Multiple Sclerosis Flashcards by Sarah Anderson

What demographic does Multiple sclerosis affect

Relatively common neurological disease of young people

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Where exactly does multiple sclerosis occur

In the central nervous system white matter

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What is the pathology if multiple sclerosis

auto-immune process as activated T cells cross blood brain barrier causing demyelination

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What can occur in the repair and recovery of an attack of demyelination

Gliosis - reactive change of glial cells, involving the proliferation and hypertrophy of glial cells in the CNS

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What can progressive multiple sclerosis pathologically lead to

Lead to axonal loss and cerebral atrophy

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What is the affect of progressive multiple sclerosis

Development of persistent disability - affecting daintily living

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Who has a worse prognosis men or woman

Men

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What is the pathogenies of MS

Complex genetic inheritance (F:M 2-3:1)

Commoner in colder temperate climate

(Age of exposure to colder climates affects chances of MS development)

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What is the initial presentation of MS

Gradual onset over days
stabilises day to weeks
Gradual resolution to complete or partial recovery

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For multiple sclerosis to be diagnosed after initial presentation, what needs to occur

A Relapse to occur within months or years of first presentation

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What is the statistic of MS cases relapses

80% cases MS presents with a relapse

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How are not all MS relapses the same

All have variable site and severity

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What are the variable symptoms than can occur with MS relapse

Optic neuritis,

Ophthalmoplegia (paralysis of eye muscle)

Limb weakness

Vertigo, diplopia.
Ataxia,
Nystagmus,

Sensory symptoms,

Sphincter disturbance (bladder and bowel involvement)

Sexual disfunction

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What are the sensory symptoms experienced in MS

Hyperasethesia - excess physical sensitivity

Sensation of

Burning, Tingling, Pins and needles, Crawling, Numbness, Prickling, Sensitive skin, Wetness

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What is the initial to lateral presentation of optic neuritis

Swelling of optic disc
to
Optic atrophy

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What is the symptoms and signs experienced in optic neuritis

Symptoms:
Subacute visual loss
Pain on moving eye
Colour vision disturbed

Signs:
relative afferent pupillary defect

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How is limb weakness caused in MS

Due to MS causing a lesion to upper motor neurone

Weakness occurs below level of lesion

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What is bilateral symptoms experienced if MS myelitis - inflammation of the spinal cord

Paresis - muscle weakness

Loss of sensation

Reflex changes

Autonomic dysfunction (eg, bowel, bladder, and erectile dysfunction; loss of sweating)

Painful

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What is affected in a brainstem relapse due to MS

Pons - cranial nerves

Cerebellum

Upper motor neurones

Sensory involvement

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What causes progressive phase of MS

Accumulation of symptoms and signs

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What is the symptoms experienced in Progressive phase MS

Fatigue,

temperature sensitivity

Sensory

Stiffness or spasms

Balance,
slurred speech

Swallowing

Bladder & bowel

Diplopia/ oscillopsia - visual disturbance/visual loss

Cognitive-dementia/ emotional lability

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What is the definition of MS used for diagnosis

Episode of demyelination disseminated in space and time

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What is the two diagnostic criteria for MS

Posers criteria - clinical examination

Macdonalds criteria - MRI based diagnosis

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What is potentially found on examination of MS

Afferent pupillary defect

Nystagmus or abnormal eye movements

Cerebellar signs

Sensory signs

Weakness

Spasticity

Hyperreflexia

Plantars extensor

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What is found on examination in MS is dependant on

Where demyelination has occurred and stage of disease

What can be seen on MRI scan that shows areas of demyelination

lesions or plaques

What is the lesions or relapse ratio for a MS patient

For 10 lesions a patient experiences 1 relapse

What does black hole on an MRI scan indicate

Cerebral atrophy

What are further investigations for MS

Lumbar puncture Visual/somatosensory evoked response Blood tests - exclude other inflammatory conditions Chest X ray

What is found in a Lumbar puncture of a MS patient

Oligoclonal bands (Immunoglobins) appear in CSF and not serum - shows a CNS disease

What is a differential diagnosis of myelitis symptoms

Inflammation - Devics - Sarcoidosis Infection Tumour Paraneoplastic process Stoke

What is the different types of MS

Relapse remitting Secondary progressive Primary progressive Sensory Malignant

What occurs in relapsing remitting MS

MS patient has episodes of new or worsening symptoms, known as "relapses". These typically worsen over a few days, last for days to weeks to months, then slowly improve over a similar time period

What are periods between relapse attacks called

remission

What occurs in secondary progressive MS

symptoms gradually worsen over time without obvious attacks.

What do relapsing remitting MS usualy go on to develop

secondary progressive MS within 15- 20 years

What occurs in primary progressive MS

symptoms gradually worsen and accumulate over several years, and there are no periods of remission

When would primary progressive MS present, and what is the prognosis

In 5th and 6th decade Poor prognosis

What symptoms does primary progressive usually involve

Spinal and bladder

What is the affect of sensory MS

Little impairment, and few relapses

What symptoms and relapse pattern usually indicate for a good prognostic

Optic neuritis Long internal between 1st and 2nd relapse few relapse in first 5 years

What symptoms usually indicate for a bad prognostic

Multifocal symptoms and signs Motor symptoms and signs

What is devics disease

heterogeneous condition consisting of the simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis)

How is Devics disease detected

Aquaporin-4 antibodies | Antibody negative in some cases

How is MS managed

Disease modifying treatment Relapse treatment Symptomatic treatment General health and diet Multidisciplinary approach

Who are the potential (8) profession used in the Multidisciplinary treatment of MS

``` MS nurse Physiotherapy Occupational therapy Speech and language therapy Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry ```

What is the symptomatic treatment of spasticity in MS

Muscle relaxants Antispasmodics Physiotherapists

How is sensory involvement: hyperaesthesia treated in MS

Amitriptyline | Gabapentin

How is bladder and bowel symptoms of MS treated

Anticholingeric Bladder stimulation Catherisation Laxatives

What is the medical treatment of an acute relapse

Oral prednisolone

What should always take place with high rise steroids

urinary dipstick

What is the further management in an acute relapse

look for underlying infection Exclude worsening of usual symptoms with intercurrent illness Rehabilitation Vaccination - prevent further relapse

Disease modifying treatment is not a cure, but what is its benefit

Reduces frequency and severity of relapse

What is the 1st line treatments that are subcutaneously or intramuscular injections

Beta Interferons Glatiramer acetate

What is the 1st line treatments that are oral

Terifunomide Di-methy fumarate

What is the overall side effects of 1st line treatments

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

What is the reduced relapse rate of 1st line treatment of MS

reduced relapse rate 1/3

What is the three 2nd line treaments of MS

Natalizumab (month infusions) Fingolimod tablets Alemtuzumub

What is the reduced relapse rate of 2nd line treatment of MS

reduced replace rate 2/3

What is the side affect of Fingolimod tablets

bradycardia

What is the side affect Alemtuzumub

Autoimmune thyroid disease Immune thrombocytopenic purpura Good pastures

What is the overall affect of disease modifying mediation

Causes immunosuppression of the body

What treatment of MS can cause Progressive Multifocal Leukencephalopathy (PML)

natalizuab, finglomod (2nd line) dimethyl fumarate (1st line) as

What is Progressive Multifocal Leukencephalopathy (PML)

Rare viral disease of the brain caused by the JV virus affecting a weakened immune system (due to MS treatment) causing progressive damage/inflammation of the white matter of the brain at multiple locations

How is the progression of PML monitored on MS treatment

MRI annual JC antibody blood and urine 6 monthly