Multiple Sclerosis Flashcards
What is MS? What types are there?
Chronic autoimmune disorder
Plaques of demyelination are found throughout the brain and spinal cord, relapsing/remitting - dissemination of symptoms in space and time crucial for diagnosis
Goes from relapse/remitting to secondary progressive phase. Also can get primary progressive MS (10-15%), presents in 5th/6th decade).
What are the types of symptoms/signs of MS?
Most cases present with a relapse - gradual onset over days
Relapse symptoms
- Optic neuritis
- Myelitis/Spinal cord symptoms
- Brainstem symptoms
Progressive symptoms
What are the symptoms of optic neuritis in MS?
Subacute visual loss Pain on moving Colour vision disturbed Optic disc swelling sometimes Optic atrophy seen later Relative afferent pupillary defect
What are the brainstem related symptoms/signs of MS?
Diplopia Vertigo Facial numbness/weakness Dysarthria Dysphagia Nystagmus Bilateral internuclear opthalmoplegia = pathognomonic for MS
What are the myelitis related symptoms/signs of MS?
Paraparesis developing over days or weeks Numbness/tingling Often with band of hyperaesthesis Weakness below level Bladder/bowel involvement May be painful
What are the symptoms of the progressive stage of MS?
Fatigue Temperature sensitivity Sensory symptoms Stiffness/spasms Balance, speech issues Poor balance, speech problems Swallowing issues Bladder/bowel problems Cognitive/emotional problems Brainstem symptoms
What investigations might be done in suspected MS?
Examination
- cranial nerves
- cerebellar, sensory signs
- UMN signs
- plantaris extensor
MRI
- 1 relapse per 10 lesions
Others
- LP - oligoclonal bands in CSF but not serum
- Bloods to exclude other conditions
- CXR
Possible differential diagnoses of MS?
Inflammatory disorders - Devics, SLE, Sarcoidosis
Infection - HIV, HSV, TB, Borrelia
Tumour
Stroke
General treatments for MS?
Acute relapse
- look for underlying infection
- oral/IV prednisolone
- rehab
- symptomatic treatments
Longer-term
- disease modifying treatments
- vaccinations
What are the disease-modifying treatments in MS?
Beta-inferferons
Glatiramer acetate
Teriflunomide
Dimethyl fumarate
Others
- Natalizumab
- Fingolimod tablets
- Alentuzumab
Symptomatic treatments in MS?
Spasticity - muscle relaxants/antispasmodics Dyaesthesia - Amitripyline, Gabapentin Urinary - anticholinergic, bladder stimulator/catheter Constipation - laxatives Sexual dysfunction - sildenafil Fatigue - exercise, medication Depression - CBT, medication Cognitive - memory aids Tremor - aids, pharmaceuticals Vision/oscillopsia - Carbamazepine Speech/swallowing - SALT Motor/sensory - MDT
Risks in treating MS with immunosuppressants?
Progressive Multifocal Leukencephalopathy
caused by JC virus
What causes the demyelination in MS?
Activated T cells cross BBB causing demyelination
Acute inflammation of sheath leading to loss of function
Repair = recovery
Post-inflammatory gliosis
What causes MS? (Pathogenesis?)
Complex genetic inheritance Females 2-3x more likely Commoner in temperature climate Vitamin D link? EBV?
