Multiple Sclerosis Flashcards
What is MS?
Most common neuroinflammatory disorder in western populations
-T cell mediated disorder
Pathophysiology found in MS?
Multiple plaques of demyelination are found throughout the brain and spinal cord occurring sporadically over years
Who gets MS?
- Women
- Age 20-40 years
- Genetic predisposition
Pathology of MS?
- Plaques of demyelination (only effects CNS)
- Plaques can occur anywhere in CNS but certain sites are more commonly affected
- Acute relapses caused by focal inflammation causing myelin damage and conduction block
- When damage is severe, secondary permanent axonal destruction occurs
- Grey matter damage also takes place early pm and the extent of the damage correlates with severity of disability and cognitive involvement
Sites commonly affected with plaques of demyelination in MS?
- Optic nerves
- Periventricular region
- Corpus callosum
- Brainstem
- Cerebellar connections
- Cervical spine cord
Pathological basis for MS?
Progressive axonal damage, this causes the progressive disability seen in progressive forms of MS
What does presentation of MS depend on?
Area of CNS affected
What sign are there in MS?
UMN not LMN (because peripheral myelinated nerves are not directly affected)
Types of presentation of MS?
Pyramidal dysfunction
Optic neuritis
Sensory nerve involvement
Cerebellar dysfunction
What is pyramidal dysfunction? (+ explain it)
Dysfunction of corticospinal tract
- Increased tone
- Spasticity
- Muscle weakness
- Extensors of upper limbs are weak and flexors of lower limbs
What is optic neuritis?
Painful visual loss in an eye develops over 1-2 weeks
- Painful on eye movements
- Loss of central vision
- RAPD positive
- Most improve
Explain sensory nerve involvement?
Unusual symptoms
Reduced vibration and proprioception
Pain
Paraesthesia
DANISH?
Dysdiadochokinesia Ataxia Nystagmus Intention tremor Scanning dysarthria Hypotonia
Brainstem involvement in MS
Compression of the 6th and 7th cranial nerves?
Compression of 6th cranial nerve causes?
Diplopia
Compression of 7th cranial nerve causes?
Facial weakness
Diagnosis and investigation for MS?
- 2 or more episodes suggesting demyelination
- Evidence of damage to CNS that is disseminated in time and space
- Blood tests should be done to exclude other inflammatory disorders
- MRI= definitive investigation
Types of MS?
- Relapsing and remitting
- Secondary progressive
- Primary progressive
- Relapsing progressive
What is relapsing and remitting MS?
- Most common
- Symptoms occur in attacks which get partially or fully better over weeks
- Patient may accumulate disability over time
What is secondary progressive MS?
-75% of people with RRMS evolve into this type within 35 years of onset
Primary progressive MS?
Gradually worsening disability without relapses or remissions
What is relapsing progressive MS?
Least common type
-Relapses on pattern of progressive disability from the outset
Symptomatic management of MS: Pyramidal dysfunction?
- Physio
- Occupational Therapy
- Baclofen for spasticity
Symptomatic management of sensory symptoms?
Neuropathic pain involved gabapentin, amitriptyline or other agents
Symptomatic treatment of urinary tract symptoms?
Bladder training advice
Anticholinergics (oxybutynin sometimes given to reduce detrusor instability)
Fatigue: rules out other causes
Symptomatic treatment for fatigue in MS?
Rule out other causes
- Do fatigue diaries with OT to ID triggers
- Amantadine works for some people
Treatment of a moderate acute exacerbation?
Oral steroids over five days (methylprednisolone)
Treatment of a severe acute exacerbation of MS?
Admit to hospital and give IV steroids
1st line disease modifying therapy for RRMS>
Tecfidera (oral) OR Interferons OR Glutamir acetate injections
2nd line treatment for RRMS?
Fingolimod
Cladribine
Monoclonal ABs
(More effective at reducing relapses but more toxic)
