Multiple Sclerosis

Question 1

What is multiple sclerosis

Answer 1

disease of unknown aetiology characterised by scattered area of inflammation in the CNS

Question 2

Diagnosis of multiple sclerosis

Answer 2

depends on at least 2 lesions disseminated in time and space.

mainly affect CN2

1. INO (internuclear ophthalmoplegia)
   - affected eye: weak adduction
   - unaffected eye: horizontal nystagmus on abduction
2. optic neuritis
3. Marcus Gunn pupil (relative affarent pupillary defect)
4. UMN weakness
5. cerebellar sign (gait, balance, coordination)
6. posterior column sensory less (vibration & proprioception)
7. faecal/ urinary incontinence

Question 3

Prevalence

Answer 3

F:M = 3:1
mean age of onset = 30
commoner in temperate region
rare in Blacks and Asians

Question 4

Charcot’s triad of MS

Answer 4

1. nystagmus
2. intentional tremor
3. scanning speech

Question 5

Ix for MS

Answer 5

1. MRI
   - sensitive but not specific for plaque detection
   - exclude other cause eg. cord compression
2. CSF
   - oligoclonal IgG band on electrophoresis that’s not present in serum
   = suggest inflammation in CNS

Question 6

Poor prognosis if

Answer 6

older

male

motor signs at onset

many relapse early on

Question 7

Management for MS

Answer 7

1. encourage a happy, stress free life if possible (reduce development of new lesions)
2. steroids - methyl prednisolone; doesn’t alter prognosis
3. monoclonal antibodies - alemtuzumab against T cells
4. non- immunosuppressive -glatiramer, mitoxantrone (safety issue)
5. other drugs: azathioprine (as good as IFN and much cheaper)
6. palliation: treat spasticity, tremor, urgency/frequency (teach intermittent self-catheterisation)

Question 8

Macdonald’s criteria for Dx Ms

Answer 8

MS remains a clinical diagnosis!

attack must last >1 hr and >30 days between attacks

• 2 or more relapses with 2 or more objective clinical lesions = clinical evidence will do; no need for additional data
• 2 or more relapses with 1 objective clinical lesion = do MRI to see if more than 1 lesions consistent with MS, +ve CSF
• 1 attack with 2 or more clinical lesions = disseminated in time (MRI or 2nd attack)
• 1 attack with 1 lesion = disseminated in space; do MRI or +ve CSF

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