Multiple Sclerosis Flashcards

1
Q

What is MS?

A

An inflammatory demyelinating disorder of the CNS with plaques disseminated in time and space

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2
Q

What is the gender ratio of MS?

A

F:M 3:1

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3
Q

When does MS usually present?

A

30s and 40s

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4
Q

What are the clinical courses of MS?

A

Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive

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5
Q

What are the clinical features of MS?

A
Pyramidal dysfunction
Optic neuritis
Sensory symptoms
Lower urinary tract dysfunction
Cerebellar & brain stem features
Cognitive impairment
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6
Q

What does pyramidal dysfunction in MS cause?

A

Increased tone, spasticity, weakness, effects extensors of upper limbs and flexors of lower limbs

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7
Q

Describe optic neuritis in MS

A

Painful visual loss for 1-2wks. Most improve in time.

RAPD present

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8
Q

What sensory symptoms occur in MS?

A
Pain
Paraesthesia
Dorsal column loss (proprioception & vibration)
Numbness
Trigeminal neuralgia
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9
Q

What occurs due to cerebellar dysfunction in MS?

A
Ataxia
Intention tremor
Nystagmus
Past pointing
Pendular reflexes
Dysdiadokinesis
Dysarthria
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10
Q

What palsys occur due to brain stem dysfunction in MS?

A

R VI palsy-diplopia

R VII palsy- facial weakness

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11
Q

What lateral gaze disorder occurs due to MS?

A

Internuclear ophthalmoplegia

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12
Q

What occurs in internuclear ophthalmoplegia in MS?

A
Demyelination of medial longitudinal fasciculus
Distortion of binocular vision
Failure of adduction-diplopia
Nystagmus in abducting eye
Lag
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13
Q

What urinary tract problems occur due to MS?

A
Frequency
Nocturia
Urgency
Urge Incontinence
Retention
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14
Q

How is fatigue treated in MS?

A

Amantadine
Modafinil if sleepy
Hyperbaric oxygen

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15
Q

What is the diagnostic criteria for MS?

A

At least 2 episodes suggestive of demyelination
Dissemination in time and space
McDonald criteria

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16
Q

What should be on the DDx in suspected MS?

A
Vasculitis
Granulomatous disorder
Vascular disease 
Structural lesion
Infection
Metabolic disorder
17
Q

How is MS diagnosed?

A
Clinical
MRI
CSF
Neurophysiology
Blood tests
18
Q

Which blood tests should be done and come back as -ve to aid in a MS diagnosis?

A
PV, FBC, CRP
Renal liver bone profile
Auto-ab screen
Borellia, HIV, syphilis serology
B12 and folate
19
Q

Will oligoclonal bands be present or absent in CSF?

A

Present, but caution when absent

20
Q

How is a mild acute exacerbation of MS treated?

A

Symptomatic treatment

21
Q

How is a moderate acute exacerbation of MS treated?

A

Oral steroids

22
Q

How is a severe acute exacerbation of MS treated?

A

Admit/IV steroids

23
Q

What is the symptomatic treatment for pyramidal dysfunction?

A

Physiotherapy
OT
Anti-spasmodic agent: baclofen, tizanidine, botulinum toxin, intrathecal baclofen/phenol

24
Q

How are sensory symptoms treated in MS?

A
Anti-convulsant e.g. gabapentin
Anti-depressant e.g. amitriptyline
Tens machine
Acupuncture
Lignocaine infusion
25
How is lower urinary tract dysfunction treated in MS?
Bladder drill Anti-cholinergics e.g. oxybutynin Desmopressin Catheterisation
26
What pathologies occur in urinary tract dysfunction in MS?
Increased tone at bladder neck Detrusor hypersensitivity Detrusor sphyncteric dyssenergia
27
What is the first line therapy in MS?
Interferon Beta – Avonex, Rebif, Betaseron, Extavia Glitiramer Acetate (Copaxone) Tecfedira
28
What is the second line therapy in MS?
Monoclonal antibody- Tysabri, Lemtrada | Fingolimod
29
What is the third line therapy in MS?
Mitoxantrone
30
Describe Interferon beta and copaxone
``` Injectable agents-SC,IM Decrease relapse rate by 1/3 Decrease severity of relapses by 50% Effect on disability All comparable re efficacy ```
31
Describe Tecfidera
Oral agent First line in RR MS 44% reduction in relapse rate
32
Describe Fingolimod
Oral agent Sphingosine 1-phosphate (S1P) modulator >50% reduction in relapse rate Significant effect on disease progression
33
What is the role of alpha4beta1 integrins in MS?
Trans-endothelial migration of activated T-cells across BBB in EAE mediated by integrins
34
What is the inflammatory cascade in MS?
Immune cells pass through BBB Cells may re-activate and produce cytokines Cells mount AI attack against myelin
35
What is the MOA of Tysabri?
Leucocyte migration from blood to tissue Leucocyte priming and activation Modulation of leucocyte apoptosis
36
What virus are MS sufferers at risk of contracting if they take Tysabri?
Progressive multifocal leukoencephalopathy (PML) caused by JC virus
37
Describe mitoxantrone
For relapsing progressive MS 12 infusions over 2 years Cardiac toxicity dose related