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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Pathophysiology of MS

A

Typically only affects the CNS where there is inflammation around myelin and infiltration of immune cells that cause damage to the myelin

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2
Q

Causes of MS

A

Genes, EBV, low vit D, smoking, obesity

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3
Q

Diagnosis of MS

A

Based on clinical picture and symptoms suggesting lesions that change location over time Other causes need to be excluded

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4
Q

Investigations supporing diagnosis

A

MRI scans to demonstrate typical lesions, LP to detect oligoclonal bands in CSF

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5
Q

How long do symptoms need to progress for a diagnosis of primary progressive MS

A

1 year

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6
Q

Focal weakness symptoms in MS

A

Bells palsy, Horner’s syndrome, limb paralysis, incontinence

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7
Q

Focal sensory symptoms in MS

A

Trigeminal neuralgia, numbness, paraesthesia, Lhermitte’s sign

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8
Q

Two different types of ataxia in MS

A

Sensory or cerebellar

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9
Q

What causes cerebellar ataxia

A

Problems with the cerebellum coordinating movement

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10
Q

What causes sensory ataxia

A

Result of loss of the proprioception sense

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11
Q

What are the lesions seen on MRI scans of MS patients

A

periventricular white matter lesions

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12
Q

Management of acute attack of MS

A

Glucocorticoids, rule out infection first

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13
Q

Chrnic management of MS

A

Disease modifying therapies and symptomatic therapies

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14
Q

First line injectable DMTs

A

Beta interferon injections and glatiramer acetate

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15
Q

Oral agents used in MS

A

Dimethyl fumarate, Teriflunomide, Fingolimod, Siponimod, Cladribine

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16
Q

Biologic agents used in MS

A

Natalizumab, Alemtuzumab, Ocrelizumab

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17
Q

What is the role of dimethyl fumarate

A

Anti inflammatory, neuroprotective and anti-oxidative stress

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18
Q

Side effects of dimethyl fumarate

A

GI upset and flushing

19
Q

Role of Teriflunomide

A

Immunomodulatory drug

20
Q

Role of Fingolimod

A

Immunosuppressive, used in more extreme forms to reduce relapses

21
Q

Side effects of Teriflunomide

A

Nausea, diarrhoea, hair loss and increased ALT

22
Q

Side effects of Fingolimod

A

Bradycardia, macular oedema and heart block

23
Q

Role of Siponimod

A

Immunosuppressive but does not act on cardiac receptors. USed in secondary progressive MS

24
Q

Role of Cladribrine

A

Immunosuppressive and anti lymphoproliferative. Given in highly acting relapsing remittingMS

25
Q

Side effects of Cladribrine

A

Infections, alopecia, lymphpenia

26
Q

Role of Natalizumab

A

Immunosuppressive. Relapsing remitting use. Monthly brain infusion

27
Q

Side effect of Natalizumab

A

Progressive multifocal leukoencaphalopathy

28
Q

Role of Alemtuzumab

A

Immunosuppressive. Given once or twice for breakthrough disease during treatment

29
Q

Role of Ocrelizumab

A

Immunosuppressive, option for relapsing remitting in adults with active MS

30
Q

Treatment for spasticity

A

Backofen and botox

31
Q

Treatment for fatigue

A

Modafenil and exercise

32
Q

Treatment for bladder dysfunction

A

Antocholinergics

33
Q

Treatment for tremor

A

Clonazepam

34
Q

Spectrums of MS

A

Clinically isolated syndrome, relapsing-remitting, secondary progressive, primary progressive

35
Q

What is the Clinically isolated syndrome of MS

A

First episode of demyelination and neurological signs and symptoms. May never go on to have another episode

36
Q

What is relapsing remitting MS

A

Characterised by epsidoes of disease and neurological symptoms, followed by recovery. Symptoms occur in different areas with different episodes

37
Q

Most common type of MS at diagnosis

A

Relapsing remitting

38
Q

Classifications of relapsing remitting MS

A

Active or worsening, not active or not worsening

39
Q

What is active vs not active relapsing remitting MS

A

New symptoms are or are not developing / lesions are appearing or not developing on MRI

40
Q

What is worsening vs not worsening relapsing remitting MS

A

There is an overall worsening in disability over time or no worsening in disability

41
Q

What is secondary progressive MS

A

There was relapsing remitting MS at first, but now there is a progressive worsening of symptoms with incomplete remissions.

42
Q

Classifications of secondary progressive MS

A

Active / not active and progressing / not progressing

43
Q

What is primary progressive MS

A

Worsening of disease and neurological symptoms from point of diagnosis without initial relapses and remissions.

Neurology (21 decks)

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