Multiple Sclerosis Flashcards
What demographic does Multiple sclerosis affect
Relatively common neurological disease of young people
Where exactly does multiple sclerosis occur
In the central nervous system white matter
What is the pathology if multiple sclerosis
auto-immune process as activated T cells cross blood brain barrier causing demyelination
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
What can progressive multiple sclerosis pathologically lead to
Lead to axonal loss and cerebral atrophy
What is the affect of progressive multiple sclerosis
Development of persistent disability - affecting daintily living
Who has a worse prognosis men or woman
Men
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)
What is the initial presentation of MS
Gradual onset over days
stabilises day to weeks
Gradual resolution to complete or partial recovery
For multiple sclerosis to be diagnosed after initial presentation, what needs to occur
A Relapse to occur within months or years of first presentation
What is the statistic of MS cases relapses
80% cases MS presents with a relapse
How are not all MS relapses the same
All have variable site and severity
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
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
What is the initial to lateral presentation of optic neuritis
Swelling of optic disc
to
Optic atrophy
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
How is limb weakness caused in MS
Due to MS causing a lesion to upper motor neurone
Weakness occurs below level of lesion
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
What is affected in a brainstem relapse due to MS
Pons - cranial nerves
Cerebellum
Upper motor neurones
Sensory involvement
What causes progressive phase of MS
Accumulation of symptoms and signs
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
What is the definition of MS used for diagnosis
Episode of demyelination disseminated in space and time
What is the two diagnostic criteria for MS
Posers criteria - clinical examination
Macdonalds criteria - MRI based diagnosis
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
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
