Multiple Sclerosis ☺️

Question 1

Epidemiology

Genetics and risk factors

Answer 1

Women 20-40s
More common at higher latitudes

Higher concordance in MZ
EBV
Low VitD
Smoking
Early life obesity

Question 2

Subtypes

Answer 2

Relapsing-remitting - most common
-acute (1-2month) attack => remission

Primary progressive - older, progressive deterioration from onset

Secondary progressive - relapsing-remitting patients who deteriorate
-Gait and bladder disorders

Question 3

Presentation

Answer 3

Initially non specific - FATIGUE

Visual - OPTIC NEURITIS

• pain on mv
• low visual acuity, colour vision
• RAPD, central scotoma

Ascending sensory changes/muscle weakness
Ataxia
Lhermitte sign - electrical sensation running through back into limbs on neck flexion

Trigeminal neuralgia

Autonomic - urinary incontinence, sexual dysfunction

Question 4

Investigations

Diagnosis

Answer 4

Diagnosis made on

• 2+ relapses AND 2+ lesions OR
• 1 lesion + evidence of past relapse

MRI

• high signal T2 lesion
• periventricular plaque
• Dawson fingers - hyperintense lesions perpendicular to corpus callosum
• spinal MRI - SC lesions

CSF

• oligoclonal bands in CSF and not in serum
• increased intrathecal IgG synthesis

Question 5

Management

-lifestyle

Answer 5

Exercise
Reduce smoking - may slow down progression
Healthy diet

Question 6

Management - relapse

-signs of relapse

Answer 6

Development of new symptoms
Worsening of existing symptoms
These last for 24hrs+ in absence of other causes after a stable period of 1 month min

Methylprednisolone

• PO if mild
• IV if severe

Question 7

Management

-ongoing

Answer 7

DMARDs - 
Cognition - OT, neuropsych assessment
Emotional lability, pain - amitryptiline
Mobility and fatigue - exercise program
Spasticity - baclofen/gabapentin

Question 8

Pathophysiology

Answer 8

Chronic cell mediated AI => demyelination of CNS