Multiple sclerosis

Question 1

What is MS?

Answer 1

T4 hypersensitivity reaction vs myelin basic protein of oligodendrocytes (CNS myelinating cells)
Demyelination of CNA neurones

Question 2

Rf for MS?

Answer 2

Female
20-40
Autoimmune disease
fHx
EBV

Question 3

What are the 3 types of MS?

Answer 3

Relapsing-Remitting
1^ progressive
2^ progressive

Question 4

What Is relapsing-remitting?

Answer 4

Sx , incomplete recovery, Sx ….

Question 5

what is 1^ progressive MS?

Answer 5

Gradual deterioration without recovery

Question 6

What is 2^ progressive MS?

Answer 6

Relapsing-remitting to 1^ progressive
-75% RR cases evolve to this

Question 7

Sx of MS?

Answer 7

Parasthesia
Blurred vision
Uthoff’s phenomenon (Sx exacerbated with heat, after a shower)

Question 8

What is the 1st presenting Sx?

Answer 8

optic neuritis (inflamed optic nerve + can’t see RED properly)

Question 9

What other Sx would you see?

Answer 9

Internuclear opthalmoplegia
(lateral gaze impaired, damaged medial longitudinal fasiculus)

Brainstem signs

Sensory signs

UMN signs (not LMN)

Lhermitte’s phenomenon
(electric shock sensation with neck flexion)

Charcot neurological triad - Dysarthria, nystagmus, intention tremor

Question 10

Dx of MS?
What criteria is used?

Answer 10

McDonalds criteria
2 or more attacks disseminated in time (separate events) + space (diff part of CNS affected)

Question 11

Diagnostic for MS?
What would be seen?

Answer 11

MRI brain and cord
shows dissemination in space (where is white demyelination?)
+ time (give gadolinium contrast - show how long these have been there for)

Question 12

What else is seen?

Answer 12

Delayed conduction speeds
LP may show oligoclonal IgG bands (non specific)

Question 13

Tx of MS?

Answer 13

Acutely (in episodes) - IV methylprednisolone
Prophylaxis - Beta interferon (DMARD, Biologic)