Multiple Sclerosis

Question 1

What is MS?

Answer 1

Disease of CNS characterized by occurrence of focal areas of inflammation with demyelination. Must document two separate areas of CNS involvement

Question 2

What are the 3 major versions of MS?

Answer 2

1. Primary progressive, a slow but steady worsening of the disability from the onset, with no remissions or relapses, worsening year to year.
2. Relapsing-remitting, acute episodes of worsening neurologic function followed by complete or partial recovery with no progression between relapses
3. Secondary progressive, disease course after initial relapse when progression of disability occurs between additional clear-cut relapses.

Question 3

What is the mean age of onset, and the median age of onset? Which gender is more affected? What race and geographic location is more affected?

Answer 3

Mean age is 28, median age is 22. 3/4 of MS patients are female. 95% of MS patients are caucasian. Geographically restricted to northern Europe, US, Canada, Australia, New Zealand.

Question 4

What is the risk of an identical twin having MS if their twin has it?

Answer 4

About 30%.

Question 5

How does vitamin D influence MS?

Answer 5

Higher serum vitamin D levels have been associated with a lower rate of getting MS

Question 6

Where do MS lesions cluster?

Answer 6

Around the ventricles and follow the post-capillary venule distribution.

Question 7

What does the histology study of acute lesions show?

Answer 7

Inflammatory cells clustered in perivascular spaces

Question 8

What is Uhthoff’s phenomenon?

Answer 8

The worsening of symptoms with heat

Question 9

What is the time course for exacerbations of MS symptoms?

Answer 9

Hours/days (so not vascular, which occurs over seconds to minutes)

Question 10

What are the common sensory symptoms of MS?

Answer 10

Decreased or altered sensation, loss of pain, loss of vibration and proprioception (whichare more common)

Question 11

What are the vision symptoms of MS?

Answer 11

Monocular visual loss (optic neuritis) or double vision (diplopia)

Question 12

What are the motor symptoms of MS?

Answer 12

Weakness of one limb, both legs, or half of the body. Upper motor neuron signs are common.

Question 13

What are the brainstem symptoms of MS?

Answer 13

Spinning (vertigo), dysarthria, dysphagia, facial weakness. Trigeminal neuralgia is also common. Nystagmus is also often seen

Question 14

What are the 3 signs that are so often associated with MS that MS should be on the differential when found?

Answer 14

Optic neuritis, internuclear ophthalmoplegia, and partial myelitis

Question 15

What is optic neuritis?

Answer 15

presenting with unilateral visual loss and pain with eye movement. Often with an afferent pupillary defect. Optic pallor often develops as well

Question 16

What is internuclear ophthalmoplegia?

Answer 16

Results from demyelination of the MLF, resulting in an inability to adduct the eye to the side of the lesion. Nystagmus of the contralateral abducting eye may also occur. Medial rectus function spared.

Question 17

What is partial myelitis?

Answer 17

Focal demyelination of spinal cord that causes sensory and motor abnormalities localized to a specific spinal cord level

Question 18

What is transverse myelitis?

Answer 18

Total demyelination across entire spinal cord

Question 19

What is Devic’s disease?

Answer 19

Transverse myelitis with optic neuritis; also known as neuromyelitis optica.

Question 20

What do CT scans show with MS? What do MRIs show?

Answer 20

CT scans are normal in MS. MRI is almost always abnormal and demonstrates MS lesions

Question 21

What is Dawson’s fingers?

Answer 21

periventricular lesions that are ovoid with perpendicular orientation to the lateral ventricles

Question 22

What are the CSF findings in MS?

Answer 22

• Total spinal fluid protein decreased to below 50, always below 100
• Increased intrathecal synthesis of IgG and/or clusters of polyclonal IgG

Question 23

What other diseases can mimic MS?

Answer 23

Sjogren’s and sarcoidosis. Infections such as borrelia, syphilis, JC virus, and retroviruses. Vitamin B12 deficiency

Question 24

What is a consideration with MS patients and surgery/anesthesia?

Answer 24

They do not trigger attacks, but the repaired nerves are more reliant on sodium channels, so sodium channel blockers may be more potent and last longer

Question 25

Name factors that seem to exacerbate MS symptoms (2)? What improves MS symptoms (1)? What seems to have no effect (2)

Answer 25

Exacerbate: Heat and infections (and possibly vaccines)
Improve: pregnancy
No effect: trauma and surgery