Multiple Sclerosis Flashcards
What kind of cells mediate the immune reaction in MS?
T cells
What causes the relapsing and remitting symptoms seen in MS?
The axons demyelinate but then the myeline sheath grows back incompletely and can demyelinate again.
What causes the progressive symptoms seen in MS?
Prolonged demyelination causes axonal loss over time, which leads to deterioration in function.
Give examples of some of the symptoms seen in MS?
Optic neuritis Pyramidal dysfunction Sensory symptoms Lowere urinary tract dysfunction Cerebellar & brain stem features Cognitive impairment
What are the clinical features of pyramidal dysfunction?
Increases muscle tone
Spasticity
Weakness
(Look in the extensors of upper limbs and the flexors of lower limbs)
What is optic neuritis?
Painful visual loss that lasts for 1 - 2 weeks.
RAPD
What sensory symptoms are seen in MS?
Pain Paraesthesia Dorsal column loss (loss of proprioception and vibration) Numbness Trigeminal neuralgia
What are the symptoms of cerebellar dysfunction?
Ataxia Intention tremor Nystagmus Past pointing Pendular reflexes Dysdiadokinesis Dysarthria
What is dysdiadokinesis?
Inability to perform rapid, alternating movements.
What is dysarthria?
Difficulty speaking caused by a problem in the motor muscles of the mouth.
What is a pendular reflex?
Muscle will osscilate after being tapped with a tendon hammen
What nerve has been damaged if the patient has double vision?
Abducens (CNVI)
What nerve has been damaged if their is facial weakness?
Facial (CNVII)
What two drug treatments are used to treat fatigue seen in MS
Amantadine
Modanafil (If sleepy during the day)
What are the three diagnostic criteria that must be reached for a diagnosis of MS to be made?
- At least 2 episodes suggestive of demyelination
- Dissemination in time of lesions
- Dissemination in location of lesions
What are the four types of MS?
- Relapsing remitting
- Primary progressive
- Secondary progressive
- Progressive relapsing
If a patient who has had relapsing remitting MS for 13 years now complains of a constant numbness in their legs and finds daily living more difficult. What is the likely diagnosis?
Secondary progressive MS
What drug treatment would you use for a patient having a moderate acute exacerbation of their MS?
Oral steroids
What oral medications help with the spasticity associated with MS?
Baclofen
Tizanidine
What IM injection is used in the treatment of spasticity in MS?
Intra muscular botulinum toxin
What are the first line disease modifying drugs used in MS?
Interferon beta
Glitramer Acetate (Copaxone)
Tecfedira
What are the second line disease modifying drugs used in MS?
Tysabri
Fingolimod
What are the third line disease modifying drugs used in MS?
Mitoxantrone
How are interferon beta and copaxone given?
SC or IM
What is the first line drug in relapsing remitting MS?
Tecfidera
What drug therapies are given to patients with highly active rapidly evolving relapsing remitting MS?
Tysabri and Fingolimod
What drug therapies are given to patients who have high MS disease activity despite treatment with interferon?
Tysabri and Finglimod
What rare viral disease is associated with tysabri use?
Progressive multifocal leukoencephalopathy (inflammation of the white matter of the brain at several distinct points) - caused by the JC virus
How is Fingolimod given?
Orally
How is mitoxantrone given?
As 12 infusions over 2 years
What dose related side effect is seen with mitoxantrone?
Cardiac toxicity
What particular glial cells are affected in MS?
Oligodendrocytes
Does MS affect the CNS or PNS?
CNS
What symptoms do you get if there is internucleur opthalmoplegia?
Slowed/absent adduction in one eye and compensatory nystagmus in the other
On asking a patient to look to the left you notice that the right eye doesn’t appear to move and that there is nystagmus in the patients left eye. What is this called and what structure is damaged?
Damage to the right medial longitudinal fasiculus.
Internuclear opthalmoplegia.
