Multiple Sclerosis Flashcards
what type of disease is MS?
autoimmune
MS is mediated by what leukocyte?
T cell
what leukocyte directly destroys the myelin?
which tracts are particularly affected?
macrophage
white matter tracts
which tracts, white or grey are particularly affected?
why theses tracks and not the other?
white matter tracts
white tracts are myelin dominant
grey matter is predominantly composed of what stuff?
neural cell bodies
can you be asymptomatic?
yes
what is theorised as to why there is poorer recovery from acute relapses?
chronic low-level inflammation
which fibre tract when damaged in MS causes intranuclear ophthalmoplegia?
in which major structure is this tract located?
Medial longitudinal fasciculus
brainstem
what are the three patterns of disease in MS?
Relapsing-remitting
Secondary progressive
Primary progressive
how any pts will be primary progressive?
-% wise
15%
how any pts will be relapsing-remitting?
-% wise
how many of these cases will become secondary progressive?
-%wise
85%
60%
which gene is implicated?
HLA-DR2 gene
which infection is a risk factor?
EBV
which vitamin deficiency is a risk factor?
low vitamin D
what is the most common age range for diagnosis?
20-40
which gender is a risk factor?
female
which peoples are more effected?
northern Europeans
is southern latitude or northern latitude a risk factor?
northern latitude
which lifestyle factor is a risk factor?
Smoking
MS in first degree relative increase your chance of MS by how much?
20-40x
what is prevalence of MS in UK?
- as a %
0.18%
Demyelination of which two pathways leads to sensory loss?
spinothalamic
dorsal column pathway
hallmark feature seen on MRI?
plaques
on MRI which lesions will enhance with contrast, new or old?
why is this important in diagnosis in MS?
new lesions
evidence of dissemination of lesions through space and time is needed to diagnose MRI
what is Uhthoff’s?
symptoms worsen with ↑temp e.g. after hot bath
what urological symptoms are there?
-2
bladder dysfunction (incontinence)
Erectile dysfunction
what ophthalmological symptoms are there?
blurred vision
red desaturation
optic neuritis
what does Internuclear ophthalmoplegia look like?
inability to move both your eyes together when looking to the side
will there be UMN or LMN signs?
UMN
MS pt feel electric shock run down neck, back, and sometimes limbs. Triggered by neck flexion often.
what is this sign called?
Lhermitte’s phenomenon
what colour can MS pts sometimes not see?
red
on ophthalmoscope what sign is seen?
pale optics disk
on doing swinging light tests what sign is seen?
relative afferent pupillary defect
on MRI,
lesions will be high signal on T1 or T2?
T2
hallmark feature on LP?
oligoclonal bands
which criteria used to diagnose?
describe this criteria?
McDonald Criteria
≥ 2 relapses & either
o objective clinical evidence of 2 or more lesions or
o objective clinical evidence of one lesion with reasonable history of previous relapse.
1st line treatment for relapse?
how long do you give this drug for?
methylprednisolone
5 days
2nd line treatment for acute relapse?
Plasma exchange (PLEX)
which monoclonal antibodies can be used for maintenance?
-2
alemtuzumab or natalizumabBeta-Interferon
which immunomodulators can be used to maintain MS remission?
-2
Glatiramer acetate
Fingolimod
which interferon can be used to maintain MS remission?
beta interferon
list all drugs that can be used for maintenance in MS?
-4
beta interferon
alemtuzumab natalizumab
Glatiramer acetate
Fingolimod
MS patient has spasticity.
what drugs can be used to treat?
-2 named e.g.
what non-drug option is there?
baclofen or gabapentin
physiotherapy
MS patient has depression.
what drug is used to treat?
amitriptyline
MS patient has oscillopsia.
what is 1st line drug?
gabapentin
MS patient has fatigue.
what non-drug option is there for management?
provided there is no anaemia or thyroid problem etc, what drug option is used?
CBT
amantadine
MS patient has bladder dysfunction.
on US there is significant residual volume.
what is 1st line treatment?
intermittent self-catheterisation
MS patient has bladder dysfunction.
on US there is insignificant residual volume.
what is drug is used for this?
what type of drug is this?
oxybutynin
anti-cholinergic
what type of drug is baclofen?
what effect does it have on muscles?
antispasmodic
muscles relax
what type of drug is Oxybutynin?
explain moa of this drug in how it helps MS?
anticholinergic
ACh sends signals to brain triggering abnormal bladder contractions, oxybutynin will block ACh.
how many MS cases have normal CSF?
-% wise
10-20%
moa of Alemtuzumab?
hits on lymphocyte CD52 receptor causing lymphocyte lysis
moa of Fingolimod?
Stops lymphocytes leaving lymph node.
what hallmark sign is seen on FLAIR MRI?
Dawson’s fingers.
list complications of MS?
-8
- Fatigue
- UTIs
- Incontinence
- Constipation
- Depression
- Vision impaired (Oscillopsia)
- Mobility impaired/spastic gait
- Erectile dysfunction
which contrast do you use to look for new lesions in MRI?
how will these new lesion appear visually?
Gadolinium
bright
how new must lesion be for a Gadolinium MRI to show it?
<8 weeks
