Multiple Sclerosis Flashcards
Multiple sclerosis
Chronic cell-mediated autoimmune disorder characterised by demyelination in the central nervous system.
What is the epidemiology of MS?
3 times more common in women
Most commonly diagnosed in people aged 20-40 years
Much more common at higher latitudes (5 times more common than in tropics)
What gender is most affected by MS?
3 times more common in women
What glial cells produce myelin in the CNS?
Oligodendrcytes
What are the 3 variants of MS?
o Relapsing-remitting disease
o Secondary progressive disease
o Primary progressive disease
What are the features of Relapsing-remitting disease (MS)?
Most common form, accounts for around 85% of patients
Acute attacks (e.g. last 1-2 months) followed by periods of remission
What are the features of Secondary progressive disease in MS?
Describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
Gait and bladder disorders are generally seen
What are the features of Primary progressive disease in MS?
Accounts for 10% of patients
Progressive deterioration from onset
More common in older people
Worst prognosis
What are the guidelines for clinical diagnosis of MS?
Made on the basis of two or more relapses and either objective clinical evidence of two or more lesions or objective clinical evidence of one lesion together with reasonable historical evidence of a previous relapse.
What are the visual signs of MS?
Optic neuritis
Optic nerve atrophy
Uhthoff’s phenomenon
Internuclear ophthalmoplegia
What is Uhthoff’s phenomenon?
worsening of vision following rise in body temperature
What are the sensory signs of MS?
o pins/needles
o numbness
o trigeminal neuralgia
o Lhermitte’s syndrome
What is Lhermitte’s syndrome?
paraesthesia in limbs on neck flexion
How is trigeminal neuralgia treated?
Carbamazepine
What are the motor signs of MS?
Spastic weakness: most commonly seen in the legs
What are the cerebellar signs of MS?
Ataxia
Nystagmus
Intention Tremor
Ataxia
lack of muscle control and coordination
Nystagmus
eyes move rapidly & uncontrollably
Intentional tremor
A trembling of a part of the body when attempting a precise movement, associated
Other general features of MS?
Urinary incontinence Lower urinary tract dysfunction – Sexual dysfunction Intellectual deterioration Diplopia Bell’s palsy Horner’s syndrome
Investigations for MS
Clinical
Blood tests
MRI
MRI changes seen for MS
High signal T2 lesions
Periventricular plaques
CSF changes seen in MS
Oligoclonal bands (and not in serum) Increased intrathecal synthesis of IgG
Management of acute relapse of MS
High dose steroids (e.g. oral or IV methylprednisolone) may be given for 5 days to shorten the length of an acute relapse.
What drug is used for fatigue in MS?
Once anaemia, thyroid or depression have been excluded NICE recommend a trial of amantadine
What drugs are used in spasticity in MS?
baclofen and gabapentin are first line.
Other options include diazepam, dantrolene and tizanidine
What drug is used for Oscillopsia (visual fields appear to oscillate) in MS?
Gabapentin is first line
Why are DMARDs used in MS?
Reduces number of relapses and MRI changes, however, doesn’t reduce overall disability
1. First line therapy - Tecfidera, Aubagio, Interferon Beta , Glatiramer Acetate
First line DMARDs in MS
Tecfidera, Aubagio, Interferon Beta , Glatiramer Acetate
Second line DMARDs in MS
Fingolimod/Cadrabine
Third line DMARDs in MS
Mitoxantrone, HSCT (Stem cell transplantation)
