Multiple sclerosis Flashcards
What is the definition of multiple sclerosis?
An inflammatory demyelinating disorder of the CNS
What is the morphology of MS? (What are the pathological features?)
Areas of demyelination called plaques diseminated in time and place
A certain extent of axonal loss
Which virus is ? associated with MS in later life?
EBV infection in early life causing MS in later life
What are the 4 clinical courses of MS?
Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive
Clinical features of MS?
Pyramidal dysfunction (Weakness, spasticity)
Optic neuritis
Sensory symptoms
Lr Urinary tract symptoms
Cerebellar and brain stem features
Cognitive impairment
What problems does pyramidal dysfunction lead to?
Increased tone
Spasticity
Weakness
Problems with extension of upper limbs and flexion of lower limbs
What is optic neuritis?
Painful vision loss with pain on movement of eyes
How is optic neuritis treated?
Course of Methylprednisolone
What sensory symptoms are there in MS?
Pain
Paraesthesia
Loss of proprioception and vibration touch due to damage to dorsal column
Numbess
Trigeminal neuralgia
Which symptoms does cerebellar dysfuncton lead to?
Ataxia
Intention tremor
Nystagmus
Failed finger nose test (Past pointing)
Pendular reflexes
Dysdiadokinesis
Dysarthria
How is dysdiadokinesis tested?
Hand out, tap palm with fingers of opposite hand, alternating quickly between pronation and supination
Palsy of which nerve causes diplopia
CN VI
Palsy of which nerve causes facial weakness?
CN VII
What are the features of internuclear ophthalmoplegia
Distortion of binocular vision
Failure of adduction causing diplopia
Nystagmus in abducting eye
Lag
What are the lower urinary symptoms MS causes?
Frequency
Nocturia
Urgency
Urge incontinence
Retention
How can fatigue be combatted
Modafinil
Amantadine
Hyperbaric oxygen
Whats the criteria of diagnosis for MS
At least 2 episodes suggestive of demyelination
Dissemination in time and place
McDonald criteria
Which investigations can be carried out in MS?
MRI
Lumbar puncture
Neurophysiology
How are mild to severe acute exacerbations treated?
Mild- Symptomatic
Moderate- Oral methylprednisolone 500mg for 5 days
Severe- Admit/IV steroids (1000mg for 3 days)
What are the treatment options for spasticity?
Physiotherapy
Baclofen/Tizanidine
Botulinum toxin
Intrathecal Baclofen/phenol
What are the treatment options for sensory symptoms?
Anti convulsant eg Gabapentin
Anti depressant eg Amitriptyline
TENS machine
Acupuncture
Lignocaine infusion
What is the underlying pathology of lower urinary tract symptoms in MS?
Increased muscle tone at bladder neck
Detrusor Hypersensitivity
Detruser sphyncteric dyssenergia
Symptoms similar to BPH i.e bladder outflow obstruction
Treatment options for Lr urinary tract dysfunction?
Bladder Drills
Anti cholinergics eg Oxybutynin
Desmopressin
Catheterisation
First line disease modifying therapy?
Interferon Beta
Glitiramer Acetate (Copaxone)
Tecfidera
Second line disease modifying therapy?
Monoclonal antibody
Fingolimod
Third line disease modifying therapy?
Mitoxantrone
How is Interferon administered and what benefits does it have?
S/C or IM
Decrease relapse rate by 1/3
Decrease severity of relapse by 50%
How is tecfidera administered and what are it’s benefits?
Oral agent
44% reduction in relapse rate
Side effects of Tecfidera?
Flushing
Bowel problems
Reduced white cell count
What class of drug is Fingolimod, how is it administered and what are it’s benefits?
Sphingosine 1-phosphate (S1P) Modulator
Oral agent
> 50% reduction in relapse rate
Side effects of Fingolimod?
Cardiac problems (Which can cause death, only first pass effect, doesn’t tend to last)
Macular oedema
When is Tysabri and Lemtrada indicated for use?
Highly active, rapidly evolving severe RR MS
When is Mitoxantrone indicated, how is it administered and what are the side effects?
Relapsing progressive
12 infusions over 2 years
Cardiac toxicity related to dose
