Multiple sclerosis Flashcards
1
Q
What is the definition of multiple sclerosis?
A
Chronic progressive condition in which there is damage of the nerve sheeth
2
Q
How common is multiple sclerosis?
A
Prevalence of 60 per 10,000 in England
3
Q
What is the pathophysiology of multiple sclerosis?
A
- Autoimmune – starts in early childhood
- Multiple plaques of demyelination of nerves in the brain and the spinal cord
- Inflammation of the white matter – mediated by B cells and CD4 T cells
- Peripheral nerves are not affected
- Relapsing and remitting symptoms due to inflammatory oedema and partial remyelination
- Death normally from:
- UTI
- Uraemia
- Bronchopneumonia
4
Q
What are the risk factors/aetiology of multiple sclerosis?
A
- Woman
* EBV exposure in childhood
5
Q
What are the signs/symptoms of multiple sclerosis?
A
- Relapsing and remitting symptoms
- Optic neuropathy
- Blurred vision
- Unilateral eye pain
- Disc swelling and pallor on fundoscopy
- Brainstem demyelination
- Diplopia
- Vertigo
- Dysphagia
- Nystagmus
- Spine cord lesions
- Numbness
- Pins and needles
- Spastic paraplegia – weakness and stiffness in the leg muscles
- Final stages:
- Spastic tetraparesis – cerebral palsy affecting all 4 limbs
- Ataxia
- Brainstem signs
- Blindness
- Incontinence
- Dementia
6
Q
What investigations are conducted to diagnose multiple sclerosis?
A
- MRI
- Electrophysiological tests
- CSF
- ↑ Protein
- ↑ Cell count
- Oligoclonal IgG bands
7
Q
What are the pharmacological treatments for multiple sclerosis?
A
- Methylprednisolone – during relapse
- Β interferon
- Glatiramer acetate
- Natalizumab/mitoxantrone – 2nd line therapy
- Baclofen/dantrolene/benzodiazepines – muscle relaxants
8
Q
What are the non pharmacological treatments for multiple sclerosis?
A
- Urinary catheterisation
- Physiotherapy
- Occupational health
- Support via the multiple sclerosis society
