Multiple Sclerosis Flashcards
Is MS an issue with the CNS or PNS?
CNS
What is MS?
An inflammatory demyelinating disorder in the CNS
Where in the world is MS most common?
The further north (e.g. Scandinavia) or south (e.g. Tanzania) you go from the equator
What are the three types of MS course?
Relapsing remitting MS (RRMS) - 85-90%
- Secondary progressive MS (SPMS) - (20-50% of RRMS patients develop this)
Primary progressive MS (PPMS) - 10-15%
Are females or males more likely to have MS?
Females
F3:1
How does MS effect the pyramidal (corticospinal) tract?
- Increased tone
- Spasticity
- Weakness
- Effects extensors of upper limb
- Effects flexors of lower limbs
How long does optic neuritis last in MS?
1-2 weeks
What sensory symptoms do you get in MS?
Pain
Paresthesia
Dorsal column loss (proprioception & Vibration)
Numbness
Trigeminal neuralgia
Symptoms of MS related cerebellar dysfunction
Dysarthria
Ataxia
Nystagmus
Intention Tremor
Past pointing
Dysdiadokinesis
Pendular reflexes
What are the symptoms of brain stem dysfunction in MS?
Diplopia (R VI palsy)
Facial weakness (R VII palsy)
Does MS effect the urinary tract?
yes
Is fatigue common in MS?
yes
What investigations can be done in MS?
Blood tests
MRI
CSF
What are we looking for in CSF for a positive result for MS?
presence of oligoclonal bands
What treatment is given for a mild relapse in MS?
Symptomatic treatment
What treatment is given for a moderate relapse in MS?
500mg oral steroids
What treatment is given for a severe relapse in MS?
Admit + 1000mg IV steroid
What medications are commonly given to treat spasticity in MS?
Baclofen, tizanidine
What medications are commonly given for sensory symptoms in MS?
Anti-convulsant (i.e. gabapentin)
Anti-depressant (i.e. amitryptiline)
How are lower urinary tract symptoms managed in MS?
Bladder drill
Anti-cholinergic (e.g. oxybutynin)
Desmopressin
Catheter
How is fatigue managed in MS?
Amantadine
Hyperbaric oxgen
What is first line therapy in MS?
Tecfedira, Aubagio
Interferon beta
Glitiramer acetate
What is second line therapy in MS?
- Fingolimod, Cladrabine
- Monoclonal antibody - Tysabri, Ocrevus, Lemtrada
What is first line in RRMS?
Tecfidera
When are monoclonal antibodies indicated for treatment in MS?
In highly active RRMS after a previous therapy (tecfidera) has been tried
How does spasticity effect reflexes?
More brisk reflexes
What does a lower limb pattern of weakness look like in the lower limb?
Reduced hip, knee & plantar flexion
