Multiple Sclerosis Flashcards
What is the gender split of incidence for MS
Twice as likely in females
What cells of the CNS does MS affect?
Oligodendrocytes
Where geographically is MS most prvelant
The further from the equator you are
What is destroyed in MS and by what mechanism?
Autoimmune against myelin and Oligodendrocytes
What is the PNS equivalent of oligodendrocytes?
Schwann cells
What cells cross the BBB in MS which normally wouldn’t
Macrophages
What is show on MRI in a patient with Ms?
Plaques throughout the CNS
Where would MS most commonly be visualised on MRI?
Optic nerves, peri ventricular, brain stem and cerebellar connections
What are the 4 modes of progression in MS?
Progressive relapsing, secondary progressive, primary progressive relapsing remitting
Describe progressive relapsing MS
Disability gets steadily worse with attacks superimposed on top
Describe secondary progressive MS
Has attacks intermittently and worsening and then goes on to progressive picture no attacks
Describe primary progressive MS
A steady decline in patient function against time
Describe relapsing remitting MS
Unpredictable attacks which may or may not leave the patient permanently deficient followed by periods of remission
What is the most common disease progression in MS
Relapsing-remitting MS at 80-90% of cases
Give three optic pathologies found in MS
Optic neuropathy, optic disc swelling, relative afferent pupillary defect
What is Uthoff’s phenomenon?
Worsening MS signs in hot weather or during exercise
What UMN signs will you find in the MS patient?
Spasticity, weakness and hyperreflexia
What is Lehrmittes sign?
On flexing of the head there is a shock sensation travelling down spine and to legs
What sensory signs will be found in MS?
Numbness and parasthesis
What autonomic defects are found in MS
Urinary retention, sexual dysfunction
How should you investigate a patient with MS
MRI - 85% of cases will show plaques
Visual Evoked potentials - EEG detects stimuli an measures response time
Oligoclonal bands in CSF
How is diagnosis made in MS?
At least 1 attack + positive MRI
How would you manage an acute MS attack?
With steroids. 3g/ day methlyprednisolone IV
Which drugs are used to prevent MS attacks ?
B-interferon, glatiramer acetate, natalizumab, baclofen
What is Glatiramer Acetate used to treat and how does it work?
MS is is similar to myelin and so reduces number of attacks
What is natalizumab and what does it treat?
MS. Monoclonal antibody which reduced no. of macrophages crossing BBB
What is bacofen used to treat and how does it work?
MS, for symptomatic relief. GABA agonist
