Multiple Sclerosis Flashcards
What causes multiple sclerosis?
Plaques of demyelination occur at multiple CNS sites, from T cell mediated immune response
Why is is relapsing and remitting?
Demyelination heals poorly.
Why is it progressive?
Prolonged demyelination causes axonal loss and clinically progressive symptoms.
What race is it least common in?
Black african/ Asian
What is the lifetime risk of developing it in the UK/
1:1000
If I move countries will my risk change?
Adult migrants take their risk, children acquire the risk of where they settle
What vitamin can affect it?
Vitamin D status relates to prevention of MS.
What makes symptoms worse?
Hot baths and exercise
Can anything trigger an episode?
Stress
What are some signs of a worse prognosis?
Older males, motor signs on onset, many relapses early on, many MRI lesions, axonal loss
What CSF results indicate MS?
Oligoclonal bands of IgG on electrophoresis that are not present in serum.
Non-medication treatments?
Encourage a happy, stress-free life if possible, give vitamin D, physiotherapy and occupational therapy
What are the medications?
Steroids, monoclonal antibodies (Alemtuzumab), palliative (spasticity, tremor, urgency/frequency)
What do the steroids do?
Methylprednisolone shortens acute relapses but doesn’t alter overall prognosis
What do monoclonal antibodies (alemtuzumab) do?
Alemtuzumab acts against T cells in relapsing-remitting MS. Decreases relapses and MRI lesions
What are side effects of monoclonal antibodies?
Infections, autoimmune diseases, antibody-mediated resistance
What are the sensory clinical features of MS?
Pins and needles, decreased vibration sensation, trigeminal neuralgia.
What are the motor features of MS?
Spastic weakness, myelitis
What are the sexual GU features of MS?
Erectile dysfunction, anorgasmia, urine retention, incontinence
What are the GI features of MS?
Swallowing disorders, constipation
What are the eye features of MS?
Diplopia, hemianopia, optic neuritis, visual phenomena on exercise, bilateral internuclear ophthalmoplegia, pupil defects
What are the cerebellum features of MS?
Trunk and limb ataxia, intention tremor, scanning speech, falls
What are the cognitive features of MS?
Accidents/isolation, amnesia, mood changes, decrease executive functioning
What is MS
A chronic debilitating autoimmune disorder of the central nervous sytem
What are does MS usually start
Usually early adulthood
Is MS more common in men or women?
Women
What virus is thought to predispose to the later development of MS?
EBV
Which nerves are affected?
Te central ones, never the peripheral ones
What causes the regression of symptoms
The resolution of inflammatory oedema and partial remyelination
What are the common presentations of MS?
Optic neuropathy, brainstem demyelination and spinal cord lesions
What symptoms does optic neuritis causes?
Blurred vision and unilateral eye pain
What symptoms does brainstem demyelination cause?
diplopia, vertigo, dysphagia and nystagmus
What symptoms do spinal cord lesions cause?
Sensory symptoms including numbness and pins and needles. Spastic paraparesis is the result of plaques of demyelination in the cervical or thoracic cord.
What are the main causes of death in MS?
UTI, uraemia and bronchopneumonia
What palliative medications can you give for spasticity?
Muscle relaxants (baclofen) reduces the discomfort and pain of spasticity
What palliative medications can you give for tremor?
Botox type A
What palliative medications/non-medications can you give/do for urinary frequency?
Teach self-catheterisation, try tolterodine
Is it genetic?
It can happen more than once in a family, but that is unlikely. There is a 2% chance your child will get it and a 3% your sibling will get it
Does it depend on where you live?
It is much rarer in hot countries
Can I do anything to slow down the progression?
Yes, if you smoke, stop! Lose weight!
Can I drive?
Yes, most people can continue driving
Do people die from MS?
People don’t die directly from MS but it can increase your risk of developing an infection, the life expectancy is slightly lower than the general population
Will I need to use a wheel chair?
Some patients with MS will eventually need a wheelchair or a stick. This can be a difficult decision but it can help you regain some more independence
Will I still be able to work?
Many people with MS continue to work after a diagnosis. Some need to make appropriate adjustments to allow them to continue in their job, or they may choose to do a different job. And some may decide they are no longer able to work.
Can I still have children?
MS doesn’t affect fertility so yes! A parent with MS may be faced with more day-to-day problems but it doesn’t stop you being an excellent parent.
What are the types of MS?
Relapsing-remitting (85%), primary progressive (10-15%), secondary progressive
How quickly will a relapse come on?
Symptoms usually come on over a short period of time – over hours or days.
How long will the relapse last for?
They often stay for a number of weeks, usually four to six, though this can vary from very short periods of only a few days to many months.
Will I need to go to hospital for every relapse?
Relapses can vary from mild to severe. At their worst, acute relapses may need hospital treatment, but many relapses are managed at home, with the support of the GP, MS specialist nurse, and other care professionals.
Will I recover completely from my relapse?
People often make a very good recovery from a relapse, with complete remission. However, this is not always the case and around half of all relapses may leave some lingering problems, however slight.
Is there anything that triggers a relapse?
Many people with MS feel they can identify things that trigger a relapse for them. Unfortunately, what appears to affect one person doesn’t always apply to someone else. These include, stress, infection, vaccinations and pregnancy
What do I do if I’m having a relapse?
If you think you are having a relapse, you need to contact your MS nurse or GP as soon as possible. Tell them about: your symptoms, how you’re feeling in general, any difficulties your symptoms are causing you.
My GP won’t give me steroids for this relapse, why?
NICE also recommends that steroids should not be given more than three times in any year, and a course of steroids should last no longer than three weeks.
What are the short-term side effects of steroids?
mood alteration (up or down)
altered sleep pattern (often difficulty in falling asleep)
upset stomach or gut – including feeling nauseous
palpitations (faster than normal heart rate)
metallic taste in the mouth
increased appetite
weight gain (usually short-term)
flushing/ reddening of the face
ankle swelling
acne (temporary)
What are the long term side effects of steroids?
thinning of the skin thinning of bones (osteoporosis)
increased blood pressure diabetes
very rarely, some people can experience severe damage to the hip (known as avascular necrosis of the hip)
When/how likely is it that relapsing/remitting will become secondary progressive?
65 per cent of people with relapsing remitting MS will develop secondary progressive MS 15 years after being diagnosed.
How is secondary progressive MS diagnosed?
Most neurologists will look for at least six months of clear progression before they use the term secondary progressive.
What complementary therapies are recommended by NICE?
reflexology massage t'ai chi magnetic field therapy neural therapy fish oils combination of some forms of complementary therapy (known as ‘multi-modal therapy')
Do my periods effect my MS?
Women with MS say that their symptoms often feel worse around their periods, especially weakness, balance, fatigue and depression.
Why is my MS affected by my periods?
Just before, and during a period, the core body temperature rises a little and this can sometimes make MS symptoms feel worse.
Is there anything I should do if I’m trying for a baby?
If you are taking any medications, and you decide to try for a baby, the usual advice is to wait at least three months after stopping treatment before trying to conceive.
