Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

Chronic, inflammatory, autoimmune disease of the CNS.

Characterised by demyelination and axonal loss of neurons.

Question 2

How does multiple sclerosis occur?

Answer 2

Myelin covers the axons of neurones and helps electrical impulses travel faster.

MS affects oligodendrocytes.

Inflammation and immune cell infiltration cause damage to the myelin, affecting the electrical signals moving along the neurones.

Question 3

Cause of multiple sclerosis?

Answer 3

Unknown

Influenced by:
Multiple genes
Epstein–Barr virus (EBV)
Low vitamin D
Smoking
Obesity

Question 4

Symptoms and signs of multiple sclerosis?

Answer 4

Vision:
optic neuritis: common -loss of central vision, loss of red desaturation and painful eye movements
optic atrophy
Uhthoff’s phenomenon: worsening of vision following rise in body temperature
internuclear ophthalmoplegia

Sensory:
pins/needles
numbness
trigeminal neuralgia
Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion

Motor:
spastic weakness: legs

Cerebellar:
ataxia
tremor

Others:
urinary incontinence
sexual dysfunction
intellectual deterioration

Question 5

How is multiple sclerosis diagnosed?

Answer 5

Diagnosis can be made on the basis of two or more relapses

and either

objective clinical evidence of two or more lesions or objective clinical evidence of one lesion together with reasonable historical evidence of a previous relapse.

Question 6

IVx for multiple sclerosis?

Answer 6

MRI

Lumbar puncture -Oligoclonal bands in CSF

Question 7

Management of acute relapse of multiple sclerosis?

Question 8

Management of chronic multiple sclerosis?