Multiple Sclerosis

Question 1

At what age does MS usually present?

Answer 1

30s-40s

Question 2

Does MS affect CNS or PNS?

Answer 2

CNS

Question 3

Which part of the CNS is affected by MS?

Answer 3

White matter

Question 4

What is the pathological process behind MS?

Answer 4

Demyelination

Question 5

Is MS more common in men or women?

Answer 5

Women

Question 6

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?

Answer 6

Complete or partial loss of vision

Question 7

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?

Answer 7

Diplopia
Vertigo/ataxia

Question 8

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?

Answer 8

Bilateral motor and sensory symptoms
Bladder involvement

Question 9

What is a common presentation of MS?

Answer 9

Optic neuritis

Question 10

What would someone with optic neuritis present with?

Answer 10

Subacute vision loss
Pain on moving eye
Impaired colour vision

Question 11

What would be seen upon examination of someone with optic neuritis?

Answer 11

Initial swelling of optic disc
Optic atrophy seen later
Relative afferent pupillary defect

Question 12

What would be observed if there was a left eye relative pupillary reflex?

Answer 12

When shining a light into right eye, both pupils would constrict (normal reflex).
When shining light in left eye, both pupils dilate.

Question 13

If there was an MS brainstem relapse in the pons, what would this cause?

Answer 13

Interneuclear opthalmoplegia

Question 14

If there was an MS brainstem relapse in the cerebellum, what would this cause?

Answer 14

Vertigo, nystagmus, ataxia

Question 15

What occurs in demyelination?

Answer 15

Autoimmune process
Activated T ells cross blood brain barrier which causes the demyelination.

Question 16

What happens as a result of demyelination?

Answer 16

Acute inflammation of myelin sheath
Loss of function

Question 17

What happens as demyelination repairs?

Answer 17

Gliosis- proliferation of glial cells in injured area

Question 18

Which imaging is good to see areas of demyelination?

Answer 18

MRI

Question 19

For MS to be diagnosed, what does a patient need to have?

Answer 19

More than one episode/relapse of demyelination in different parts of the NS

Question 20

What is it called if a patient only has one episode of inflammation and demyelination?

Answer 20

Clinically isolated syndrome

Question 21

As time goes on, most patients develop progressive MS. What is this due to?

Answer 21

Loss of axons

Question 22

In the progressive phase of MS, which symptoms may be experienced?

Answer 22

Fatigue
Temperature sensitivity
Stiffness
Spasms
Balance issues
Slurred speech
Bladder and bowel symptoms
Swallowing problems
Visual loss
Dysesthesia/paraesthesia

Question 23

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?

Answer 23

Afferent pupillary defect
Nystagmus
Abnormal eye movements
Weakness
Spasticity
Hyperreflexia
Plantars extensor

Question 24

What are the three types of MS?

Answer 24

Relapsing-remitting MS
Secondary progressive MS
Primary progressive MS

Question 25

What will most people with relapsing-remitting MS go onto develop?

Answer 25

Secondary progressive MS ->patients will stop having significant relapses but will notice increasing loss of strength and ability

Question 26

What happens in primary progressive MS?

Answer 26

Never has relapses. progressive disease from onset

Question 27

At which age does primary progressive MS present?

Answer 27

40-50s

Question 28

Which types of symptoms are common in primary progressive MS?

Answer 28

Spinal and bladder symptoms

Question 29

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.

Answer 29

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

Question 30

List some of the differential diagnosis's of optic neuritis

Answer 30

Neuromyelitis optica Sarcoidosis Ischaemic optic neuropathy Drugs/toxins/vitamin B12 deficiency Local compression Infection

Question 31

List some of the differential diagnosis' of myelitis

Answer 31

Neuromyelitis optica Sarcoidosis Tumour Stroke

Question 32

What is the treatment for MS?

Answer 32

No cure but there is treatment of relapse and disease modifying treatment (which reduce number of relapses but do not slow nature of disease)

Question 33

What are some symptomatic treatments for MS?

Answer 33

Spasticity-muscle relaxants Antispasmodics Physiotherapy Amitriptyline or gabapentin for pain Laxatives for constipation Bladder stimulants/catherization

Question 34

List some vital members of a MDT in the support and management of MS.

Answer 34

MS nurse Physiotherapist OT Speech and language therapist Dietician Rehabilitation services Continence advisor Psychology/psychiatry

Question 35

What are some of the first line disease modifying treatments?

Answer 35

Injections: beta-interferons, glatiramer acetate Oral: teriflunomide, dimethyl fumarate

Question 36

List some of the second line treatments for the disease modificaion.

Answer 36

Natalizumab Fingolimod Cladribine

Question 37

What can long-term immunosuppression be associated with?

Answer 37

Progressive multifocal leukoencephalopathy