Multiple Sclerosis Flashcards
What is multiple sclerosis?
A cell-mediated autoimmune disorder characterised by demyelination in the CNS
Who is MS most common in?
MS is 3 times more common in women
When does MS typically present?
In people under 50
What are the three sub-types of MS?
Primary progressive
Secondary progressive
Relapsing-remitting
What is the most common subtype of MS?
Relapsing-remitting
What is the pathophysiology of MS?
The myelin sheath of oligodendrocytes becomes inflamed, and is infiltrated by immune cells
What are some risk factors for developing MS?
Genetics
EBV
Low vitamin D
Smoking
Obesity
What is the most common initial presentation of MS?
Optic neuritis
What is relapsing-remitting MS?
Periods of neurological disease and illness followed by recovery.
What is primary progressive MS?
MS that progressively worsens, without relapsing and remitting episodes
What is secondary progressive MS?
Progressive worsening of the disease with relapses that have incomplete remissions
What is required for a diagnosis of MS?
Lesions disseminated in space and time
What investigations can be carried out to confirm MS?
Contrast MRI
Lumbar puncture
What would be seen on MRI?
Periventricular white matter lesions
What would be found on lumbar puncture in the CSF?
Oligoclonal bands
Mildly raised protein
Lymphocytes
What is the first line management of an MS relapse?
1g IV methylprednisolone for 3 days
What is the second line management of an MS relapse?
Plasma exchange
What is the long term treatment of MS?
Disease modifying therapies
- Natalizumab
- Interferon beta
- Glatiramer
- Dimethyl fumarate
- Diroximel fumarate
What are the symptoms of MS?
Fatigue
Difficulty walking
Vision problems
Numbness
Tingling
Muscle spasms
Muscle stiffness
Weakness
What factors are associated with a worse prognosis in MS?
Male
Motor signs at onset
Early relapses
Many MRI lesions
Axonal loss
Why is a contrast MRI performed to diagnose MS?
You can age the different lesions on a contrast MRI (to see lesions disseminated in space and time)
What contrast is used in a contrast MRI scan?
Gadolinium
What medication is first line for muscle spasticity in MS?
Baclofen
Gabapentin
What are the symptoms of optic neuritis?
Unilateral decrease in visual acuity over hours to days
Central scotoma
Pain worse on eye movement
Relative afferent pupillary defect
Poor discrimination of colours
