Multiple Sclerosis Flashcards
Is MS a disease of the old or young?
Young
What is MS?
An autoimmune inflammatory disease that affects the myelin sheath surrounding neurons
Is MS a grey or white matter disease?
White matter
What type of process is demyelination?
Inflammatory
Is MS a disease of the CNS or PNS?
CNS
How does MS manifest?
Depends where the inflammation of the myelin is present
How does demyelination occur?
Activated T cells cross the BBB and attack causing demyelination
What can be seen on an MRI of MS?
Lesions or plaques of scarring where the myelin has attempted to repair itself
Black holes
Which country has the highest prevalence of MS?
Scotland
Does MS affect more M or F?
F
Describe the relationship of MS to the earths equator?
The further you move away from the equator the greater the incidence of MS
Is there a genetic link with MS?
Yes
Which is the highest age group being diagnosed with MS?
20-30yrs
What is the initial presentation of MS?
Present with a relapse of an attack of demyelination
Give some examples of MS relapses
Optic neuritis Sensory symptoms Limb weakness Brainstem diplopia Vertigo Signs including or excluding the bladder (e.g urine incontinence)
What are the symptoms of optic neuritis?
Subacute visual loss
Pain on moving the eye
What are the signs of optic neuritis?
Initial swelling of optic disc
Optic atrophy
Relavent afferent pupillary defect
What are the potential signs an symptoms of a brainstem relapse in MS?
Problems with eye movements (CN III,IV and VI) Vertigo, nystagmus, ataxia (CNVIII) Sensory involvement Upper motor neurone changes limbs
Where can MS relapses occur?
Anywhere in the CNS
What are some symptoms of an MS relapse?
Optic neuritis Sensory symptoms Limb weakness Brainstem diplopia/vertigo/ataxia Spinal cord - bilateral symptoms and signs +/_ bladder
What is myelitis?
Inflammation of the spinal cord
What is the definition of MS?
Episodes of demyelination disseminated in space AND time
What are the signs and symptoms of myelitis?
Sensory level often with band of hyperaesthesia Weakness/ upper motor neurone changes below level Bladder and bowel involvement - urinary retention - Constipation May be painful
Is an isolated episode of demyelination MS?
No
MS = episode of demylelination disseminated in space and time
There has to be another episode
Where is a common site for MS relapse?
Variable sites and severity
Totally unpredictable
Totally variable
What can be seen on examination in MS?
Depends on where demyelination has occurred and stage of disease: Afferent pupillary defect Nystagmus or abnormal eye movements Cerebellar signs (balance ect...) Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor
What is the diagnosis of MS?
Evidence of demyelination separated in time and space
How is MS diagnosed?
Can be clinical or MRI based
What criteria is used for clinical diagnosis of MS?
Posers criteria
What criteria is used for MRI diagnosis of MS?
Macdonald criteria
What other investigations can be done in MS apart from MRI?
LP
Bloods - to exclude other inflammatory conditions
How can a LP be useful in MS diagnosis?
Can look at oligoclonal bands
If you have matched bands in the blood or serum then it is likely to be widespread inflammation occurring but if only present in the CSF then means it is isolated and diagnosed as MS
What are the types of MS?
Relapsing Remitting Secondary progressive Primary progressive Sensory Malignant
Who are prognostic indicators good for?
Female
Present with optic neuritis
Long interval between 1st and 2nd interval
Few relapses in first 5 years
Who are prognostic indicators bad for?
Male
Older age
Multifocal symptoms and signs
Motor symptoms and signs
When does primary progressive MS usually present?
50-60 yrs
Are there relapses in Primary progressive MS?
No
What is the prognosis for primary progressive MS?
Poor
What is
Neuromyelitis Optica Spectrum Disorder?
Variant of MS
Inflammatory demyelination causes attacks of optic neuritis and myelitis
What is a differential diagnosis for MS?
Progressive Multifocal Leukencephalopathy (PML)
Neuromyelitis Optica Spectrum Disorder:
What is Progressive Multifocal Leukencephalopathy (PML)?
Progressive multifocal leukoencephalopathy (PML) is a rare and usually fatal viral disease characterized by progressive damage or inflammation of the white matter of the brain
What is the treatment approach for MS?
Treat the symptoms not the disease
How should spastic muscles be treated?
Muscle Relaxants
How should dysaethesia be treated?
Amitriptyline
How should urinary problems be managed?
Bladder stimulator
Catheterisation
How should constipation be treated?
Laxatives
How should depression be treated in MS?
CBT
What treatment is used for MS?
Ocrelizumab Dimethyl Fumarate Beta-interferons Natalizumab Alemtuzumub
Does MS treatment reduce disease progression?
No but reduces relapse rate
What is the only disease modifying therapy approved for primary progressive MS?
Ocrelizumab
What are the side effects of MS treatment?
Flu-like symptoms Injection site reaction Abnormalities of blood count and liver function Reduce relapse rate ~1/3 No effect on progression of disability Not a cure
Who would be involved in the MS Multidisciplinary team?
MS nurse Physiotherapy Occupational therapy Speech and language therapy Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry
What is optic neuritis?
Inflammation of the optic nerve
What could be symptoms of a sensory attack?
Pins and needles
Decreased vibration sense
Dysaethesia
What could be symptoms of a GI relapse?
Swallowing problems
Constipation
What could be symptoms of a Sexual/GU relapse?
ED
Urinary incontinence
Urinary retention
What are general Rx advice for MS?
Regular exercise
Stop smoking
Avoid stress
What drug is used for treating relapses?
Methylprednisolone
Describe relapsing remitting MS
Most common
Clearly defined as attacks followed by periods of partial or complete recovery/remission
Gradual worsening over time
Describe Primary Progressive MS
Worsening neuroloigcal function from onset without relapses or remission
Without relapses or remission
Describe secondary MS?
Follows initial relapsing-remitting course
Transition to progressive /decline without periods of remission
Describe Sensory MS
Those who have only ever had mild sensory episodes
Describe Malignant MS?
Severe disability in small period of time
Very aggressive demyelination attacks
Rapid decline in function
