Multiple Sclerosis

Question 1

What is Multiple sclerosis?

Answer 1

a chronic and progressive autoimmune condition where the central nervous system becomes demyelinated

Question 2

What does the immune system do in multiple sclerosis?

Answer 2

it attacks the myelin sheath of myelinated neurons, making conduction slower

Question 3

What is the typical patient of MS?

Answer 3

a woman under 50

Question 4

What does myelin do and where is it?

Answer 4

it covers the axons of neurones and makes electrical impulses travel faster

Question 5

What cells provide myelination in the CNS?

Answer 5

oligodendrocytes

Question 6

What cells provide myelination in the PNS?

Answer 6

Schwann cells

Question 7

What can happen in early MS disease?

Answer 7

re-myelination can occur

Question 8

What is usually found when diagnosing multiple sclerosis?

Answer 8

That there are often demyelinating lesions in the whole CNS that aren’t causing symptoms

Question 9

What can happen in late stage MS disease?

Answer 9

re-myelination is incomplete and symptoms become permanent

Question 10

What is unique about the MS lesions?

Answer 10

they are disseminated in time and space meaning the lesions vary in location so the signs and symptoms change overtime

Question 11

What are the causes of MS?

Answer 11

Unclear but may be due to:
- multiple genes
- EBV
- low vitamin D
- smoking
- obesity

Question 12

What is the onset of the presentation of MS?

Answer 12

• symptoms usually progress over more than 24 hours
• they tend to last days to weeks from the first presentation then improve

Question 13

What are the main symptoms?

Answer 13

present in many ways- depending where the lesion is
- optic neuritis
- eye movement abnormalities
- ataxia

Question 14

What are the focal neurological symptoms of MS?

Answer 14

• incontinence
• Horner syndrome
• facial nerve palsy
• limb paralysis

Question 15

What are the focal sensory symptoms in MS?

Answer 15

• trigeminal neuralgia
• numbness
• paraesthesia (pins and needles)
• Lhermitte’s sign

Question 16

How do you diagnose MS?

Answer 16

• clinical picture
• MRI scans showing spatially distributed gadolinium-enhancing areas
• lumbar puncture- oligoclonal bands in CSF

Question 17

What is the management of MS?

Answer 17

• relapses treated with steroids
• disease modifying therapies to induce long term remission
• symptomatic management eg modanifil for fatigue

Question 18

Disease patterns: clinically isolated syndrome

Answer 18

first episode of demyelination action and neurological signs and symptoms

Question 19

Disease patterns: relapsing and remitting MS

Answer 19

most common- episodes followed by recovery

Question 20

Disease patterns: secondary progressive MS

Answer 20

was relapsing and remitting disease but now there is a progressive worsening of symptoms with incomplete remissions

Question 21

Disease patterns: primary progressive MS

Answer 21

worsening disease and neurological symptoms from point of diagnosis without relapses and remissions

Question 22

What features lead to a worse prognosis of MS

Answer 22

• male sex
• older age
• motor symptoms at onset
• early relapses
• many lesions on MRI
• axonal loss