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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

A chronic autoimmune disease of the central nervous system

There are multiple, disseminated plaques of demyelination within the brain and spinal cord

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2
Q

MS affects Schwann cells.

True or false?

A

False!

It affects oligodendrocytes

MS only affects the central nervous system, and these neurons are myelinated by oligodendrocytes

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3
Q

Which cells myelinate the CNS and PNS?

A

CNS: oligodendrocytes
PNS: Schwann cells

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4
Q

Epidemiology of MS?

A

Disease usually begins in early adulthood: ages 20-40

More common in women

Affects Caucasians more than others

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5
Q

Aetiology of MS? What causes it?

A

A combination of chance, genetic and environmental factors

Multiple genes are involved in MS

Environmental factors include:

  • race
  • latitude, vitamin D exposure
  • age
  • socio-economic status
  • exposure to EBV in childhood
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6
Q

Why does exposure to Epstein-Barr virus increase the risk of MS?

A

Exposure to EBV triggers an immune response

In some people (with a particular genetic make up) the antibodies produced against EBV start to attack the myelin sheath because of molecular mimicry

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7
Q

What is the link between vitamin D exposure and MS?

A

Sufficient levels of vitamin D can be preventative of MS

It also can result in fewer symptoms and lesions in MS

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8
Q

What features of the immune system are involved in MS?

A

Lymphocytes
Monocytes
Complement
Cytokines

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9
Q

In terms of the immune system, what is the pathogenesis of MS?

A

Autoreactive T lymphocytes are triggered by genetic or environmental reasons

They activate B cells, macrophages, complement

These all come together to form a complete inflammatory attack on myelin sheath

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10
Q

After being damaged, does the myelin sheath regenerate?

A

Yes but not completely
Re-myelination occurs but it forms a thinner layer

Also the distance between each Node of Ranvier is shorter

Still not as efficient as a normal myelin sheath

Conduction is still slower

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11
Q

What does the myelin sheath do?

A

Speeds up conduction of nerve impulses

The depolarisation jumps between the myelin cells from Node of Ranvier to Node of Ranvier

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12
Q

What sites in the nervous system does MS affect?

A

Cerebral hemispheres
Optic nerves
Medulla and pons
Optic nerve

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13
Q

How do people usually first present with MS?

A

Optic neuritis, visual symptoms

Numbness or tingling in the limbs

Muscle weakness, spasticity

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14
Q

Clinical features of MS?

A

Visual symptoms:

  • optic neuritis
  • nystagmus, double vision

Spasticity + weakness in limbs

Sensory signs:

  • tingling, numbness
  • Lhermitte’s sign

Bladder + sexual function

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15
Q

What is optic neuritis?

Clinical features?

A

Inflammation of optic nerve

Cloudy or complete vision loss

Loss of colour vision, dim vision

Pain when moving eyes

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16
Q

What is Lhermitte’s sign?

A

A sudden sensation like an electric shock that passes down the back of the neck, into the spine and then radiates out into the arms and legs

17
Q

What is the essential diagnosis criteria?

A

2 or more CNS lesions disseminated in space and time

The lesions should give a different clinical picture

18
Q

A patient presents with optic neuritis. 6 months ago they presented with a similar problem.

Could this count as an MS diagnosis?

A

No, because the problems were too similar

The problems need to be different

19
Q

There are 4 types of disease progression in MS. What are they?

A

Relapsing / remitting

Primary progressive

Secondary progressive

Progressive relapsing

20
Q

Describe the disease progression of relapsing / remitting MS.

A

Unpredictable attacks, which may or may not leave permanent deficits after them

Interspersed with periods of remission

21
Q

What is primary progressive MS?

A

Steady increase in disability, without attacks

22
Q

What is secondary progressive MS?

A

Progression is initially relapsing/remitting

Suddenly though, decline progresses without remission + relapse

23
Q

What is progressive relapsing MS?

A

Steady decline interspersed with attacks

24
Q

Investigations of MS?

A

Examine their reflexes: they are usually exaggerated in MS

Brain MRI: shows lesions, often around the ventricles

Spinal cord MRI: also shows lesions

Lumbar puncture: oligoclonal bands

25
Q

Which conditions are commonly mistaken for MS?

A

SLE
Lyme disease
HIV
Others

26
Q

Management of MS?

A

Steroids: methylprednisolone

Beta interferon:

  • a DMARD
  • an anti-inflammatory drug

Other DMARDs: dimethyl fumarate

Biologics:

  • monoclonal antibodies against autoantibodies
  • natalizumab, alemtuzumab, fingolimod

Treat the symptoms:

  • anti-spastic
  • treat tremor
  • help with sexual/bladder function

Rehabilitation

27
Q

How is beta interferon administered?

A

An injection every other day

28
Q

What happens in rehabilitation for an MS patient?

A

Physiotherapy to maintain mobility of joints

OT: so they can be as independent as possible

Help with gait, bladder and spasticity problems

29
Q

What is spasticity?

A

Intermittent or sustained involuntary activation, tightness of muscles

Increased muscle tone

30
Q

Define muscle tone?

A

Resistance of muscle to passive movement

Increased muscle tone = resistant to passive movement, like in spasticity

31
Q

What is the clasp knife response?

A

When you start to open the knife there is resistance, but if you pull hard enough it suddenly opens

When you stretch the muscle os someone with spasticity, the muscle resists initially
Once the force is hard enough to activate the Golgi tendon organs, they inhibit the anterior horn cells so the muscle relaxes quickly

32
Q

Why does spasticity occur in MS?

A

MS can mean that messages from the brain are unable to get to the muscles

When this happens, the muscles don’t know what to do, so anterior horn cells get a stimulus from sensory nerves around them and tell the muscle to contract

33
Q

How do you treat spasticity? In what circumstances wouldn’t you treat it?

A

Anti-spastic drugs: baclofen, gabapentin

Botox injection

Cannabis in the form of an oral spray

No, because in some people their spasticity is what is enabling them to keep walking, if you took it away they would be wheelchair bound

34
Q

Why do patients with MS often have trouble walking?

A

They get foot drop, when they lift up their foot to take a step the foot is floppy

Unsafe, makes walking slower, risk of tripping

35
Q

How can you treat foot drop?

A

With a splint / support

Electrical stimulator that picks up when the patient is walking and stimulates the peroneal nerve to keep the foot up

36
Q

What bladder problems do you get with MS?

A

Problems emptying, incomplete emptying

Problems with storage, unable to hold on

37
Q

Why do you get bladder problems in MS?

A

The pontine micturition centre is not able to communicate to the bladder

So the detrusor muscle contracts and relaxes at different times to the sphincter

38
Q

How can you treat bladder problems in MS?

A

Convene drain men
Pads women

Anti-cholinergics inhibit detrusor muscle contraction
- oxybutinin, tolterodine

Intermittent self catheterisation if retention problems

Neurology (23 decks)

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