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Multiple Sclerosis Flashcards

1
Q

What age group is affected by MS?

A

young people

>20yrs

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2
Q

how severe is MS?

A

MS symptoms vary a lot due to different amounts of demyelination

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3
Q

what is the prognosis of MS?

A

uncertain since the symptoms are so variable

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4
Q

where abouts in the body is the infection of MS?

A

CNS

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5
Q

is the grey or white matter affected during MS?

A

white matter

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6
Q

what is the outcome for most MS patients ?

A

most develop progressive disability

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7
Q

what mechanism causes the demyelination of MS?

A

Activated T cells cross blood brain barrier

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8
Q

is MS an autoimmune disease?

A

yes

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9
Q

is MS chronic or acute inflammation?

A

acute inflammation

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10
Q

what is post inflammatory gliosis ?

A

hypertrophy of glial cells

- this can result in functional damage

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11
Q

what is seen on an MRI scan for a MS patient?

A

white lesions or plaques in the white matter

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12
Q

during MS does axonal loss occur early or late

A

thought to start late but can be variable which is what gives variability to MS

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13
Q

what is seen on the MRI is there is axonal loss ?

A

cerebral atrophy

- black holes

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14
Q

what type of MRI is used best for axonal loss/old inflammation?

A

T1

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15
Q

what type of MRI is used best for demyelination?

A

T2

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16
Q

what is the prevalence in scotland per 100,000?

A

190

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17
Q

on average how many MS patients will a GP have?

A

2-4 patients

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18
Q

how many new cases of MS are there per year in aberdeen?

A

50-60

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19
Q

is MS more common in males or females?

A

females

2-3:1

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20
Q

what gender are autoimmune disease more common in?

A

females

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21
Q

where abouts in the world is MS seen most?

A

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

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22
Q

how long will the onset of symptoms be for MS?

A

over a few days

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23
Q

do MS patients recover fully after a relapse?

A

some patients can but for most patients permanent damage is done

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24
Q

what areas of the body can a relapse of MS occur?

A

optic neuritis
brain stem
spinal cord

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25
what symptoms can a MS patient have during a relapse ?
``` sensory symptoms - numbness limb weakness - ataxia vision loss - diplopia vertigo bladder problems ```
26
what colour is the optic disc during optic atrophy?
optic disc looks paler
27
what are the symptoms with optic neuritis ?
pain on moving the eye | everything looks greyer
28
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 ```
29
if a MS relapse occurs in the brain stem what symptoms would be experienced ?
vertigo nystagmus ataxia cranial nerve involvement
30
what are the criteria for MS diagnosis ?
episodes of demyelination at different times (within months or years) and in different area of the body
31
what are the four types of MS?
1. Relapsing-Remitting MS (RRMS) - 85% 2. Primary-Progressive MS 3. Secondary-Progressive MS 4. Progressive-Relapsing MS
32
what is the progressive phase of MS ?
symptoms get worse and won't go away | - accumulation of symptoms
33
what does the examination of MS depend on?
the severity of the MS and the area where MS has occurred
34
what examination can be done for MS patients ?
- afferent pupillary defect - nystagmus - cerebellar signs (balance, coordination) - sensory signs (numbness) - weakness - spasticity - hyperreflexia - plantars extensor
35
what criteria has to be met on MRI for MS diagnosis to be made?
McDonald criteria
36
what criteria has to be met on clinical signs for MS diagnosis to be made?
posers criteria
37
approximately how many lesions are there for each relapse of MS does a patient need to have?
10 lesions for each relapse
38
what colour is the CSF in a T2 MRI?
white | - the white matter is darker than the grey matter
39
is the white matter lighter than the grey matter with a T1 MRI ?
yes
40
what are some risk factors for demyelination?
age smoking diabetes HT
41
why would a chest X ray be done while investigating MS?
to check for sarcoidosis
42
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 ```
43
Describe the Relapsing Remitting MS ?
1. demyelination results in relapse 2. patient recovers 3. the following relapse results in a the patient not recovering fully 4. therefore there is a gradual decline in function after each relapse
44
Describe the Secondary Progressive MS ?
1. demyelination results in permanent damage 2. the second relapse results is even more less recovery 3. following relapses results in disability and the patient doesn't get better
45
Describe the Primary Progressive MS ?
1. patient never has a relapse | 2. the symptoms just get worse and worse
46
what is sensory MS ?
patient only has mild symptoms
47
what percentage of people are affected by sensory MS?
5-10%
48
is it common for patients with relapse remitting MS to develop Secondary progressive MS?
yes 25% by 10yrs 50% by 20yrs 75% by 35yrs
49
what percentage of MS patients will need a wheel chair?
25%
50
what are the good prognostic indicators for MS?
- female - presenting with optic neuritis - long intervals between releases - few relapses in first 5yrs
51
what are the bad prognostic indicators for MS?
- male - older - multifocal symptoms - motor symptoms
52
what effects can MS have on life ?
``` work family pregnancy sexual function bladder and bowel function ```
53
what age range is primary progressive MS most common?
50-60yrs
54
what is the prognosis for primary progressive MS?
poor
55
what gender is most effected by primary progressive MS?
equal males and females
56
what is the name of Neuromyelitis Optica Disorder
Devic’s Disease
57
what is Neuromyelitis Optica Disorder?
commonly affects the optic nerves and spinal cord, which can lead to: - optic neuritis - transverse myelitis
58
Is Neuromyelitis Optica Disorder an autoimmune disease ?
yes
59
what antibody may be present in the blood which could diagnose Neuromyelitis Optica Disorder?
aquaporin-4 antibodies
60
what is the treatment for Neuromyelitis Optica Disorder?
immunosuppression general health and diet symptomatic treatment
61
what is the 1st line treatment for MS?
Injections Oral treatments - Teriflunomide - Dimethyl Fumarate
62
what effect do the injections used 1st line for MS have on the progression of MS?
no effect | - not a cure
63
what are the side effects of the 1st line injections for MS?
- flu like symptoms - reaction at injection site - abnormal blood count and LFTs
64
what drug is used 2nd line given monthly for MS?
natalizumab
65
what 2nd line drug can give cardiac problems for MS/
fingolimod tablets
66
what 5 day aggressive treatment can be given for MS ?
alemtuzumub
67
what are the side effects of alemtuzumub ?
high risk thyroid and kidney problems
68
what is a serious side effect of immunosuppression?
Progressive Multifocal Leukencephalopathy (PML)
69
what causes Progressive Multifocal Leukencephalopathy (PML)?
JC-virus
70
what three immunosuppression drugs can cause Progressive Multifocal Leukencephalopathy (PML)?
Natalizumab Dimethyl fumarate Fingolimod
71
what can commonly trigger a relapse of MS?
having an infection such a cold | - therefore treating the underlying injection could help the relapse
72
do releases increase or decrease during pregnancy ?
decrease
73
what symptoms can be treated during a relapse of MS?
1. spasticity 2. dysaesthesia 3. urinary 4. constipation 5. sexual dysfunction 6. fatigue 7. depression 8. cognitive 9. tremor 10. vision 11. speech/swallowing
74
is MS just treated by one person ?
no | - a multi disciplinary team is involved
75
state some people involved in the MDT
``` MS nurse Physiotherapy Occupational therapy Speech and language therapy (SALT) Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry ```
76
what is the cause of MS?
unknown
77
does everyone with MS present in the same way?
no | - MS is very variable

Y2 Neurology (52 decks)

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