Multiple sclerosis

Question 1

What is MS?

Answer 1

chronic autoimmune inflammatory demyelinating disease of the brain and spinal cord

Question 2

What is the most common age to develop MS?

Answer 2

20s, 30s, 40s

Question 3

Is MS UMN or LMN?

Answer 3

UMN

Question 4

What causes the damage in MS?

Answer 4

immune-driven
target antigens/targets in CNS
cause local areas of damage

Question 5

Name 4 types of MS

Answer 5

Benign MS (flares then resumes same baseline disability)

Relapsing remitting MS (flares cause baseline disability to increase)

Secondary chronic progressive MS (gradually acquire new neurological symptoms - most have relapsing remitting then it gradually worsens)

Primary progressive MS (gradually worsening neurological symptoms - no relapses, symptoms always present)

Question 6

MS clinical presentation

Answer 6

numbness
tingling
cognitive dysfunction
dizziness
vision problems
pain
fatigue
depression
muscle spasms
bladder dysfunction
bowel dysfunction
walking
weakness

Question 7

What is an MS relapse?

Answer 7

when MS symptoms get worse
subacute onset
focal
persisting - days to weeks
usually objective signs
no better explanation

Question 8

Optic neuritis symptoms

Answer 8

pain
subacute visual loss - not normally complete visual loss
improves
under 55y

70% unilateral
RAPD present

Question 9

What is a common first manifestation of MS?

Answer 9

optic neuritis (50% will be idiopathic, 50% will be an MS presentation)

Question 10

What can be a sign of previous nerve injury/atrophy on fundoscopy?

Answer 10

pale optic disc

Question 11

Motor symptoms of MS

Answer 11

loss of dexterity - hands
weakness (mono-, para-, hemi- or quadriparesis) - usually asymmetric
limb spasms

Question 12

MS signs

Answer 12

RAPD
intranuclear ophthalmoparesis
spastic paraparesis
ataxia
cord sensory signs

Question 13

How is MS diagnosed?

Answer 13

diagnosis requires evidence of at least 2 lesions separated in time and space without a better explanation

Question 14

MS differential diagnosis

Answer 14

primary CNS vasculitis
post-infectious encephalomyelitis
lyme disease
behcet’s disease
sarcoidosis/sjogren’s syndrome
B12 deficiency/tertiary syphilis
leukodystrophies of adulthood

Question 15

MS investigations

Answer 15

T2 MRI - shows white matter area lesions (current and previous)#
oligoclonal bands in CSF - quite specific for MS

Question 16

MS treatment

Answer 16

steroids in relapses
- high dose methylprednisolone, but won’t put off next attack

then treat symptoms
- pain
- bladder
- spasticity
- fatigue
- depression
- tremor

immune medications

Question 17

Side effects of high dose steroids

Answer 17

cataracts
osteoporosis
diabetes
avascular necrosis

Question 18

When are steroids used in MS?

Answer 18

during relapses
decrease severity/duration of exacerbations
IV (3-5 days) or oral 500mg/5days

Question 19

Signs of a good prognosis in MS

Answer 19

young
female sex
onset with optic neuritis or an isolated sensory symptom
full recovery from attack
long interval to second relapse
no disability after 5 years
normal MRI/low lesion load
no posterior fossa lesions

Question 20

Signs of a bad prognosis in MS

Answer 20

older age at onset
male sex
‘multifocal’ onset
efferent system affected (motor or cerebellar)
high relapse rate in 1st 2-5 years
substantial disability after 5 years
abnormal MRI with large lesion load
posterior fossa lesions
possible genomic factors