Multiple sclerosis

Question 1

Genetics

Answer 1

monozygotic twin concordance = 30%

Question 2

most common form, accounts for around 85% of patients
acute attacks (e.g. last 1-2 months) followed by periods of remission

Answer 2

Relapse-remitting subtype

Question 3

describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
around 65% of patients with relapsing-remitting disease go on to develop secondary progressive disease within 15 years of diagnosis
gait and bladder disorders are generally seen

Answer 3

Secondary progressive disease

Question 4

accounts for 10% of patients
progressive deterioration from onset
more common in older people

Answer 4

Primary progressive disease

Question 5

Inevstigation: MRI

Answer 5

high signal T2 lesions
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions penpendicular to the corpus callosum

Question 6

Investigation: CSF

Answer 6

oligoclonal bands (and not in serum)
increased intrathecal synthesis of IgG

Question 7

Features: visual

Answer 7

Lethargy
Optic neurits
Uhthoff’s phenomenon
internuclear ophthalmoplegia

Question 8

Sensory features

Answer 8

Lhermitte’s syndrome: paraesthesia on neck flexion

Question 9

Motor features

Answer 9

spastic weakness: most commonly seen in the legs

Question 10

Cerebellar

Answer 10

Cerebellar
ataxia: more often seen during an acute relapse than as a presenting symptom
tremor

Question 11

Mx of relapse

Answer 11

Steroids e.g. oral or IV methylprednisolone

Question 12

When to use disease modifying drugs
E.g.

Answer 12

2 or more relapses in 2 years
Natalizumab