Multiple Sclerosis

Question 0

What is the gender split of incidence for MS

Answer 0

Twice as likely in females

Question 1

What cells of the CNS does MS affect?

Answer 1

Oligodendrocytes

Question 2

Where geographically is MS most prvelant

Answer 2

The further from the equator you are

Question 3

What is destroyed in MS and by what mechanism?

Answer 3

Autoimmune against myelin and Oligodendrocytes

Question 4

What is the PNS equivalent of oligodendrocytes?

Answer 4

Schwann cells

Question 5

What cells cross the BBB in MS which normally wouldn’t

Answer 5

Macrophages

Question 6

What is show on MRI in a patient with Ms?

Answer 6

Plaques throughout the CNS

Question 7

Where would MS most commonly be visualised on MRI?

Answer 7

Optic nerves, peri ventricular, brain stem and cerebellar connections

Question 8

What are the 4 modes of progression in MS?

Answer 8

Progressive relapsing, secondary progressive, primary progressive relapsing remitting

Question 9

Describe progressive relapsing MS

Answer 9

Disability gets steadily worse with attacks superimposed on top

Question 10

Describe secondary progressive MS

Answer 10

Has attacks intermittently and worsening and then goes on to progressive picture no attacks

Question 11

Describe primary progressive MS

Answer 11

A steady decline in patient function against time

Question 12

Describe relapsing remitting MS

Answer 12

Unpredictable attacks which may or may not leave the patient permanently deficient followed by periods of remission

Question 13

What is the most common disease progression in MS

Answer 13

Relapsing-remitting MS at 80-90% of cases

Question 14

Give three optic pathologies found in MS

Answer 14

Optic neuropathy, optic disc swelling, relative afferent pupillary defect

Question 15

What is Uthoff’s phenomenon?

Answer 15

Worsening MS signs in hot weather or during exercise

Question 16

What UMN signs will you find in the MS patient?

Answer 16

Spasticity, weakness and hyperreflexia

Question 17

What is Lehrmittes sign?

Answer 17

On flexing of the head there is a shock sensation travelling down spine and to legs

Question 18

What sensory signs will be found in MS?

Answer 18

Numbness and parasthesis

Question 19

What autonomic defects are found in MS

Answer 19

Urinary retention, sexual dysfunction

Question 20

How should you investigate a patient with MS

Answer 20

MRI - 85% of cases will show plaques
Visual Evoked potentials - EEG detects stimuli an measures response time
Oligoclonal bands in CSF

Question 21

How is diagnosis made in MS?

Answer 21

At least 1 attack + positive MRI

Question 22

How would you manage an acute MS attack?

Answer 22

With steroids. 3g/ day methlyprednisolone IV

Question 23

Which drugs are used to prevent MS attacks ?

Answer 23

B-interferon, glatiramer acetate, natalizumab, baclofen

Question 24

What is Glatiramer Acetate used to treat and how does it work?

Answer 24

MS is is similar to myelin and so reduces number of attacks

Question 25

What is natalizumab and what does it treat?

Answer 25

MS. Monoclonal antibody which reduced no. of macrophages crossing BBB

Question 27

What is bacofen used to treat and how does it work?

Answer 27

MS, for symptomatic relief. GABA agonist