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Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

what part of the nervous system is affected in ms?

A

central nervous system
white matter disease
demyelination

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2
Q

what is demyelination?

A

Auto immune process
Activated T cells cross blood brain barrier causing demyelination
Acute inflammation of myelin sheath
Loss of function

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3
Q

how does the repair of demyelination affect the functional recovery?

A

Repair-Recovery of function

Post inflammatory gliosis- may have functional deficit

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4
Q

what investigation shows ms?

A

Lesions or plaques on MRI scan

Later seen as cerebral atrophy

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5
Q

who more commonly gets ms?

A

Female:male 2-3:1
Complex genetic inheritance
Association with autoimmune disease
Commoner in temperate climate

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6
Q

how often do cases MS present with a relapse?

A

80%

“attack of demyelination” or “inflammation”

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7
Q

how long does the initial relapse last?

A

Gradual onset over days
Stabilises days to weeks
Gradual resolution to complete or partial recovery

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8
Q

what is affected in the first ms relapse?

A

Optic neuritis
Sensory symptoms
Limb weakness
Brainstem Diplopia/Vertigo/Ataxia-
Spinal cord-bilateral symptoms and signs +/- bladder

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9
Q

what are the symptoms of optic/retrobulbar neuritis?

A 
Subacute visual loss
Pain on moving eye
Colour vision disturbed
Usually resolves over weeks
Initial  swelling optic disc
Optic atrophy seen later
Relative afferent pupillary defect
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10
Q

describe a brainstem relapse?

A

Cranial nerve involvement
Pons- internuclear ophthalmoplegia
E.g. Vertigo, nystagmus, ataxia
Upper motor neurone changes limbs

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11
Q

what is myelitis?

A 
infection or inflammation of spinal cord
Partial or Transverse (complete)
Sensory level
Weakness/ upper motor neurone changes below level
Bladder and bowel involvement
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12
Q

is an isolated episode of demyelination ms?

A

no, MS=episodes of demyelination disseminated in space and time

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13
Q

when do further relapses occur?

A

within months or years of first relapse

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14
Q

what is affected in further ms relapses?

A

Variable site and severity

Optic nerve                            
Sensory                                  
Limb weakness                     
Diplopia                                
Vertigo                                
Ataxia                                  
Sphincter disturbance  etc etc
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15
Q

what can be found on examination of ms?

A 
Afferent pupillary defect
Nystagmus or abnormal eye movements
Cerebellar signs
Sensory signs
Weakness
Spasticity
Hyperreflexia
Plantars extensor
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16
Q

how can ms be diagnosed when areas of demyelination are found on MRI scan?

A

For 10 lesions (approximately) patient experiences 1 relapse
Scan and patient symptoms and signs often do not correlate-patient can be clinically well
Allowed a couple of lesions in a decade so someone in 60s has quite a few
patients who smoke/have diabetes will have more

17
Q

how do you confirm if a lesion of inflammation is active?

A

old lesion of inflammation is seen in T2 but not shown in T1 (with Gadolinium)-inactive
active lesion seen in both

18
Q

apart from mri what other investigations can diagnose ms?

A

Lumbar puncture-oligoclonal bands present in CSF but not serum
Visual/ somatosensory evoked response
Bloods-exclude other inflammatory conditions
Chest X Ray

19
Q

what are the different types of ms?

A 
Relapsing remitting-85% at outset (RRMS)
Secondary progressive (SPMS) 
Primary progressive – 10-15% (PPMS)
Sensory – 5%
Malignant
20
Q

what percentage of patients who present with RRMS go on to develop secondary progressive disease?

A

25% 10 years from onset
50% 20 years
75% after 35 years.

21
Q

how does the progression of ms vary?

A

1/4 MS never affects activities of daily living (ADL)
15% severely disabled quickly
1 in 4 will require a wheel chair at some point

22
Q

what are good prognostic indicators?

A

female
Present with optic neuritis
Long interval between 1st and 2nd relapse
Few relapses in 1st 5 years

23
Q

what are bad prognostic indicators?

A

male
Older age
Multifocal symptoms and signs
Motor symptoms and signs

24
Q

describe Primary progressive ms

A 
Often presents in 5th and 6th decade
No relapses
Spinal symptoms
Bladder symptoms
Prognosis poor
M:F = 1:1
25
Q

what is Devic’s Disease?

A 
Optic neuritis
Myelitis
Aquaporin-4 antibodies
Antibody negative in some cases
Treat slightly different and manage a bit better
26
Q

what are the 1st line disease modifying treatments?

A 
Beta-interferons/ glatiramer acetate
Reduce relapse rate ~1/3
No effect on progression of disability
Not a cure
Daily-weekly im/ sc injection

Oral treatments
Teriflunomide
Dimethyl Fumarate

27
Q

what are side effects of 1st line disease modifying treatments?

A

Flu-like symptoms
Injection site reaction
Abnormalities of blood count and liver function

28
Q

what are the 2nd line disease modifying treatments?

A 
Natalizumab 
Reduce relapse rate ~2/3
Monthly infusion
Fingolimod- tablets
Alemtuzumub
29
Q

what does the treatment of ms make patients more vulnerable to?

A 
JC-virus
Immunosuppression (AIDS)
Natalizumab
Dimethyl fumarate
Fingolimod
30
Q

what is the treatment for acute relapse of ms?

A 
look for underlying infection
exclude worsening of usual symptoms with intercurrent illness
oral prednisolone (intravenous)
rehabilitation
symptomatic treatment
31
Q

what is the treatment for further relapses of ms?

A

Underlying viral infection-25-30%

Vaccination usually advised

32
Q

how does pregnancy affect the risk of relapses?

A

Fewer relapses during pregnancy

Increased risk in first 3 months post partum

33
Q

what is the symptomatic treatment of ms?

A 
Spasiticity-muscle relaxants/ antispasmodics/ physiotherapy
Dysaesthesia-amitriptyline
Urinary-anticholinergic Rx
Constipation-laxatives
Sexual dysfunction
Fatigue-graded exercise, medication
Depression-CBT, medication
Cognitive-memory aids etc
Tremor-aids/ pharmaceutical
Vision/ oscillopsia-carbamazepine
Speech/ swallowing-SALT
Motor/ sensory impairment- multi-disciplinary team

Nervous System (37 decks)

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