Multiple Sclerosis

Question 1

What is the strongest genetic predictor of MS?

Answer 1

HLA-DRB1*1501 (2x-4x increased risk)

Other risk factors: female, northern latitudes, exposure to EBV

Question 2

How is MS diagnosed?

Answer 2

Formally diagnosed using the McDonald critera (updated in 2017), requires demonstration of CNS demyelinating lesions disseminated in time and space and exclusion of other diagnoses

Question 3

What is Uhthoff phenomenon?

Answer 3

Transient worsening of MS symptoms by heat

Question 4

What is Lhermitte sign?

Answer 4

Passive neck flexion causes shooting, electric pain in neck and shoulders (dural tension - irritating the already irritated myelin)

Question 5

What are MS-typical CNS regions on imaging?

Answer 5

juxtacortical/cortical, periventricular, infratentorial, spinal cord

Question 6

Type of MS?
Intermittent acute attacks with return to neurological baseline (or near-neurological baseline) between episodes

Answer 6

Relapsing-remitting MS (85%)

Question 7

Type of MS?
initial attack which may be compatible w/ MS, in which full diagnostic criteria may not be met

Answer 7

Clinically Isolated Syndrome (CIS)

Question 8

Type of MS?
Gradual progression of symptoms from onset of disease

Answer 8

Primary progressive MS (PPMS)

Male sex and spinal cord lesions are predictive of PPMS

Question 9

Type of MS?
Patients start with relapsing-remitting episodes, but later develop a progressive course?

Answer 9

Secondary Progressive MS (SPMS)

Question 10

CSF findings in Multiple Sclerosis?

Answer 10

Oligoclonal bands

(Ab produced by B cells - unclear if they are directly or indirectly involved)

Question 11

Vitamin D supplementation is associated with what in regards to MS?

Answer 11

decreased lesions on MRI

Question 12

Neurostimulants for chronic fatigue associated w/ MS?

Answer 12

Amantadine (good evidence to support use)

Methylphenidate, modafanil can also be considered

Question 13

Rehab considerations for central fatigue and MS?

Answer 13

Focus on energy-conserving strategies, submaximal exercise is recommended

Question 14

Medication approved for MS patients to increase walking speed?

Answer 14

Dalframpridine

Pts considered dalfampridine “responders” if they demonstrate at least 20% improvement in walking speed

Question 15

Factors associated w/ good prognosis in MS?

Answer 15

Optic neuritis as presenting symptom, female gender, younger age at onset

Question 16

Factors associated w/ poor outcomes in MS?

Answer 16

spinal cord lesions, presence of CSF oligoclonal bands, male gender, older age at onset

Question 17

Increase in lesion volume over the first ____ years is associated w/ greater disability from MS 20 years later?

Answer 17

first 5 years of the disease

Question 18

In relapsing remitting MS, ______ # of relapses in the first 2 years is associated w/ higher level of disability?

Answer 18

3 relapsing episodes

Question 19

receiving disease-modifying treatment before a second attack is associated w/ lower risk of disability in which type of MS?

Answer 19

Relapsing remitting MS

Question 20

Factors associated w/ higher rates of relapses and progression of disability in MS?

Answer 20

Vitamin D deficiency, smoking

Question 21

Is fertility affected in MS?

Answer 21

No

There are fewer MS exacerbations during pregnancy, but risk of exacerbation is increased in early post-partum