Multiple Sclerosis

Question 1

Definition of MS

Answer 1

An inflammatory demyelinating disease of the CNS, that is characterised by episodic neurological dysfunction in at least 2 areas of the CNS (brain, spinal cord, optic nerves)

Question 2

Aetiology of MS

Answer 2

• First degree family members that have MS, put you at a very high risk of developing the same
• Some researchers state that EBV may be related to the development of MS
• Relapses are sometimes triggered by infections or postnatal hormonal changes
• Relapsing-remitting MS is the most common form

Question 3

Pathophysiology of MS

Answer 3

• Autoimmune basis can lead to acute presentations of inflammation that results in demyelination (affecting the oligodendricytes) ->axonal loss ->neurodegeneration
• T cell and B cell infiltration
• There can then be periods of remission. The periods of remission can then be ‘lost’ and neurological deficit would accumulate

Question 4

History and Examination of MS

Answer 4

• Optic neuritis: one of the most common presenting symptoms: May have greying or blurring in one eye, pain when moving that eye and/or loss of colour description (particularly reds)
• Peculiar sensory phenomena: odd sensations of a patch of wetness or burning, sensory loss or tingling. Lhermitte’s sign: electric shock like sensation going down the spine and radiating to limbs
• Limb weakness, leg cramping
• Increased muscle tone
• Urinary frequency or bowel dysfunction

Question 5

Risk factors for MS

Answer 5

• Female sex
• Family history
• Genetics
• EBV virus
• VIT D deficiency?

Question 6

Investigations for MS

Answer 6

• MRI Brain: May see hyperintensities (plaques) in the white matter. Almost all patients with MS will have abnormal cranial MRI
• MRI Spinal cord: recommended for all patients. Many patients with MS will have demyelinating cervical spinal cord lesions (high specificity)
• FBC, Metabolic panel, TSH: to rule out other conditions

Question 7

Treatment of MS if ‘Acute relapse affecting function’:

Answer 7

)IV methylprednisolone: Give in high doses (given for 3 days)

Question 8

Treatment of MS if relapsing and remitting MS:

Answer 8

1) Immunomodulators: Can give Interferon Beta preparations

Question 9

Complications and prognosis of MS

Answer 9

• UTI
• Visual impairment: primary manifestation of the disease
• Erectile dysfunction
• Depression

Varied prognosis, some may have more benign course, whereas others become rapidly disabled within several years of diagnosis
Frequent relapses and motor or cerebellar onset (as opposed to optic neuritis onset) are associated with worse prognosis