Multiple Sclerosis

Question 1

MS definition

Answer 1

Chronic inflammation of CNS

Multiple demyelination plaques disseminated in time and space

Question 2

Epidemiology of MS

Answer 2

1/1000
30yrs
F>M 3:1
North America and Europe

Question 3

Cause of MS

Answer 3

HLA-DRB1 gene
Environmental
Viral

Question 4

Pathophysiology of MS

Answer 4

CD4 mediated destruction of oligodendrocytes –> demyelination

Question 5

Classification of MS

Answer 5

Relapsing remitting 80%
Secondary progressive
Primary progressive
Progressive relapsing

Question 6

Presentation of MS

Answer 6

Tingling
Eye: optic neuritis (decreased central vision)
Ataxia
Motor: spastic paraparesis (weak legs)

Question 7

Special signs for MS

Answer 7

Lhermitte’s - neck flection causes electric shocks in limbs
Uhthoff’s - Vision decreases with heat (e.g. bath)
Internuclear ophthalmoplegia - weak adduction –> nystagmus in other eye

Question 8

Investigations for MS

Answer 8

MRI- gadolinium enhanced (activity)
LP -  IgG oligoclonal bands
Anti-MBP antibody
NMO-IgG antibody (neuromyelitis optica)
Evoked potentials (delayed auditory/visual potentials)

Question 9

Diagnosis of MS

Answer 9

Use McDonald Criteria

Question 10

Differentials of MS

Answer 10

CNS sarcoidosis
SLE
Neuromyelitis optica

Question 11

Treatment of MS

Answer 11

Acute: methylprednisolone

Preventing relapse:
DMARDS (IFN-B, Glatiramer)
Biologics (Natalizumab, Alemtuzumab)

Symptomatic control

Question 12

Prognosis of MS

Answer 12

Poor prognosis if:
Older
Male
Motor signs at onset
Many relapses early on
Many MRI lesions
Axonal loss