Multiple Sclerosis Flashcards
What is the definition of MS?
demyelinating central nervous system condition clinical defined by two episodes of neurological dysfunction (brain, spinal cord or optic nerves) that are separated in space and time
What sort of reaction is happening in MS?
Type IV hypersensitivity reaction
What is the pathophysiology of MS?
- Oligodendrocyte produce myelin that surround axon
- Oligodendrocytes get attacked so not myelin to protect axon
- Remyelination occurs in early MS but stops eventually
Why are shwan cells not affected?
shwan cell in PNS and oligodendrocytes in CNS and MS affects CNS mainly
What are common RF for MS?
- FHx
- Female
- Northern latitude
- Genes encoding for HLA-DR2
- Vit D defic
What is the classic epid in MS?
- White women
2. Between 20-40years
What are common symptoms and signs in MS?
- Visual disturbance in one eye
- Peculiar sensory phenomena (e.g. Lhermitte’s sign)
- Pain on eye movement
- Fatigue
- Leg cramping
- Urinary frequency
- Bowel dysfunction
- Spasticity/increased muscle tone
- Imbalance/incoordination
What is Charcot’s neurological triad?
- Dysarthria
- Intention tremor
- Nystagmus
Why is there such a range of symptoms in MS?
plaques can affect sensory, motor and autonomic system hence range of symptoms
What are possible DDx for MS?
- Myelopathy due to cervical spondylosis
- Fibromyalgia
- Sleep disorders
- Sjorgen syndrome
- Vit B12 deficiency
- Ischaemic stroke
What investigations would you do in MS?
- MRI brain
- MRI spinal cord
- CSF
What bloods do you do in MS?
- FBC
- Comprehensive metabolic panel
- TSH
- Vitamin B12
What would MRI brain show in MS?
hyperintensities in periventricular white mater
What would MRI spinal cord show in MS?
- demyelinating lesions in the spinal cord, particularly the cervical spinal cord
- detection of alternate diagnosis, such as cervical spondylosis
What would CSF show in MS?
- IgG oligoclonal bands on electrophoresis with 95% of MS patient
- can have high level of antibodies in CSF (shows autoimmune process)
What is the acute treatment of MS?
- 1st line: methylprednisolone: 1000mg IV once daily 3 days
- Sometimes w plasma exchange
What is the ongoing treatment for MS?
1st line: immunomodulators: e.g. interferon beta 1a
What is the ongoing treatment for secondary progressive MS?
1st line: Siponimod or methylprednisolone
2nd line: cladribine
What treatment can be used for relapsing midl/moderate MS?
Dimethyl-fumarate
What other medication can be used for relapsing remitting disease of MS?
monoclonal antibodies alemtuzumab and natalizumab
When else do you prescribe medication for MS?
for treating complications
What complications of MS may be need to be prescribed for?
- Fatigue
- Spasticity e.g. baclofen or gabapentin
- Ataxia and tremor
- Mental health
- Bladder problems
What are possible complications of MS?
- UTI
- Osteopenia and osteoporosis
- Depression
- Visual impairment
- Erectile dysfunction
- Cognitive impairment
- Impaired mobility
What criteria is used for MS?
McDonald criteria used
