Multiple Sclerosis

Question 1

A disorder of the brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbation and remissions), which result from loss of myelin at multiple sites in the CNS, defines what?

Answer 1

MS

Question 2

What are 7 common symptoms of patients with MS?

Answer 2

1) Paresthesias
2) Gait disturbances (i.e., transverse myelitis)
3) Weakness
4) Visual loss (i.e., optic neuritis)
5) Urinary difficulty
6) Dysarthria
7) Hemiparesis

Question 3

What are the 4 major types of MS?

Answer 3

1. Relapsing remitting
2. Secondary progressvie
3. Primary progressive
4. Benign

Question 4

MS patients with the seconary progressive form of the disease begin their disease process as which form?

Answer 4

Relapsing remitting

Question 5

Which test can confirm the diagnosis of MS?

Answer 5

No single test can confirm the diagnosis of MS

Question 6

How does age of onset affect the prognosis of MS?

Answer 6

In general, earlier onset is a more favorable prognostic feature

*However, if really young (i.e., adolescent/early adult) = unfavorable

Question 7

What are the typical diagnostic features seen with an MRI of the head and CT of the spine in a patient with MS?

Answer 7

• Ovoid lesions of high signal on T2WI in periventricular white matter and spinal cord
• Acute lesions may enhance

Question 8

CSF analysis via lumbar puncture will have what diagnostic findings in a patient with MS?

Answer 8

Presence of oligoclonal bands and/or increased IgG index/synthesis rate

Question 9

Which drug is the only approved treatment for patients with the primary progressive form of MS (PPMS) in addition to the relapsing forms of the disease?

Answer 9

Ocrevus (ocrelizumab)

Question 10

Which 2 drugs can be given to treat acute exacerbation in MS?

Why is each drug used?

Answer 10

1) High dose corticosteroids: reduces length of exacerbation, but not the overall outcome
2) ACTH (acthar gel) or IVIg used in pt’s who do not tolerate traditional steroid tx.

Question 11

In terms of clinically isolated syndrome (CIS) what is a monofocal episode as a differential diagnosis for MS?

Answer 11

Person experiences a single neurologic sign or symptom that’s causes by a single lesion (i.e., optic neuritis in one eye)

Question 12

In terms of clinically isolated syndrome (CIS) what is a multifocal episode as a differential diagnosis for MS?

AKA?

Answer 12

• aka Acute Disseminated Encephalomyelitis (ADEM)
• Person experiences more than one sign or symptom caused by lesions in more than one place (i.e., optic neuritis in one eye plus hemiparesis)

Question 13

When CIS patients have multiple demyelinating lesions on MRI, they have a __________% chance of developing MS within several years

Answer 13

60-80%

*High risk

Question 14

When CIS patients do not have multiple demyelinating lesions on MRI, they have a ______% chance of developing MS within several years

Answer 14

20%

*Low risk

Question 15

What are some conditions which can mimic MS?

Answer 15

• Autoimmune disease: SLE w/ cerebritis or CNS vasculitis or Polyarteritis Nodosa w/ transverse myelitis
• Devic’s disease (neuromyelitis optica)
• B12 deficiency
• Lymphoma or leukemia w/ CNS involvement
• Spinocerebellar ataxias
• Infections: HIV, West Nile, HTLV-1, CMV, Lyme disease, Syphillis
• Granulomatous disease
• Metachromatic leukodystrophy, adrenomyeloleukodystrophy

Question 16

Which 6 drugs/treatments can be used for management of spasticity in patients with MS?

Answer 16

1) Baclofen (oral or intrathecal)
2) Tizanadine
3) Diazepam
4) Carbamazepine
5) Botox injections
6) Dantrolene

Question 17

Which 3 drugs can be used for the management of intention tremor in patients with MS?

Answer 17

1. Propranolol
2. Primidone
3. Clonazepam

Question 18

Which 2 drugs can be used for the management of urinary urgency (spastic bladder) in patients with MS?

Answer 18

1) Oxybutinin
2) Detrol LA

Question 19

Which drug can be used for the management of urinary retention/hesitancy in patients with MS?

Answer 19

Bethanechol

Question 20

Which 5 drugs can be used for the management of painful dysesthesias in MS?

Answer 20

1. Carbamazepine
2. Oxcarbazepine
3. Gabapentin
4. Phenytoin
5. Baclofen

Question 21

Which disease is sometimes considered a “variant” of MS and is characterized by inflammation and demyelination of optic nerves and spinal cord (often long segments of spinal cord) with relative sparing of brain?

Answer 21

Devic’s Disease (aka neuromyelitis optica)

Question 22

What is considered a fairly sensitive and specific test for Devic’s disease (aka NMO)?

Answer 22

Aquaphorin antibodies in blood and CSF

Question 23

What is the general treatment for Devic’s Disease (aka NMO)?

Answer 23

• Steroids and/or plasma exchange (plasmapheresis)
• Followed by: immunosupression (i.e., azothiaprine, mycophenolate mofetil, or rituxumab)

Question 24

Which 5 agents are disease modifying/maintenance drugs used in the treatment of MS?

Answer 24

• Interferons
• Monoclonal antibodies (-mab)
• Glatirimer Acetate
• Fingolimod
• Dimethyl Fumarate