Multiple Sclerosis Flashcards
cause
discrete plaques of demyelination occur at multiple CNS sites, T cell mediated immune response
what causes relapsing/ remitting symptoms
demyelination healing poorly
what does prolonged demyelination cause
axonal loss, and clinically progressive symptoms
what is the mean age of onset
30 years. female 3:1 male
presentation
usually monosymptomatic- unilateral optic neuritis, numb/tingling in limbs, leg weakness, brainstem/cerebellar symptoms. may worsen with heat or exercise
what are the poor prognostic signs
older male, motor signs at onset, many relapses early on, many MRI lesions, axonal loss
diagnosis
clinical, lesions disseminated in time and space. MRI sensitive but not specific for plaque detection. CSF- oligoclonal bands of IgG on electrophoresis suggest CNS inflam
treatment
steroids- methylprednisolone; interferons- IFN-1b, IFN-1a; monoclonal antibodies- alemtuzumab, natalizumab; non immunosuppresives- Glatiramer, mitoxantrone; azathrioprine
what can be used for palliation
spasticity- Baclofen, diazepam, dantrolene,tizanidine, Tremor- botulinium toxin type A. urgency/frequency- teach intermittent self catheterisation, tolterodine.
clinical features MS sensory
dysaesthesia (abnormal sense of touch), pins and needles, vibration sense decr, trigeminal neuralgia, swallowing disorders, constipation, diplopia, hemianopia, optic neuritis
clinical features MS motor
spastic weakness, myelitis, trunk and limb ataxia (lack of voluntary coordination of limbs), falls
clinical features MS sexual/GU
erectile dysfunction, anorgasmia, urine retention, incontinence, cognitive/visuospatial decline
what is the criteria for diagnosing MS
McDonald criteria
McDonald criteria- when do you need no additional criteria
2 or more attacks with 2 or more clinical lesions
McDonald criteria what constitutes an attack
must last >1h with >30d between attacks
