multiple sclerosis Flashcards
what is it
chronic, immune mediated demyelinating inflammatory condition
leads to progressive severe disability
what does it affect
brain
optic nerves
spinal cord
most common pattern of disease
relapsing remitting
what is relapsing remitting disease
periods of exacerbation of symptoms (relapses) followed by unpredctable periods of stability (remission)
what is active disease
at least two clinically significant relapses occur within the last 2 years.
what is highly active disease
characterised by an unchanged/increased relapse rate or by ongoing severe relapses compared with the previous year, despite disease-modifying drug treatment
what is rapidly-evolving severe relapsing-remitting multiple sclerosis
two or more disabling relapses in 1 year, and one or more gadolinium-enhancing lesions on brain MRI or a significant increase in T2 lesion load compared with a previous MRI.
the clinical pattern of relapsing remitting MS often develops into
secondary-progressive multiple sclerosis, with progressive disability unrelated to relapses.
what course does primary progressive MS follow
Primary-progressive multiple sclerosis follows a gradual course, with the development of symptoms that worsen over time, without relapses and remissions.
what course does progressive relapsing MS follow
Progressive-relapsing multiple sclerosis follows a course of steadily worsening neurological function from onset, in addition to acute relapses.
cure?
no
name a risk factor for develpoing MS
Low levels of vitamin D are believed to be a risk factor for developing multiple sclerosis.
should pt be offered vit D soley for purpose of testing MS
Low levels of vitamin D are believed to be a risk factor for developing multiple sclerosis.
Patients with multiple sclerosis are usually given regular vitamin D after assessment of their serum levels of vitamin D, but there is insufficient evidence to support its use as a treatment for multiple sclerosis.
Patients should not be offered vitamin D solely for the purpose of treating multiple sclerosis.
which drugs for Relapsing-remitting multiple sclerosis
Under specialist care, disease-modifying drugs such as anti-lymphocyte monoclonal antibodies, antimetabolites, immunomodulators, immunostimulants, and interferons may be used for the treatment of relapsing-remitting multiple sclerosis.
which drugs for secondary progressive MS
Under specialist care, disease-modifying drugs such as immunomodulators and interferons may be used for the treatment of secondary progressive multiple sclerosis.
which drugs for primary progressive MS
Under specialist care, disease-modifying drugs such as anti-lymphocyte monoclonal antibodies may be used for the treatment of primary progressive multiple sclerosis.
what treatment for progressive relapsing MS
There are no specific treatment options for this type of multiple sclerosis. None of the currently licensed disease-modifying drugs are recommended in non-relapsing progressive disease.
this increases the progression of disability in MS
smoking - must encourage smoking cessation
What is recommended for reducing inflammation and accelerating recovery in acute relapses of relapsing-remitting multiple sclerosis
CCs
- methylprednisolone oral
- IV methylprednisolone if above failed, not tolerated, or if hospitalisation
What drug treatment can be tried for people who wish to try a drug treatment for fatigue (specialist)
3 options
amantadine
SSRI
modafinil
although this drug is licensed for improvement of walking in pt with MS who have a walking disability, NICE do not consider it cost effective so do not recommend it
fampridine
what can aggravate spasticitiy
infection
bladder and bowel dysfunction
poor posture or positioning
pressure ulcers
pain
treatment options for spasticity
- baclofen
- gabapentin is ineffective or not tolerated
- both in combination - CAUTIOUSLY if individual drugs are ineffective or if SE prevent dose increases
moderate to severe spasticity: 4 week trial of cannabis extract as adjunct if other treatments not effective - specialist
2 options for oscillopsia
- gaba
- memantine
1 treatment option for emotional lability
amitriptyline
