Multiple Sclerosis Flashcards
what is multiple sclerosis?
inflammation of the myelin sheath and a focal disturbance of function - it is a relapsing and remitting disease so functional loss is periodic
when do most people present with the disease?
20s/30s but it can be picked up later
what is the pathogenesis of MS?
complex genetic inheritance, it is an autoimmune disease and is more common in women, commoner in temperate climates
how does MS present?
relapse (demyelination of white matter in the CNS) –> inflammation which has a gradual onset over days and then stabilises, gradual resolution and partial or complete recovery
where does this relapse and inflammation occur and what does it cause?
it can happen anywhere in the CNS eg optic neuritis, sensory symptoms, limb weakness, brainstem, bladder involvement
what is optic neuritis?
it is a common presentation of MS- visual loss, pain in moving the eye and colour vision is impaired- it usually resolves over weeks/months
what is the process of demyelination?
autoimmune process due to activated T cells crossing the BBB causing demyelination= inflammation of the myelin sheath and loss of function - repair and recovery of function and gliosis may leave you with functional deficit which can be seen as lesions or plaques on MRI scan
how is a diagnosis of MS made?
episodes of demyelination disseminated in space (different areas of the CNS) and time
what are the 3 types of MS?
relapsing remitting, secondary progressive and primary progressive
what is relapsing remitting MS?
85% at outset and most progress to SPMS, relapses may occur within months or years of first relapse and may occur for no reason but sometimes due to underlying infection and there are fewer relapses during pregnancy so must be hormonal relationship
what is secondary progressive MS?
relapses have stopped but do notice loss of strength and disability
what is primary progressive MS?
never have relapses and have progressive disease from the onset- faster progression and spinal symptoms are common with more involvement of leg weakness and bladder symptoms
what is clinically isolated syndrome?
only one episode of inflammation- patient cannot be diagnosed with MS as not been “disseminated in time and space”
what investigations are useful to support the diagnosis?
MRI scans which can demonstrate the typical lesions and lumbar puncture can detect oligoclonal (inflammatory) bands in the CSF
how is MS treated?
there is no cure for this condition so treat the relapse- disease modifying treatment reduces relapses but does not slow progression of disease, general health and diet, symptomatic treatment and use a MDT approach
