multiple sclerosis

Question 1

what are the types of MS

Answer 1

relapsing remitting MS, secondary progressive MS, primary progressive MS

Question 2

what is the pattern in RRMS

Answer 2

typically onset over days, recover over weeks

Question 3

what happens in secondary progressive

Answer 3

gradually worsening disability over years. 75% of RRMS patients evolve into secondary progressive

Question 4

what happens in primary progressive

Answer 4

gradually worsening disability with no relapses or remissions. later in onset and less inflammatory changes on MRI

Question 5

what are the three characteristic presentations of MS

Answer 5

optic neuritis, brainstem demyelination, spinal cord lesions

Question 6

symptoms of optic neuritis

Answer 6

visual loss, mild fogging of central vision, central scotoma, painful eye movements

Question 7

symptoms of brainstem demyelination

Answer 7

diplopia, vertigo, nystagmus, dysarthria, dysphagia

Question 8

what is pathognomonic for MS

Answer 8

blateral internuclear ophthalmoplegia (INO)- disorder of conjugate lateral gaze so affected eye cant adduct

Question 9

signs of spinal cord lesions

Answer 9

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

Question 10

what is Lhermittes sign

Answer 10

electric like sensation down the trunk and limbs on neck flexion

Question 11

what is Unthoffs phenomenon

Answer 11

worsening of pre existing symptoms with increase in body temperature eg after exercise or taking a hot bath

Question 12

common symptoms

Answer 12

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)

Question 13

what is a rare but pathognomonic presentation

Answer 13

tonic spasms- frequent brief spasms of one limb

Question 14

diagnosis of MS

Answer 14

> 2 attacks affecting different parts of the CNS. disseminated in time and space

Question 15

what criteria is used in the diagnosis of MS

Answer 15

McDonald criteria

Question 16

what is required in investigations of MS and what is the main investigation

Answer 16

evidence of dissemination in time and space. MRI is the main investigation

Question 17

what could the MRI show

Answer 17

multiple scattered lesions showing dissemination through space.

Question 18

why can the MRI not be the most effective investigation

Answer 18

in patients >50 small ischaemic lesions cant be distinguished and in younger patients those with neuro inflammatory disorders eg sarcoidosi, Bechets, vasculitis

Question 19

what other investigations can be used

Answer 19

cord imaging, CSF- oligoclonal IgG bands (not specific), evoked responses, blood tests to exclude other inflammatory disorders

Question 20

treatment of acute relapse of MS

Answer 20

short course of steorids eg IV methylprednisolone 1g/day for 3 days or high dose oral steroids

Question 21

treatment MS

Answer 21

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.

Question 22

when are disease modifying drugs given to patients

Answer 22

if the patient is ambulatory and has had 2 or more significant attacks in 2 years or one serious attack

Question 23

what can be added into the treatment of aggressive RRMS

Answer 23

monoclonal antibodies eg natalizumab

Question 24

what are poor prognostic factors

Answer 24

high MR lesion load at diagnosis, high relapse rate, male gender and late presentation