Multiple Sclerosis Flashcards
What is multiple sclerosis?
- an acquired, chronic, immune-mediated inflammatory condition of the CNS
What are some risk factors of MS?
- Genetics
- Vitamin D deficiency
- Cigarette smoking
- Diet and obesity in early life
- Female gender
What are the two phases of MS?
Inflammatory and degenerative phases
What are the three patterns of disease in MS?
- Relapsing remitting (RR-MS)
- Secondary progressive (SP-MS)
- Primary progressive (PP- MS)
What are the complications of MS?
Fatigue, pain, spasticity, ataxia, tremor, reduced mobility, urinary problems, mental health problems
How is MS diagnosed?
Neurological examination, Imaging (MRI)
How are acute management of relapses treated and what are its contraindications?
Oral methylprednisone 0.5g daily for 5 days
- started ASAP after onset and within 14 days
- C/Is - infection, poorly controlled diabetes, hypertension
What are disease modifying treatments indicated for?
Relapsing forms of MS
How would you manage fatigue in MS?
- Check sleep hygiene, alcohol and caffeine intake
- Treat depression, restless legs, spasticity, pain, bladder frequency
- Regular aerobic, balancing and stretching exercises including yoga
- Trial of amantadine HCl (off-label)
How would you manage mobility problems in MS?
- Referral to rehab specialist and physiotherapist
- Fampridine (Fampyra) may improve walking speed CAUTION SEIZURES
How would you manage spasticity in MS?
- Assess and treat aggravating factors
- Baclofen (1st line) or Gabapentin (2nd line, off-label)
- Physiotherapy
How would you manage mental health issues in MS?
- Amitriptyline HCl (off-label) for emotional lability
- CBT
How would you treat Oscillopsia (visual disturbance) in MS?
- Trials of Gabapentin or memantine (off-label)
How would you treat urinary dysfunction in MS?
- Limit intake of caffeine and ‘vitamin waters’, management of constipation
- Antimuscarinics, e.g. oxybutynin, solifenacin, tolterodine.
