Multiple sclerosis

Question 1

What is the pathogenesis of multiple sclerosis?

Answer 1

Development of inflammatory plaques of demyelination in the CNS. Typical age of onset around 30 years. Prevalence increases further from equator.

Question 2

What are the clinical features of multiple sclerosis?

Answer 2

Sensory - Trigeminal neuralgia, pins and needles, dysaesthesia, decreased vibration sense
GU - erectile dysfunction, urinary retention, incontinence
Motor - Myelitis, spastic weakness

Question 3

What is the progression of secondary progressive MS?

Answer 3

It initially follows the relapsing remitting cycle and then goes on to become secondary progressive where it progresses without remission
Primary progressive is like this from the start

Question 4

How is MS diagnosed?

Answer 4

By using the mcdonald criteria of symptoms. Also then can perform MRI, CSF will show IgG present in the csf that is not present in the serum. Can evoke potentials that will show delay in visual, auditary and somatosensory areas

Question 5

What is the pathogenesis early vs late in the disease?

Answer 5

Early is inflammation and demyelination

Late is atrophy, axonal loss and increased tissue destruction - this causes progressive disability

Question 6

What is the management of MS?

Answer 6

Lifestyle advise - regular exercise, stop smoking
Disease modifying drugs:
- dimethyl fumerate for mild disease
-Monoclonal antibodies such as alemtuzumab (against t cells)
Relapses treated with prednisolone
Spasticity treated with gabapentin