Multiple Sclerosis Flashcards
What is MS?
autoimmune demyelinating disorder
What is MS characterised by?
2 or more separate lesions disseminated in time and space (at separate times and places in the brain)
Who typically gets MS?
young white women (20-40)
What are risk factors for MS?
female sex
northern latitude
What are the subtypes of MS?
relapsing and remitting
primary progressive
secondary progressive
What is clinical isolated syndrome (CIS)?
The first symptom or lesion - MS can’t be diagnosed until multiple
e.g. optic neuritis
What is the most common type of MS?
Relapsing and remitting
What causes MS?
Plaques of demyelination occur at multiple CNS sites
Describe relapsing and remitting MS?
Patients have distinct attacks of symptoms - fade away either partially or completely
What is a relapse?
the appearance of new symptoms or return of old symptoms for >24hours
How long do relapses usually last?
4-6weeks
What is the treatment of an acute relapse?
steroids e.g. methylprednisolone
What is primary progressive MS?
From first onset of symptoms it is progressive (symptoms gradually get worse over time rather than being acute - relapse)
When is primary progressive MS usually diagnosed?
middle aged
What is secondary progressive MS?
Comes after having had relapsing and remitting MS
No longer get relapses but disease gets steadily worse
What is the treatment of relapsing remitting MS?
disease modifying therapies (DMTs)
e.g. b interferon, dimethyl fumirate (techfidera), fingolimod
What do DMTs do in relapsing remitting MS?
Not a cure
Reduce frequency of relapses
What are the three areas of MS treatment?
acute relapse treatment
ongoing disease modifying treatment
symptomatic treatment
What can be used to treat spasticity in MS?
baclofen
What can be used to treat neuropathic pain in MS?
amitryptilline
pregabalin
gabapentin
What is the biggest risk with some DMTs?
risk of developing PML from reactivation of JC virus
How is MS diagnosed?
clinical diagnosis
MRI - brain and spinal cord
What are some symptoms of MS?
Visual disturbance (optic neuritis)
Numbness or tingling in limbs
Weakness
Spasticity
What are some findings on examination in MS?
brisk reflexes
spasticity
clonus
How can urinary tract dysfunction be treated in MS?
bladder retraining
self catheterisation
desmopressin
