Multiple Sclerosis Flashcards
At what age does MS usually present?
30s-40s
Does MS affect CNS or PNS?
CNS
Which part of the CNS is affected by MS?
White matter
What is the pathological process behind MS?
Demyelination
Is MS more common in men or women?
Women
In MS, there can be relapses which can affect anywhere in the CNS. What would be the symptoms if the MS relapsed and affected the eye?
Complete or partial loss of vision
In MS, there can be relapses which can affect anywhere in the CNS. What would be the symptoms if the MS relapsed and affected the brainstem?
Diplopia
Vertigo/ataxia
In MS, there can be relapses which can affect anywhere in the CNS. What would be the symptoms if the MS relapsed and affected the spinal cord?
Bilateral motor and sensory symptoms
Bladder involvement
What is a common presentation of MS?
Optic neuritis
What would someone with optic neuritis present with?
Subacute vision loss
Pain on moving eye
Impaired colour vision
What would be seen upon examination of someone with optic neuritis?
Initial swelling of optic disc
Optic atrophy seen later
Relative afferent pupillary defect
What would be observed if there was a left eye relative pupillary reflex?
When shining a light into right eye, both pupils would constrict (normal reflex).
When shining light in left eye, both pupils dilate.
If there was an MS brainstem relapse in the pons, what would this cause?
Interneuclear opthalmoplegia
If there was an MS brainstem relapse in the cerebellum, what would this cause?
Vertigo, nystagmus, ataxia
What occurs in demyelination?
Autoimmune process
Activated T ells cross blood brain barrier which causes the demyelination.
What happens as a result of demyelination?
Acute inflammation of myelin sheath
Loss of function
What happens as demyelination repairs?
Gliosis- proliferation of glial cells in injured area
Which imaging is good to see areas of demyelination?
MRI
For MS to be diagnosed, what does a patient need to have?
More than one episode/relapse of demyelination in different parts of the NS
What is it called if a patient only has one episode of inflammation and demyelination?
Clinically isolated syndrome
As time goes on, most patients develop progressive MS. What is this due to?
Loss of axons
In the progressive phase of MS, which symptoms may be experienced?
Fatigue
Temperature sensitivity
Stiffness
Spasms
Balance issues
Slurred speech
Bladder and bowel symptoms
Swallowing problems
Visual loss
Dysesthesia/paraesthesia
Examination in those with MS depends on the stage of the disease. What are some signs that may be seen upon examination of someone with MS?
Afferent pupillary defect
Nystagmus
Abnormal eye movements
Weakness
Spasticity
Hyperreflexia
Plantars extensor
What are the three types of MS?
Relapsing-remitting MS
Secondary progressive MS
Primary progressive MS
What will most people with relapsing-remitting MS go onto develop?
Secondary progressive MS
->patients will stop having significant relapses but will notice increasing loss of strength and ability
What happens in primary progressive MS?
Never has relapses. progressive disease from onset
At which age does primary progressive MS present?
40-50s
Which types of symptoms are common in primary progressive MS?
Spinal and bladder symptoms
Differential diagnosis depends on whether the symptoms and signs correspond to first relapse or progressive disease.
List some of the potential differential diagnoses’ of MS.
Acute disseminated encephalomyelitis
Other causes of demyelination
Other autoimmune conditions
Sarcoidosis
Vasculitis
Infection e.g. Lyme’s disease
Adrenoleucodystrophy
->look, don’t get hung up on remembering them, just read through haha
List some of the differential diagnosis’s of optic neuritis
Neuromyelitis optica
Sarcoidosis
Ischaemic optic neuropathy
Drugs/toxins/vitamin B12 deficiency
Local compression
Infection
List some of the differential diagnosis’ of myelitis
Neuromyelitis optica
Sarcoidosis
Tumour
Stroke
What is the treatment for MS?
No cure but there is treatment of relapse and disease modifying treatment (which reduce number of relapses but do not slow nature of disease)
What are some symptomatic treatments for MS?
Spasticity-muscle relaxants
Antispasmodics
Physiotherapy
Amitriptyline or gabapentin for pain
Laxatives for constipation
Bladder stimulants/catherization
List some vital members of a MDT in the support and management of MS.
MS nurse
Physiotherapist
OT
Speech and language therapist
Dietician
Rehabilitation services
Continence advisor
Psychology/psychiatry
What are some of the first line disease modifying treatments?
Injections: beta-interferons, glatiramer acetate
Oral: teriflunomide, dimethyl fumarate
List some of the second line treatments for the disease modificaion.
Natalizumab
Fingolimod
Cladribine
What can long-term immunosuppression be associated with?
Progressive multifocal leukoencephalopathy
