Multiple sclerosis

Question 1

List three presenting symptoms of MS

Answer 1

TEAM
  Tingling 
  Eye: optic neuritis (↓ central vision + eye move pain) 
  Ataxia + other cerebellar signs 
  Motor: usually spastic paraparesis

Question 2

What is Uthoff’s phenomenon?

Answer 2

transient worsening of neurological symptoms related to a demyelinating disorder such as multiple sclerosis when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs.

Question 3

List three investigations for MS

Answer 3

 MRI: Gd-enhancing or T2 hyper-intense plaques
 Gd-enhancing = active inflammation
 Typically located in periventricular white matter
 LP: IgG oligoclonal bands (not present in serum)
 Abs

Question 4

List two differentials for MS symptoms

Answer 4

SLE
CNS sarcoidosis
Devic’s: neuromyelitis optica

Question 5

What are the three main neurological dysfunctions that occur in MS?

Answer 5

limb/muscle weakness, visual loss, urinary incontinence

Question 6

Which syndromes can develop into MS?

Answer 6

optic neuritis, transverse myelitis, clinically isolated syndromes

Question 7

Which virus may cause MS?

Answer 7

EBV

Question 8

What is transverse myelitis? What is the main symptom?

Answer 8

inflammation of the spinal cord causing weakness, sensory loss
incontinence

Question 9

How is MS diagnosis made?

Answer 9

2 or more episodes of demyelination disseminated in space and time

Question 10

What are potential causes for MS?

Answer 10

smoking, EBV, genetic, generally unknown, vit D

Question 11

Which systems are affected in MS?

Answer 11

1. Central- fatigue, depression 2. Visual 3. Speech 4. Musculoskeletal 5. Sensation 6. Bowel 7. Urinary

Question 12

Which radiological feature is typical in MS?

Answer 12

Dawson fingers

Question 13

What are you looking for in LP for MS?

Answer 13

CSF oligoclonal bands, CSF cell counts to exclude other causes, CSF glucose and CSF protein shoule be normal

Question 14

What is the treatment for MS?

Answer 14

high dose steroids, however depends on the severity of the relapse, physio

Question 15

What are the side effects of steroids?

Answer 15

increased appetite, mood changes, sleeping difficulties, osteoporosis, cushing’s syndrome, depression, diabetes

Question 16

What are the pharmacological treatment options for MS patients?

Answer 16

immunosuppression- mAbs and symptomatic treatment- e.g. spasticity. Also rehab!

Question 17

Name examples of disease modifying drugs for MS

Answer 17

alemtuzumab- IV, older drugs e.g. beta interferon

Question 18

Which sex is at higher risk for MS development?

Answer 18

female