Multiple Sclerosis Flashcards
What age group is affected by MS?
young people
>20yrs
how severe is MS?
MS symptoms vary a lot due to different amounts of demyelination
what is the prognosis of MS?
uncertain since the symptoms are so variable
where abouts in the body is the infection of MS?
CNS
is the grey or white matter affected during MS?
white matter
what is the outcome for most MS patients ?
most develop progressive disability
what mechanism causes the demyelination of MS?
Activated T cells cross blood brain barrier
is MS an autoimmune disease?
yes
is MS chronic or acute inflammation?
acute inflammation
what is post inflammatory gliosis ?
hypertrophy of glial cells
- this can result in functional damage
what is seen on an MRI scan for a MS patient?
white lesions or plaques in the white matter
during MS does axonal loss occur early or late
thought to start late but can be variable which is what gives variability to MS
what is seen on the MRI is there is axonal loss ?
cerebral atrophy
- black holes
what type of MRI is used best for axonal loss/old inflammation?
T1
what type of MRI is used best for demyelination?
T2
what is the prevalence in scotland per 100,000?
190
on average how many MS patients will a GP have?
2-4 patients
how many new cases of MS are there per year in aberdeen?
50-60
is MS more common in males or females?
females
2-3:1
what gender are autoimmune disease more common in?
females
where abouts in the world is MS seen most?
north and south of the equator
- the incidence even increases the more north you go in the UK being the highest in the shetland islands
how long will the onset of symptoms be for MS?
over a few days
do MS patients recover fully after a relapse?
some patients can but for most patients permanent damage is done
what areas of the body can a relapse of MS occur?
optic neuritis
brain stem
spinal cord
what symptoms can a MS patient have during a relapse ?
sensory symptoms - numbness limb weakness - ataxia vision loss - diplopia vertigo bladder problems
what colour is the optic disc during optic atrophy?
optic disc looks paler
what are the symptoms with optic neuritis ?
pain on moving the eye
everything looks greyer
what are the differential diagnoses for optic neuritis ?
Neuromyelitis optica Sarcoidosis Ischaemic optic neuropathy Toxic/ drugs/ B12 deficiency Wegeners granulomatosis Local compression Lebers hereditary optic neuropathy
if a MS relapse occurs in the brain stem what symptoms would be experienced ?
vertigo
nystagmus
ataxia
cranial nerve involvement
what are the criteria for MS diagnosis ?
episodes of demyelination at different times (within months or years) and in different area of the body
what are the four types of MS?
- Relapsing-Remitting MS (RRMS) - 85%
- Primary-Progressive MS
- Secondary-Progressive MS
- Progressive-Relapsing MS
what is the progressive phase of MS ?
symptoms get worse and won’t go away
- accumulation of symptoms
what does the examination of MS depend on?
the severity of the MS and the area where MS has occurred
what examination can be done for MS patients ?
- afferent pupillary defect
- nystagmus
- cerebellar signs (balance, coordination)
- sensory signs (numbness)
- weakness
- spasticity
- hyperreflexia
- plantars extensor
what criteria has to be met on MRI for MS diagnosis to be made?
McDonald criteria
what criteria has to be met on clinical signs for MS diagnosis to be made?
posers criteria
approximately how many lesions are there for each relapse of MS does a patient need to have?
10 lesions for each relapse
what colour is the CSF in a T2 MRI?
white
- the white matter is darker than the grey matter
is the white matter lighter than the grey matter with a T1 MRI ?
yes
what are some risk factors for demyelination?
age
smoking
diabetes
HT
why would a chest X ray be done while investigating MS?
to check for sarcoidosis
what investigations can be done for MS?
MRI scan
This would only be done if the MRI was atypical: Lumbar puncture Bloods CXR Eye tests
Describe the Relapsing Remitting MS ?
- demyelination results in relapse
- patient recovers
- the following relapse results in a the patient not recovering fully
- therefore there is a gradual decline in function after each relapse
Describe the Secondary Progressive MS ?
- demyelination results in permanent damage
- the second relapse results is even more less recovery
- following relapses results in disability and the patient doesn’t get better
Describe the Primary Progressive MS ?
- patient never has a relapse
2. the symptoms just get worse and worse
what is sensory MS ?
patient only has mild symptoms
what percentage of people are affected by sensory MS?
5-10%
is it common for patients with relapse remitting MS to develop Secondary progressive MS?
yes
25% by 10yrs
50% by 20yrs
75% by 35yrs
what percentage of MS patients will need a wheel chair?
25%
what are the good prognostic indicators for MS?
- female
- presenting with optic neuritis
- long intervals between releases
- few relapses in first 5yrs
what are the bad prognostic indicators for MS?
- male
- older
- multifocal symptoms
- motor symptoms
what effects can MS have on life ?
work family pregnancy sexual function bladder and bowel function
what age range is primary progressive MS most common?
50-60yrs
what is the prognosis for primary progressive MS?
poor
what gender is most effected by primary progressive MS?
equal males and females
what is the name of Neuromyelitis Optica Disorder
Devic’s Disease
what is Neuromyelitis Optica Disorder?
commonly affects the optic nerves and spinal cord, which can lead to:
- optic neuritis
- transverse myelitis
Is Neuromyelitis Optica Disorder an autoimmune disease ?
yes
what antibody may be present in the blood which could diagnose Neuromyelitis Optica Disorder?
aquaporin-4 antibodies
what is the treatment for Neuromyelitis Optica Disorder?
immunosuppression
general health and diet
symptomatic treatment
what is the 1st line treatment for MS?
Injections
Oral treatments
- Teriflunomide
- Dimethyl Fumarate
what effect do the injections used 1st line for MS have on the progression of MS?
no effect
- not a cure
what are the side effects of the 1st line injections for MS?
- flu like symptoms
- reaction at injection site
- abnormal blood count and LFTs
what drug is used 2nd line given monthly for MS?
natalizumab
what 2nd line drug can give cardiac problems for MS/
fingolimod tablets
what 5 day aggressive treatment can be given for MS ?
alemtuzumub
what are the side effects of alemtuzumub ?
high risk thyroid and kidney problems
what is a serious side effect of immunosuppression?
Progressive Multifocal Leukencephalopathy (PML)
what causes Progressive Multifocal Leukencephalopathy (PML)?
JC-virus
what three immunosuppression drugs can cause Progressive Multifocal Leukencephalopathy (PML)?
Natalizumab
Dimethyl fumarate
Fingolimod
what can commonly trigger a relapse of MS?
having an infection such a cold
- therefore treating the underlying injection could help the relapse
do releases increase or decrease during pregnancy ?
decrease
what symptoms can be treated during a relapse of MS?
- spasticity
- dysaesthesia
- urinary
- constipation
- sexual dysfunction
- fatigue
- depression
- cognitive
- tremor
- vision
- speech/swallowing
is MS just treated by one person ?
no
- a multi disciplinary team is involved
state some people involved in the MDT
MS nurse Physiotherapy Occupational therapy Speech and language therapy (SALT) Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry
what is the cause of MS?
unknown
does everyone with MS present in the same way?
no
- MS is very variable
