Multiple Sclerosis

Question 1

Multiple Sclerosis

Answer 1

presumed autoimmune demyelinating disorder of the central nervous system

Question 2

Who “gets” MS?

Answer 2

• Generally occurs in younger females (20-50 yo) of Northern European descent
• However risk seems to increase with distance from the equator

Question 3

Is MS a “genetic disease?”

Answer 3

• Genetic contribution but not a “genetic disease”

– Certain HLA markers and single nucleotide polymorphisms (SNPs) increase risk

Question 4

Suspected environmental triggers of MS

Answer 4

– Viral Exposures (EBV)

• • Tobacco exposure
• • Obesity/dietary factors?

Question 5

Possible Pathogenesis of MS

Answer 5

• T cells are activated, attach to, break down, and cross blood brain barrier to release interleukins
• Ultimately causes demyelination

Question 6

Syndromes Highly Suggestive of MS- Optic neuritis

Answer 6

– Decreased monocular vision (often involving central vision)
– Pain with eye movement
– Decreased red/green color
– Clinically associated with an afferent pupillary defect
– Uhthoff phenomeon (heat intolerance)

Question 7

Brainstem Syndromes Highly Associated with MS

Answer 7

– Internuclear ophthalmoplegia (MLF)
– Oculomotor dysfunction
– Trigeminal Neuralgia
– Facial nerve palsy
– CST/upper motor neuron involvement
– Ataxia

Question 8

Syndromes Highly Suggestive of MS- Spinal Cord Syndrome

Answer 8

– Transverse myelitis
– Lhermitte’s “sign”
– Numbness/sensory level
– Deafferented hand
– Urinary urgency, incontinence, erectile dysfunction
– Progressive asymmetric spastic paraplegia

Question 9

“Silent” Symptoms of Multiple Sclerosis

Answer 9

• Fatigue
• Bladder dysfunction
• Sexual dysfunction
• Spasticity
• Pain
• Cognitive impairment
• Bowel dysfunction

Question 10

Six Essential Criteria for “Definite Multiple Sclerosis”

Answer 10

• Objective abnormalities on examination
• Evidence on exam of 3 or more separate parts of CNS
• Objective evidence must reflect predominantly while matter involvement
• Involvement of the neuroaxis must occur temporally (2 or more episodes, slow, step wise gait)
• Age 10-50
• Cannot be better explained by another process

Question 11

The diagnosis of MS is ultimately a

Answer 11

combination of a clinical diagnosis with radio-graphic corroboration

Question 12

What is a concerned risk of MS therapies?

Answer 12

Progressve Multifocal Leukoencephalopathy

Question 13

How are MS relapses treated?

Answer 13

• Goal is to speed recovery & limit injury
• Steroids
• ACTH
• Plasmapharesis
• IVIg

Question 14

Symptoms of MS

Answer 14

• Fatigue
• heat intolerance
• cognitive deficits: multitasking, recall, concentration
• spasticity
• depression
• bladder dysfunction
• pain