Multiple Sclerosis Flashcards
What is MS?
A chronic and progressive autoimmune condition involving demyelination in the CNS.
Who is more commonly affected by MS?
Women and individuals in high-income countries.
What is the primary cause of demyelination in MS?
Destruction of myelin in the CNS - oligodendrocytes.
What role do T cells play in MS?
Inflammation and immune cell (T cell) infiltration cause damage to myelin.
What is a characteristic feature of MS lesions?
Lesions vary in location; affected sites and symptoms change over time.
What are common risk factors for MS?
- Family history
- Females > males
- Aged 25-35
- Co-existing autoimmune conditions
- Smoking, obesity
- Epstein-barr virus
- Living at higher latitudes/vitamin D deficiency
How is MS classified?
Spectrum of disease with varying rates of progression and severity of symptoms.
What is Clinically Isolated Syndrome (CIS)?
An unexplained clinical episode of neurological dysfunction with radiological evidence of white matter pathology.
What percentage of MS patients have Relapsing-Remitting MS (RRMS)?
Approximately 85%.
What defines Secondary Progressive MS?
Initially presents as RRMS, then declines steadily without remission.
What is the most aggressive form of MS?
Primary Progressive MS.
What are the most common initial presentations of MS?
- Limb numbness/tingling
- Limb weakness (subacute onset)
- Cerebellar symptoms
What is Uhthoff’s phenomenon?
Worsening of symptoms with exercise or in warm environments.
What is Lhermitte’s phenomenon?
Lightning-shock pain down the spine on flexion of the neck.
List common clinical features of MS.
- Increased pain
- Paraesthesia
- Double vision
- Fatigue
- Optic neuritis
- Dysphagia
- Slurred/stuttered speech
- Urinary frequency
- Urinary incontinence/retention
- Constipation/diarrhoea
What examination findings can indicate optic neuritis?
- Pain on movement
- Visual field defect
- Loss of colour vision
What is the gold standard for radiological investigation in MS?
MRI brain and spinal cord with contrast.
What findings are expected in a lumbar puncture for MS?
- High protein content
- Oligoclonal bands of immunoglobulin
What are the McDonald criteria used for?
Diagnosis of MS based on clinical and imaging findings.
What does ‘disseminated in time’ mean in the context of MS diagnosis?
Clinical findings showing history of >2 attacks on >2 separate occasions.
What is the treatment for an acute MS episode?
High-dose steroid therapy and plasmapheresis if refractory to steroids.
List some long-term management strategies for MS.
- Injectible DMARDs (e.g., beta-interferon, glatiramer acetate)
- Oral DMARDs (e.g., dimethyl fumarate, fingolimod, cladribine)
- Ocrelizumab for slowing PPMS
