Multiple Sclerosis Flashcards
Multiple Sclerosis
define
most common immune mediated inflammatory demyelingating disease of the CNS
Multiple Sclerosis
epidemology
gender, age, genetics, environmental
- female gender
- age of onset: 28-31
- genetic susceptibility
- environmental
Multiple Sclerosis
characteristic feature on imaging
- presence of focal demyelinated plaques in CNS (optic nerve, spinal cord, brainstem, cerebellum, juxtacortical/periventricular white matter)
Multiple Sclerosis
dx
2
- clinical dx
- get good PMHx, PE, MRI
Multiple Sclerosis
clinical manifestations
2
- monosymptomatic: single lesion
- polysymptomatic: > 1 lesion
Multiple Sclerosis
sensory sx
5
- numbness/tingling
- tightness (“MS hugs”)
- coldness
- swelling of lumbs/trunk
- intense pruritis (unilateral, cervical dermatomes)
Multiple Sclerosis
Neurologic Sx
5
cognitive impairment
* difficulty w/ attention
* short term memory
* speed of information processing
* abstract conceptualization
- Frank Dementia
Multiple Sclerosis
sx of unilateral optic neuritis
- painful monocular vision loss (visual blurring, partial vision loss)
- 90% will recover their vision w/in 2-6 mo
Multiple Sclerosis
pain sx
4
- paroxysmal (sudden) pain
- persistent pain (burning, cold dyesthesias)
- musculoskeletal
- soft tissue
Multiple Sclerosis
descrive uhthoff phenomenon
3 components
- heat sensitivity
- small increases in body temp will worsen sx temporarily
- due to conduction block in central pathways as temp increases
Multiple Sclerosis
GU Sx
5 components
- urge incontinence
- overactive bladder
- functional bladder outlet obstruction
- Urination: hesitancy, interrputed stream, incomplete emptying
- Sexual: ED, decreased libido
Multiple Sclerosis
GI sx
4
- urge incontinence
- constipation
- poor evacuation
- incontinence
Multiple Sclerosis
Neurologic PE Findings
6 components
- Paraplegia/Paraparesis: lesions in the descending tract of the spinal cord
- Spasticity: tonic (resistance to movement) or phasic (involuntary jerks and spasms)
- lhermitte sign
- coordination problems (dysmetria, hypotonia)
- gait disturbances
- cerebellar dysarthria
Multiple Sclerosis
why might pts have diminished DTRs
lesions interrupting the reflex arc
Multiple Sclerosis
what is lhermitte sign
electric shock shooting down the spine or into the limbs (most often after flexion of the neck)
Multiple Sclerosis
sensory PE findings
- vibtration/joint position sense impairment
- patchy areas of reduced pain and light touch perception in limbs/trunk
- Brown-Sequard Syndrome
Multiple Sclerosis
describe Brown-Sequard Syndrome
2
- testing sensation w/ sharp object, feeling is increased or spreads like ripple effect
- contralateral weakness
Multiple Sclerosis
Ocular PE Findings
4 components
- optic neuritis (afferent pupillary defect w/ swinging flashlight test)
- disc edema if head of optic nerve is involved
- internuclear ophthalmoplegia
- pendular nystagmus
Multiple Sclerosis
what is seen on brain MRI
3 components
- hyperintense white matter lesions
- plaques (ring enhancing, ovoid)
- black hole lesions (severe demyelination and axonal loss)
Multiple Sclerosis
what would MRI spine show
5 components
- if here, pt is less likely to be asx
- size > 3mm but < 2mm
- occupy only part of SC
- little to no cord swelling
- focal: clearly delineated, well-circumscribed
Multiple Sclerosis
Spinal MRI describe chronic lesions
2
- smaller
- well-defined margins
Multiple Sclerosis
Spinal MRI describe acute lesions
3 components
- larger
- ill defined
- more gadolinium uptake (dissipates over a few wks)
Multiple Sclerosis
when to do LP
if atypical clinical features, imaging features, or in an atypical population (kids or adults)
Multiple Sclerosis
describe evoked potentials
- electrical events generated in the CNS by peipheral stimulation of a sensory organ
- detects subclinical abnormal CNS function
- define anatomic site of lesion not easily visualized by imaging
Multiple Sclerosis
describe optical coherence tomography
3
- uses infrared light waves that reflect off the internal microstructure of biologic tissue to produce images
- non-invasive way to image the retina
- measure thickness of retinal nerve fiber layers
Multiple Sclerosis
describe relapsing remitting MS
3
- 80-95% of pts
- attacks w/ full or incomplete recovery
- minimal disease progression between relapses
Multiple Sclerosis
describe Secondary Progressive MS
- initial relapsing-remitting course followed by gradual worsening w/ or w/out occasional relapses, minor remissions, and plateaus
- retrospective dx, no clinical criteria
Multiple Sclerosis
describe Primary Progressive MS
- progressive accumulation of disability from onset w/ occasional plateaus, temporary minor improvements or acute relapses
- typical presentation: spinal cord syndrome worsening over months to years
- clinical dx, only 10% of cases
Multiple Sclerosis
describe clinically isolated syndrome
first clinical episode
* resembles typical MS relapse
* no known hx, doesn’t meet dx criteria
Multiple Sclerosis
describe radiologically isolated syndrome
- MRI findings suggestive of MS
- no signs/sx
- no hx of MS
- risk factors: male, age > 37, spinal cord lesions
Multiple Sclerosis
different tx strategies
- tx of acute exacerbations w/ corticosteroids
- reduction of biologic activity w/ DMARDs
- sx management
- rehab and psychosocial support
Multiple Sclerosis
criteria for an acute attack
- episode of focal neurologic disturbance > 24 hrs
- preceding clinical stability for > 30d
- consider MRI brain
Multiple Sclerosis
acute attack tx
- goal: lessen recovery time
- glucocorticoids (methylprednisone IV or prednisone PO)
- corticotropin injection gel
- plasma exchange
Multiple Sclerosis
IV Monocloncal Antibody tx
3
- Natalizumab
- Ocrelizumab
- Alemtuzumab
Multiple Sclerosis
which med has side effect of progressive multifocal leukoencephalopathy
natalizumab
Multiple Sclerosis
Oral therapies: S1P Receptor Modulators
4
- Fingolimod
- Siponimid
- Ozanimid
- Ponesimod
Multiple Sclerosis
Injectable Tx
- Ofatumumab
- Interferons
Multiple Sclerosis
monitoring fot tx
- routine visits every 3 mo
- laboratory evaluation
- imaging (MRI) repeat- baseline, 6 mo post tx, then annually
