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Systems Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Where does multiple sclerosis affect?

A

White matter, the central nervous system - it doesn’t affect the peripheral nerves

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2
Q

What is the disease mechanism of MS?

A

Activated T cells cross the blood brain barrier causing demyelination - acute inflammation of myelin sheath - loss of function - post inflammatory gliosis

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3
Q

What is meant by gliosis?

A

Reactive change of glial cells in response to damage to central nervous system - in most cases it involves proliferation or hypertrophy of several different types of glial cells including astrocytes, microglia and oligodendrocytes.

(proliferation and hypertrophy of glial cells after damage to the CNS)

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4
Q

What is seen on MRI of MS patients?

A

Lesions or plaques

Axonal loss is seen as black holes on MRI - later seen as cerebral atrophy

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5
Q

Where is MS rare?

A

Rare in indigenous population of africa and australasia

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6
Q

What is the pathogenesis of MS?

A

Complex genetic inheritance - association with autoimmune disease

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7
Q

What percent of MS cases present with a relapse?

A

80%

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8
Q

What are the likely features of relapse?

A

Optic neuritis

Sensory symptoms

Limb weakness

Brainstem diplopia/vertigo/ataxia

Spinal cord - bilateral symptoms and signs +/- bladder

Ataxia: Loss of full control of body movements

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9
Q

What is the presentation of optic neuritis?

A

Subacute visual loss

Pain on moving eye

Distorted colour vision

Initial swelling of optic disk

Optic atrophy is seen later

Relative afferent pupillary defect (pupil dilates when light shines)

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10
Q

What is the differential diagnosis for optic neuritis?

A
  • Neuromyelitis optica
  • Sarcoidosis
  • Ischaemic optic neuropathy
  • Toxic/ drugs/ B12 deficiency
  • Wegeners granulomatosis
  • Local compression
  • Lebers hereditary optic neuropathy
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11
Q

What is the result of brainstem relapse?

A

Cranial nerve involvement

Pons - internuclear ophthalmoplegia - ophthalmoplegia is paralysis of muscles within or surrounding the eye

vertigo, nystagmus, ataxia, diploplia

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12
Q

Define myelitis

A

Inflammation of the spinal cord

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13
Q

Define transverse myelitis

A

Inflammation of the spinal cord

Inflammation results in damage to the nerve cells and loss of their myelin sheath leading to reduced conductivity

Transverse implies that the inflammation extends across the entire width of the spinal cord

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14
Q

What are the common features of transverse myelitis

A

What are the common features of transverse myelitis (complete myelitis)?

Weakness in arms and legs

Pain

Sensory alterations

Bowel and bladder dysfunction

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15
Q

What is the diagnosis of MS?

A

•MS=episodes of demyelination disseminated in space and time

May be clinical or MRI based diagnosis

Posers criteria

Macdonald criteria

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16
Q

When might further relapses occur?

A

Within months or years of first relapse

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17
Q

What signs and symptoms do MS patients accumulate?

A

Fatigue

Temperature sensitivity

Sensory

Stiffness of spasms

Balance, slurred speech

Swallowing

Bladder and bowel

Diplopia, oscillopsia, visual loss

Cognitive - demential / emotional liability

Oscillopsia is a visual disturbance in which objects in the visual field appear to oscillate

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18
Q

What are the things to look for on examination of a patient with suspected MS?

A

–Afferent pupillary defect

–Nystagmus or abnormal eye movements

–Cerebellar signs

–Sensory signs

–Weakness

–Spasticity

–Hyperreflexia

–Plantars extensor

19
Q

For every 10 lesions seen on MRI, how many relapses are expected?

A

1 - scans and patient symptoms and signs often do not correlate

20
Q

What do white spots indicate on an MRI?

A

Not necessarily MS - White spots are common in smokers and hypertensives

21
Q

What indicator is used in MRI?

A

Gadolinium - indicates acute inflammation

22
Q

What are other investigations for MS?

A

Lumbar puncture - oligoclonal bands present in CSF but not serum - Oligoclonal bands – sign of inflammation in the CNS – should only be found in CNS and not in the blood, MS is isolated to the CNS. Bands in CNS and serum just means widespread inflammation.

Bloods - exclude other inflammatory conditions

Chest X-ray

Visual/Somatosensory evoked response

23
Q

What is the differential diagnosis for MS?

A

Acute disseminating encephalomyelitis

Other autoimmune disease - SLE

Sarcoidosis

Vasculitis

Infection such as limes disease, HTLV - 1

24
Q

What are the types of MS?

A

Relapsing remitting

Secondary progressive

Primary progressive (this does not have relapses but is constantly progressive)

Sensory (does not run into disability)

Malignant

25
Q

What percentage of relapsing remitting MS go on to develop secondary disease?

A

Most:

–25% 10 years from onset

–50% 20 years

–75% after 35 years.

26
Q

What is the likelihood of affecting daily life vs causing severe disability?

A

1/4 MS never affects activities of daily living

15% severely disabled quickly

1 in 4 will require a wheelchair at some point

27
Q

What are the good prognostic indicators?

A

–female

–Present with optic neuritis

–Long interval between 1st and 2nd relapse

–Few relapses in 1st 5 years

28
Q

What are the bad prognostic indicators?

A

– male

–Older age

–Multifocal symptoms and signs

–Motor symptoms and signs

29
Q

What are the features of primary progressive MS?

A
  • Often presents in 5th and 6th decade
  • No relapses
  • Spinal symptoms
  • Bladder symptoms
  • Prognosis poor
  • M:F = 1:1
30
Q

What is the treatment for acute relapse?

A

Look out for underlying infection

Oral prednisolone

Rehabilitation

Symptomatic treatment

Vaccination usually advised to prevent further viral infections

Relapses reduced during pregnancy, however there is an increased risk in the first 3 months postpartum

31
Q

What are the first line treatments in the effort to modify the disease?

A

s/c or i/m injections:

beta interferons

glatiramer acetate

Oral treatments:

Teriflunomide

Dimethyl Fumarate

32
Q

What are the side effects of these drugs?

A

Flu-like symptoms

Injection site reaction

Abnormalities of blood count and liver function

33
Q

What is the effect of these drugs?

A

Reduce the relapse rate - 1/3

No effect on progression of disability

Not a cure

Daily - weekly IM/SC injection

34
Q

What are 2nd line agents?

A

Natalizumab

Fingolimod tablets

Alemtuzumub

35
Q

How do we treat symptoms of spasticity?

A

Muscle relaxants, antispasmodics, physiotherapy

36
Q

How do we treat symptoms of dysaesthesia?

A

Amitriptyline, gabapentin

37
Q

How do we treat symptoms of Urinary issues?

A

Anticholinergic treatment, bladder stimulation, catheterisation

38
Q

How do we treat symptoms of constipation?

A

Laxitives

39
Q

How do we treat problems with sexual dysfunction?

A

sildenafil

40
Q

What other symptoms are treated?

A

Fatigue

Depression

Cognitive function

Tremor

Vision (oscillopsia - carbamazepine)

Speech / swallowing - SALT

Motor / sensory impairment - multi disciplinary team

All these symptoms are treated the same way, regardless of the presence of MS

41
Q

What is the multi-disciplinary team for MS?

A
  • MS nurse
  • Physiotherapy
  • Occupational therapy
  • Speech and language therapy
  • Dietician
  • Rehabilitation specialists
  • Continence advisor
  • Psychology/psychiatry
42
Q

What are the components of Charcot’s triad?

A
43
Q

What is Lhermitte’s sign?

A

Electric shock runs down back and radiates to the limbs when bending neck forward

Systems Nervous System (48 decks)

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