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Neurology week 4 > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

What is the definition of multiple sclerosis?

A

An inflammatory demyelinating disorder of the CNS

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2
Q

What is the morphology of MS? (What are the pathological features?)

A

Areas of demyelination called plaques diseminated in time and place

A certain extent of axonal loss

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3
Q

Which virus is ? associated with MS in later life?

A

EBV infection in early life causing MS in later life

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4
Q

What are the 4 clinical courses of MS?

A

Relapsing remitting

Secondary progressive

Progressive relapsing

Primary progressive

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5
Q

Clinical features of MS?

A

Pyramidal dysfunction (Weakness, spasticity)

Optic neuritis

Sensory symptoms

Lr Urinary tract symptoms

Cerebellar and brain stem features

Cognitive impairment

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6
Q

What problems does pyramidal dysfunction lead to?

A

Increased tone

Spasticity

Weakness

Problems with extension of upper limbs and flexion of lower limbs

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7
Q

What is optic neuritis?

A

Painful vision loss with pain on movement of eyes

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8
Q

How is optic neuritis treated?

A

Course of Methylprednisolone

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9
Q

What sensory symptoms are there in MS?

A

Pain

Paraesthesia

Loss of proprioception and vibration touch due to damage to dorsal column

Numbess

Trigeminal neuralgia

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10
Q

Which symptoms does cerebellar dysfuncton lead to?

A

Ataxia

Intention tremor

Nystagmus

Failed finger nose test (Past pointing)

Pendular reflexes

Dysdiadokinesis

Dysarthria

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11
Q

How is dysdiadokinesis tested?

A

Hand out, tap palm with fingers of opposite hand, alternating quickly between pronation and supination

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12
Q

Palsy of which nerve causes diplopia

A

CN VI

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13
Q

Palsy of which nerve causes facial weakness?

A

CN VII

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14
Q

What are the features of internuclear ophthalmoplegia

A

Distortion of binocular vision

Failure of adduction causing diplopia

Nystagmus in abducting eye

Lag

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15
Q

What are the lower urinary symptoms MS causes?

A

Frequency

Nocturia

Urgency

Urge incontinence

Retention

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16
Q

How can fatigue be combatted

A

Modafinil

Amantadine

Hyperbaric oxygen

17
Q

Whats the criteria of diagnosis for MS

A

At least 2 episodes suggestive of demyelination

Dissemination in time and place

McDonald criteria

18
Q

Which investigations can be carried out in MS?

A

MRI

Lumbar puncture

Neurophysiology

19
Q

How are mild to severe acute exacerbations treated?

A

Mild- Symptomatic

Moderate- Oral methylprednisolone 500mg for 5 days

Severe- Admit/IV steroids (1000mg for 3 days)

20
Q

What are the treatment options for spasticity?

A

Physiotherapy

Baclofen/Tizanidine

Botulinum toxin

Intrathecal Baclofen/phenol

21
Q

What are the treatment options for sensory symptoms?

A

Anti convulsant eg Gabapentin

Anti depressant eg Amitriptyline

TENS machine

Acupuncture

Lignocaine infusion

22
Q

What is the underlying pathology of lower urinary tract symptoms in MS?

A

Increased muscle tone at bladder neck

Detrusor Hypersensitivity

Detruser sphyncteric dyssenergia

Symptoms similar to BPH i.e bladder outflow obstruction

23
Q

Treatment options for Lr urinary tract dysfunction?

A

Bladder Drills

Anti cholinergics eg Oxybutynin

Desmopressin

Catheterisation

24
Q

First line disease modifying therapy?

A

Interferon Beta

Glitiramer Acetate (Copaxone)

Tecfidera

25
Q

Second line disease modifying therapy?

A

Monoclonal antibody

Fingolimod

26
Q

Third line disease modifying therapy?

A

Mitoxantrone

27
Q

How is Interferon administered and what benefits does it have?

A

S/C or IM

Decrease relapse rate by 1/3

Decrease severity of relapse by 50%

28
Q

How is tecfidera administered and what are it’s benefits?

A

Oral agent

44% reduction in relapse rate

29
Q

Side effects of Tecfidera?

A

Flushing
Bowel problems
Reduced white cell count

30
Q

What class of drug is Fingolimod, how is it administered and what are it’s benefits?

A

Sphingosine 1-phosphate (S1P) Modulator

Oral agent

> 50% reduction in relapse rate

31
Q

Side effects of Fingolimod?

A

Cardiac problems (Which can cause death, only first pass effect, doesn’t tend to last)

Macular oedema

32
Q

When is Tysabri and Lemtrada indicated for use?

A

Highly active, rapidly evolving severe RR MS

33
Q

When is Mitoxantrone indicated, how is it administered and what are the side effects?

A

Relapsing progressive

12 infusions over 2 years

Cardiac toxicity related to dose

Neurology week 4 (8 decks)

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