Multiple Sclerosis

Question 1

What are the clinical signs of multiple sclerosis?

Answer 1

Internuclear ophthalmoplegia, optic atrophy, reduced visual acuity, any cranial nerve palsy
Upper motor neurone spastictiy, weakness, brisk reflexes, altered sensation
Cerebellar syndrome (DANiSH)

Question 2

What are the diagnostic criteria for multiple sclerosis?

Answer 2

Central nervous system demyelination causing neurological impairment that is disseminated in both space and time

Question 3

What are the causes of multiple sclerosis?

Answer 3

Unknown
But, both genetic and environmental factors appear to play a role

Environmental- increasing latitude, epstein-barr infection
Genetic - HLA-DR2, interlukin 2 and 7

Question 4

How would you investigate a patient with suspected multiple sclerosis?

Answer 4

CSF: oligoclonal IgG bands
MRI: peri ventricular white matter plaques
Visual evoked potentials: delayed velocity but normal amplitude, suggests previous optic neuritis

Question 5

What are the other (non-neurological) clinical features of multiple sclerosis?

Answer 5

Depression
Urinary retention or incontinence
Impotence
Bowel problems
Uthoff’s phenomenon - symptoms worse after a hot bath or exercise

Question 6

How is MS treated?

Answer 6

Multidisciplinary team involvement
Disease-modifying treatments -

Interferon beta and glatiramer reduce relapse rate but don’t affect progression
Monoclonal antibody therapy use may be limited by toxicity

Symptomatic treatments - methylprednisolone during acute relapse may shorten duration, anti-spasmodics, carbamazepine, laxatives1