis
optic atrophy
Uhthoff’s phenomenon -> worse vision when rise in body temp
internuclear ophthalmoplegia
MS investigations
MRI with contrast
- high signal T2 lesions
- periventricular plaques
-** dawsons’s fingers** - hyperintense lesions perpendicular to corpus callosum
CSF
- oligoclonal bands (+not in serum)
- increased intrathecal synthesis of IgG
management of acute relapse of MS
high dose steroids
- oral or IV methylprednisolone
- given for 5 days
steroids shorten duration of relapse + do NOT alter degree of recovery
indications for disease modifying drugs in MS
relapsing-remit + 2 relapses in past 2 years + able to walk 100m unaided
secondary progressive disease + 2 lapses in past 2 years + able to walk 10m (aided or unaided)
secondary progressive disease subtype of MS
relapsing-remitting which has deteriorated + have neuro sx between relapses
- gait + bladder disorders generally seen
disease modifying drugs for MS
natalizumab - given IV
ocrelizumab
fingolimid
mx of fatigue in MS
exclude anaemia, thyroid, depression
trial amantadine
- mindfulness training + CBT
mx of spasticity in MS
baclofen + gabapentin
- physio important
mx of bladder dysfunction in MS
get ultrasound !!!
(anticholinergics obvs worsen)
if signif residual volume = intermittent self-catheterisation
no residual volume = anticholinergics may improve urinary frequency
Oscillopsia in MS
= visual field appear to oscillate
gabapentin = 1st line
does MS primarily effect upper or lower motor neurons
upper
which vit deficiency is risk factor for MS
vit D
Lhermitte’s syndrome
paraesthesia on neck flexion
(multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck)
