multiple sclerosis Flashcards
what are the types of MS
relapsing remitting MS, secondary progressive MS, primary progressive MS
what is the pattern in RRMS
typically onset over days, recover over weeks
what happens in secondary progressive
gradually worsening disability over years. 75% of RRMS patients evolve into secondary progressive
what happens in primary progressive
gradually worsening disability with no relapses or remissions. later in onset and less inflammatory changes on MRI
what are the three characteristic presentations of MS
optic neuritis, brainstem demyelination, spinal cord lesions
symptoms of optic neuritis
visual loss, mild fogging of central vision, central scotoma, painful eye movements
symptoms of brainstem demyelination
diplopia, vertigo, nystagmus, dysarthria, dysphagia
what is pathognomonic for MS
blateral internuclear ophthalmoplegia (INO)- disorder of conjugate lateral gaze so affected eye cant adduct
signs of spinal cord lesions
paraparesis that develops over days/weeks, difficulty walking and limb numbing often asymmetric. Lhermittes sign. arms affected if high cervical cord lesion, tight band sensation around abdomen and chest if thoracic lesion
what is Lhermittes sign
electric like sensation down the trunk and limbs on neck flexion
what is Unthoffs phenomenon
worsening of pre existing symptoms with increase in body temperature eg after exercise or taking a hot bath
common symptoms
visual changes, sensory disturbances- abnormal sensation 40% presenting complaint- reduced vibration sense and JPS, clumsy/useless hand due to loss of proprioception, ataxic/unsteady, neuropathic pain, fatigue, urinary frequency and urgency, spasticity- baclofen, temperature sensitivity (Unthoffs)
what is a rare but pathognomonic presentation
tonic spasms- frequent brief spasms of one limb
diagnosis of MS
> 2 attacks affecting different parts of the CNS. disseminated in time and space
what criteria is used in the diagnosis of MS
McDonald criteria
what is required in investigations of MS and what is the main investigation
evidence of dissemination in time and space. MRI is the main investigation
what could the MRI show
multiple scattered lesions showing dissemination through space.
why can the MRI not be the most effective investigation
in patients >50 small ischaemic lesions cant be distinguished and in younger patients those with neuro inflammatory disorders eg sarcoidosi, Bechets, vasculitis
what other investigations can be used
cord imaging, CSF- oligoclonal IgG bands (not specific), evoked responses, blood tests to exclude other inflammatory disorders
treatment of acute relapse of MS
short course of steorids eg IV methylprednisolone 1g/day for 3 days or high dose oral steroids
treatment MS
disease modifying drugs for RRMS- immunomodulatory- B interferon or glatiramer acetate reduce relapse by 1/3 in RRMS and up to half in serious relapses.
when are disease modifying drugs given to patients
if the patient is ambulatory and has had 2 or more significant attacks in 2 years or one serious attack
what can be added into the treatment of aggressive RRMS
monoclonal antibodies eg natalizumab
what are poor prognostic factors
high MR lesion load at diagnosis, high relapse rate, male gender and late presentation
