Multiple sclerosis

Question 1

Definition of MS

Answer 1

Inflammatory demyelinating condition of the CNS

Question 2

Clinical course of MS (4)

Answer 2

1. Relapsing-remitting
2. Secondary progressive
3. Primary progressive
4. Clinically isolated syndrome

Question 3

Motor symptoms (2)

Answer 3

Increased tone

Spastic weakness

Question 4

Symptoms of optic neuritis (4)

Answer 4

Pain
Decreased visual acuity
Washed-out colours
RAPD

Question 5

Sensory symptoms (4)

Answer 5

Pain
Paraesthesia
Numbness
Dorsal column loss

Question 6

Internuclear opthalmaplegia is caused by damage to the…

Answer 6

medial longitudinal fasciculus

Question 7

Clinical signs of internuclear opthalmoplegia (2)

Answer 7

Failure of adduction of the contralateral eye during lateral gaze; also see nystagmus in abducting eye.

Question 8

How does internuclear opthalmoplegia present? (2)

Answer 8

Diplopia, distortion of binocular vision

Question 9

Examples of autonomic dysfunction in MS (4)

Answer 9

Urinary urgency
Incontinence
Urinary retention
Erectile dysfuncion

Question 10

What are the McDonald criteria for diagnosis?

Answer 10

Two or more CNS lesions with corresponding symptoms separated in time and space

Question 11

Investigations in MS:

a) Lumbar puncture
b) MRI brain, cervical and thoracic spine
c) evoked potentials

Answer 11

a) to exclude infection/inflammatory cause. CSF shows oligoclonal bands in 90%
b) plaques show up as high-signal lesions
b) evoked responses are delayed

Question 12

What does the presence of oligoclonal bands in the CSF suggest?

Answer 12

Suggests IgG response in the CNS (not present in the serum)

Question 13

Management of acute exacerbations(1)

Answer 13

Steroids (if severe, admit and give IV)

Question 14

Treatment of spasticity (1)

Answer 14

Antispasmodic e.g. baclofen. Botox injection if localised

Question 15

Treatment of neuropathic pain (2)

Answer 15

Gabapentin, amitriptyline

Question 16

Treatment of bladder disturbance (2)

Answer 16

Anticholinergics e.g. oxybutyinin, self catheterization

Question 17

Amantadine is indicated for…

Answer 17

Treatment of fatigue

Question 18

Drug to treat daytime sleepiness

Answer 18

Modafinil

Question 19

First-line disease modifying treatment (2)

Answer 19

Interferon beta

Glitiramer acetate

Question 20

What is the aim of disease modifying treatment?

Answer 20

To reduce relapse rate in relapsing-remitting MS

Question 21

What is Lhermitte’s phenomenon? In which other conditions is this seen?

Answer 21

Electric shock-like sensation in the arms and legs precipitated by neck flexion. Cervical spondylosis, SCDC, cord tumours

Question 22

Motor signs in examination in MS (3)

Answer 22

UMN signs e.g. brisk reflexes, spasticity, reduced power)

Question 23

Findings on visual examination in MS (4)

Answer 23

Impaired visual acuity
There may be central scotoma/field defects
RAPD on swinging flashlight test
Internuclear opthalmoplegia

Question 24

Cerebellar signs in MS (DANISH)

Answer 24

Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Slurred/staccato speech
Hypotonia

Question 25

Good prognostic features (6)

Answer 25

Female
Young age of onset
Relapsing remitting
Sensory only
Long interval between first two relapses
Complete recovery between relapses