Multiple Sclerosis

Question 1

Epidemiology of MS:

Answer 1

F>M 3:1
Age 20-50s
Caucasians
Most common non-traumatic neurological disability in young adults

Question 2

Common initial presentation:

Answer 2

1. Optic neuritis
2. Brainstem or cerebellar symptoms.
3. Partial transverse myelitis

Question 3

Diagnostic criteria

Answer 3

Dissemination of disease related events in time (DIT) and space (DIS)

Question 4

4 profiles in time:

Answer 4

1. Relapsing Remitting (RR) - most common
2. Secondary Progressive (SP)
3. Progressive Relapsing (PR)
4. Primary Progressive (PP)

Question 5

Clinically Isolated Demyelinating Syndromes (CIDS):

Answer 5

When any of MS presenting symptoms occur in isolation (1. Optic neuritis

2. Brainstem or cerebellar symptoms.
3. Partial transverse myelitis)
   - If normal MRI - small increased risk of developing MS.
   - If abnormal MRI (new lesions)- 55% risk of MS

Question 6

MS is associated almost exclusively with ___motor neuron signs.

Answer 6

Upper

Question 7

CSF in MS:

Answer 7

CSF abrnomalities are more sensitive and specific (95%) than MRI.
CSF:
-Elevated IgG index and synthetic rate
-Presence of oligoclonal bands that are not present in paired serum sample

Question 8

Evoked Potential (EP)

Answer 8

Response from visual and somatosensory stimuli can be delayed in MS - interrupted by demyelination.
Visual EP is most useful in diagnosis.
Establish DIS via Unilateral conduction delay of P100 potential with well-preserved waveform.

Question 9

Tests to rule out other causes:

Answer 9

CBC, CMP, ESR, ANA, Vit B12, Select patients: infection, inflammation, hypercoag….

Question 10

MS “attack”:

Answer 10

Appearance of new symptom or reappearance or worsening of old symptom. Lasts at least 48hrs before stabilize or improve. Most evolve over days and last days-weeks. >=30 days between attacks.

Question 11

Psuedo attack

Answer 11

Worsening of symptom with increased body temp due to fever, exercise (Uthoff’s phenomenon), hot bath…

Question 12

Lhermitte’s sign:

Answer 12

Electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward. Lesion in dorsal column or caudal medulla.

Question 13

Prognosis:

Answer 13

Get worse.
M worse than F.
Worse if prominent early myelopathic or cerebellar presentation.
Younger onset do better
Optic neuritis onset do better.
Pregnancy and breast feeding is a protected time. If no breast feeding - increased risk.

Question 14

Treatment

Answer 14

Several disease modifying therapies (DMT) - oral or injectable:
-Interferon beta-1b: injection