multiple sclerosis Flashcards

1
Q

what is it

A

chronic, immune mediated demyelinating inflammatory condition
leads to progressive severe disability

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2
Q

what does it affect

A

brain
optic nerves
spinal cord

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3
Q

most common pattern of disease

A

relapsing remitting

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4
Q

what is relapsing remitting disease

A

periods of exacerbation of symptoms (relapses) followed by unpredctable periods of stability (remission)

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5
Q

what is active disease

A

at least two clinically significant relapses occur within the last 2 years.

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6
Q

what is highly active disease

A

characterised by an unchanged/increased relapse rate or by ongoing severe relapses compared with the previous year, despite disease-modifying drug treatment

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7
Q

what is rapidly-evolving severe relapsing-remitting multiple sclerosis

A

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.

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8
Q

the clinical pattern of relapsing remitting MS often develops into

A

secondary-progressive multiple sclerosis, with progressive disability unrelated to relapses.

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9
Q

what course does primary progressive MS follow

A

Primary-progressive multiple sclerosis follows a gradual course, with the development of symptoms that worsen over time, without relapses and remissions.

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10
Q

what course does progressive relapsing MS follow

A

Progressive-relapsing multiple sclerosis follows a course of steadily worsening neurological function from onset, in addition to acute relapses.

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11
Q

cure?

A

no

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12
Q

name a risk factor for develpoing MS

A

Low levels of vitamin D are believed to be a risk factor for developing multiple sclerosis.

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13
Q

should pt be offered vit D soley for purpose of testing MS

A

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.

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14
Q

which drugs for Relapsing-remitting multiple sclerosis

A

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.

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15
Q

which drugs for secondary progressive MS

A

Under specialist care, disease-modifying drugs such as immunomodulators and interferons may be used for the treatment of secondary progressive multiple sclerosis.

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16
Q

which drugs for primary progressive MS

A

Under specialist care, disease-modifying drugs such as anti-lymphocyte monoclonal antibodies may be used for the treatment of primary progressive multiple sclerosis.

17
Q

what treatment for progressive relapsing MS

A

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.

18
Q

this increases the progression of disability in MS

A

smoking - must encourage smoking cessation

19
Q

What is recommended for reducing inflammation and accelerating recovery in acute relapses of relapsing-remitting multiple sclerosis

A

CCs

  1. methylprednisolone oral
  2. IV methylprednisolone if above failed, not tolerated, or if hospitalisation
20
Q

What drug treatment can be tried for people who wish to try a drug treatment for fatigue (specialist)

3 options

A

amantadine
SSRI
modafinil

21
Q

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

A

fampridine

22
Q

what can aggravate spasticitiy

A

infection
bladder and bowel dysfunction
poor posture or positioning
pressure ulcers
pain

23
Q

treatment options for spasticity

A
  1. baclofen
  2. gabapentin is ineffective or not tolerated
  3. 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

24
Q

2 options for oscillopsia

A
  1. gaba
  2. memantine
25
Q

1 treatment option for emotional lability

A

amitriptyline