Multiple Sclerosis Flashcards
what is the pathology behind multiple sclerosis?
demyelination of axons
which sex is more commonly affected by multiple sclerosis?
females
when does the initial presentation of multiple sclerosis usually occur?
30’s and 40’s
what are some symptoms of pyramidal dysfunction seen in multiple sclerosis?
increased tone
spasticity
weakness
what parts of the body can be affected by pyramidal dysfunction in multiple sclerosis?
extensors of the upper limbs
flexors of the lower limbs
what eye condition can affect patients with multiple sclerosis?
optic neuritis
how does optic neuritis present?
painful visual loss that gets worse over 1-2 weeks
may have RAPD
what sensory symptoms can be seen in multiple sclerosis?
pain paraesthesia dorsal column loss numbness trigeminal neuralgia
what symptoms can be caused by dorsal column loss?
problems with proprioception and vibration sense
what lower urinary tract symptoms can be associated with multiple sclerosis?
frequency nocturia urgency urge incontinence retention
what symptoms of cerebellar dysfunction can be seen in multiple sclerosis?
dysarthria
ataxia
nystagmus
intention tremor
what cranial nerves can be affected by brainstem dysfunction in multiple sclerosis and what symptoms can this cause?
CN VI - diplopia
CN VII - facial weakness
what causes internuclear ophthalmoplegia?
damage to the medial longitudinal fasciculus
what disease can internuclear ophthalmoplegia be associated with?
multiple sclerosis
how can internuclear ophthalmoplegia present?
distortion of vision
diplopia
nystagmus
lid lag
how is multiple sclerosis diagnosed?
clinical diagnosis based on exclusion, presence of a clinical episode suggestive of demyelination and symptoms disseminated in time and place
how can multiple sclerosis lesions be visualised?
T2 weighted MRI
lesions appear very bright
what can be seen when CSF is investigated in multiple sclerosis?
oligoclonal bands
their absence does not rule out multiple sclerosis
how is a mild acute relapse of multiple sclerosis managed?
symptomatic treatment depending on the patients individual symptoms
what is the symptomatic management of pyramidal dysfunction in multiple sclerosis?
physio
anti spasmodics
botox
intrathecal baclofen
name two anti-spasmodic drugs
baclofen
tizanidine
what is the symptomatic management of sensory symptoms in multiple sclerosis?
anti-convulsants
anti-depressants
TENS machine
acupuncture
what treatment can be used if MS patients have very resistant pain?
lignocaine infusion
name an anti convulsant drug
gabapentin
what is the symptomatic management of lower urinary tract dysfunction in multiple sclerosis?
bladder drill
anti cholinergics
desmopressin
catheterisation
name an anti-cholinergic drug
oxybutynin
how is a moderate acute relapse of multiple sclerosis managed?
oral steroids over 5 days
how is a severe acute relapse of multiple sclerosis managed?
admit
IV steroids
when are patients given first line disease modifying therapy for MS?
when they have a relapse
when are patients given second line disease modifying therapy for MS?
if first line failed or MS is very aggressive
when are patients given third line disease modifying therapy for MS?
reserved for very few patients who have incredibly aggressive disease
what is involved in first line disease modifying therapy for MS?
tecfidera
interferone beta and glatiramer acetate
what is the first line treatment for relapsing remitting MS?
tecfidera
what is involved in second line disease modifying therapy for MS?
monoclonal antibodies
oral fingolimod and cladribine
what monoclonal antibodies can be given for MS?
tysabri
ocrevus
lemtrada
what is involved in third line disease modifying therapy for MS?
stem cell transplant
