Multiple Sclerosis Flashcards
What is MS?
An inflammatory demyelinating disorder of the CNS with plaques disseminated in time and space
What is the gender ratio of MS?
F:M 3:1
When does MS usually present?
30s and 40s
What are the clinical courses of MS?
Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive
What are the clinical features of MS?
Pyramidal dysfunction Optic neuritis Sensory symptoms Lower urinary tract dysfunction Cerebellar & brain stem features Cognitive impairment
What does pyramidal dysfunction in MS cause?
Increased tone, spasticity, weakness, effects extensors of upper limbs and flexors of lower limbs
Describe optic neuritis in MS
Painful visual loss for 1-2wks. Most improve in time.
RAPD present
What sensory symptoms occur in MS?
Pain Paraesthesia Dorsal column loss (proprioception & vibration) Numbness Trigeminal neuralgia
What occurs due to cerebellar dysfunction in MS?
Ataxia Intention tremor Nystagmus Past pointing Pendular reflexes Dysdiadokinesis Dysarthria
What palsys occur due to brain stem dysfunction in MS?
R VI palsy-diplopia
R VII palsy- facial weakness
What lateral gaze disorder occurs due to MS?
Internuclear ophthalmoplegia
What occurs in internuclear ophthalmoplegia in MS?
Demyelination of medial longitudinal fasciculus Distortion of binocular vision Failure of adduction-diplopia Nystagmus in abducting eye Lag
What urinary tract problems occur due to MS?
Frequency Nocturia Urgency Urge Incontinence Retention
How is fatigue treated in MS?
Amantadine
Modafinil if sleepy
Hyperbaric oxygen
What is the diagnostic criteria for MS?
At least 2 episodes suggestive of demyelination
Dissemination in time and space
McDonald criteria
What should be on the DDx in suspected MS?
Vasculitis Granulomatous disorder Vascular disease Structural lesion Infection Metabolic disorder
How is MS diagnosed?
Clinical MRI CSF Neurophysiology Blood tests
Which blood tests should be done and come back as -ve to aid in a MS diagnosis?
PV, FBC, CRP Renal liver bone profile Auto-ab screen Borellia, HIV, syphilis serology B12 and folate
Will oligoclonal bands be present or absent in CSF?
Present, but caution when absent
How is a mild acute exacerbation of MS treated?
Symptomatic treatment
How is a moderate acute exacerbation of MS treated?
Oral steroids
How is a severe acute exacerbation of MS treated?
Admit/IV steroids
What is the symptomatic treatment for pyramidal dysfunction?
Physiotherapy
OT
Anti-spasmodic agent: baclofen, tizanidine, botulinum toxin, intrathecal baclofen/phenol
How are sensory symptoms treated in MS?
Anti-convulsant e.g. gabapentin Anti-depressant e.g. amitriptyline Tens machine Acupuncture Lignocaine infusion
How is lower urinary tract dysfunction treated in MS?
Bladder drill
Anti-cholinergics e.g. oxybutynin
Desmopressin
Catheterisation
What pathologies occur in urinary tract dysfunction in MS?
Increased tone at bladder neck
Detrusor hypersensitivity
Detrusor sphyncteric dyssenergia
What is the first line therapy in MS?
Interferon Beta – Avonex, Rebif, Betaseron, Extavia
Glitiramer Acetate (Copaxone)
Tecfedira
What is the second line therapy in MS?
Monoclonal antibody- Tysabri, Lemtrada
Fingolimod
What is the third line therapy in MS?
Mitoxantrone
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
Describe Tecfidera
Oral agent
First line in RR MS
44% reduction in relapse rate
Describe Fingolimod
Oral agent
Sphingosine 1-phosphate (S1P) modulator
>50% reduction in relapse rate
Significant effect on disease progression
What is the role of alpha4beta1 integrins in MS?
Trans-endothelial migration of activated T-cells across BBB in EAE mediated by integrins
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
What is the MOA of Tysabri?
Leucocyte migration from blood to tissue
Leucocyte priming and activation
Modulation of leucocyte apoptosis
What virus are MS sufferers at risk of contracting if they take Tysabri?
Progressive multifocal leukoencephalopathy (PML) caused by JC virus
Describe mitoxantrone
For relapsing progressive MS
12 infusions over 2 years
Cardiac toxicity dose related
