Multiple sclerosis Flashcards
Definition of MS
Inflammatory demyelinating condition of the CNS
Clinical course of MS (4)
- Relapsing-remitting
- Secondary progressive
- Primary progressive
- Clinically isolated syndrome
Motor symptoms (2)
Increased tone
Spastic weakness
Symptoms of optic neuritis (4)
Pain
Decreased visual acuity
Washed-out colours
RAPD
Sensory symptoms (4)
Pain
Paraesthesia
Numbness
Dorsal column loss
Internuclear opthalmaplegia is caused by damage to the…
medial longitudinal fasciculus
Clinical signs of internuclear opthalmoplegia (2)
Failure of adduction of the contralateral eye during lateral gaze; also see nystagmus in abducting eye.
How does internuclear opthalmoplegia present? (2)
Diplopia, distortion of binocular vision
Examples of autonomic dysfunction in MS (4)
Urinary urgency
Incontinence
Urinary retention
Erectile dysfuncion
What are the McDonald criteria for diagnosis?
Two or more CNS lesions with corresponding symptoms separated in time and space
Investigations in MS:
a) Lumbar puncture
b) MRI brain, cervical and thoracic spine
c) evoked potentials
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
What does the presence of oligoclonal bands in the CSF suggest?
Suggests IgG response in the CNS (not present in the serum)
Management of acute exacerbations(1)
Steroids (if severe, admit and give IV)
Treatment of spasticity (1)
Antispasmodic e.g. baclofen. Botox injection if localised
Treatment of neuropathic pain (2)
Gabapentin, amitriptyline
Treatment of bladder disturbance (2)
Anticholinergics e.g. oxybutyinin, self catheterization
Amantadine is indicated for…
Treatment of fatigue
Drug to treat daytime sleepiness
Modafinil
First-line disease modifying treatment (2)
Interferon beta
Glitiramer acetate
What is the aim of disease modifying treatment?
To reduce relapse rate in relapsing-remitting MS
What is Lhermitte’s phenomenon? In which other conditions is this seen?
Electric shock-like sensation in the arms and legs precipitated by neck flexion. Cervical spondylosis, SCDC, cord tumours
Motor signs in examination in MS (3)
UMN signs e.g. brisk reflexes, spasticity, reduced power)
Findings on visual examination in MS (4)
Impaired visual acuity
There may be central scotoma/field defects
RAPD on swinging flashlight test
Internuclear opthalmoplegia
Cerebellar signs in MS (DANISH)
Dysdiadochokinesis Ataxia Nystagmus Intention tremor Slurred/staccato speech Hypotonia
Good prognostic features (6)
Female Young age of onset Relapsing remitting Sensory only Long interval between first two relapses Complete recovery between relapses
