Multiple Sclerosis Flashcards
Pathophysiology of MS
Typically only affects the CNS where there is inflammation around myelin and infiltration of immune cells that cause damage to the myelin
Causes of MS
Genes, EBV, low vit D, smoking, obesity
Diagnosis of MS
Based on clinical picture and symptoms suggesting lesions that change location over time Other causes need to be excluded
Investigations supporing diagnosis
MRI scans to demonstrate typical lesions, LP to detect oligoclonal bands in CSF
How long do symptoms need to progress for a diagnosis of primary progressive MS
1 year
Focal weakness symptoms in MS
Bells palsy, Horner’s syndrome, limb paralysis, incontinence
Focal sensory symptoms in MS
Trigeminal neuralgia, numbness, paraesthesia, Lhermitte’s sign
Two different types of ataxia in MS
Sensory or cerebellar
What causes cerebellar ataxia
Problems with the cerebellum coordinating movement
What causes sensory ataxia
Result of loss of the proprioception sense
What are the lesions seen on MRI scans of MS patients
periventricular white matter lesions
Management of acute attack of MS
Glucocorticoids, rule out infection first
Chrnic management of MS
Disease modifying therapies and symptomatic therapies
First line injectable DMTs
Beta interferon injections and glatiramer acetate
Oral agents used in MS
Dimethyl fumarate, Teriflunomide, Fingolimod, Siponimod, Cladribine
Biologic agents used in MS
Natalizumab, Alemtuzumab, Ocrelizumab
What is the role of dimethyl fumarate
Anti inflammatory, neuroprotective and anti-oxidative stress
Side effects of dimethyl fumarate
GI upset and flushing
Role of Teriflunomide
Immunomodulatory drug
Role of Fingolimod
Immunosuppressive, used in more extreme forms to reduce relapses
Side effects of Teriflunomide
Nausea, diarrhoea, hair loss and increased ALT
Side effects of Fingolimod
Bradycardia, macular oedema and heart block
Role of Siponimod
Immunosuppressive but does not act on cardiac receptors. USed in secondary progressive MS
Role of Cladribrine
Immunosuppressive and anti lymphoproliferative. Given in highly acting relapsing remittingMS
Side effects of Cladribrine
Infections, alopecia, lymphpenia
Role of Natalizumab
Immunosuppressive. Relapsing remitting use. Monthly brain infusion
Side effect of Natalizumab
Progressive multifocal leukoencaphalopathy
Role of Alemtuzumab
Immunosuppressive. Given once or twice for breakthrough disease during treatment
Role of Ocrelizumab
Immunosuppressive, option for relapsing remitting in adults with active MS
Treatment for spasticity
Backofen and botox
Treatment for fatigue
Modafenil and exercise
Treatment for bladder dysfunction
Antocholinergics
Treatment for tremor
Clonazepam
Spectrums of MS
Clinically isolated syndrome, relapsing-remitting, secondary progressive, primary progressive
What is the Clinically isolated syndrome of MS
First episode of demyelination and neurological signs and symptoms. May never go on to have another episode
What is relapsing remitting MS
Characterised by epsidoes of disease and neurological symptoms, followed by recovery. Symptoms occur in different areas with different episodes
Most common type of MS at diagnosis
Relapsing remitting
Classifications of relapsing remitting MS
Active or worsening, not active or not worsening
What is active vs not active relapsing remitting MS
New symptoms are or are not developing / lesions are appearing or not developing on MRI
What is worsening vs not worsening relapsing remitting MS
There is an overall worsening in disability over time or no worsening in disability
What is secondary progressive MS
There was relapsing remitting MS at first, but now there is a progressive worsening of symptoms with incomplete remissions.
Classifications of secondary progressive MS
Active / not active and progressing / not progressing
What is primary progressive MS
Worsening of disease and neurological symptoms from point of diagnosis without initial relapses and remissions.
