Multiple Sclerosis

Question 1

Pathology of MS?

Answer 1

Plaques of demyelination occur at multiple CNS sites - from T cell mediated immune response

Question 2

Is MS more common in males or females?

Answer 2

Females, 3:1

Question 3

Typical age of onset in MS?

Answer 3

30-40 years old

Question 4

Classifications of MS?

Answer 4

Relapsing - remitting

Progressive

Question 5

Clinical features of MS?

Answer 5

Sensory - dysaesthesia , pins and needles, dorsal column loss (propioception and vibration ), trigeminal neuralgia
Optic neuritis -painful vision loss
Cerebellar dysfunction - ataxia, intention tremor, nystagmus, dysdiadokinesis
Pyramidal dysfunction - increased tone, spasticity, weakness, weakened extensors of upper limbs and flexors of lower limbs
Brainstem dysfunction - Diplopia, facial weakness
Sexual / GU- erectile dysfunction, urinary retention, in continence

Question 6

Diagnosis of MS?

Answer 6

Clinical - 2 episodes suggestive of demyelination
MRI
McDonald criteria

Question 7

Management of an acute exacerbation of MS?

Answer 7

Mild - Symptomatic
Moderate - oral methylprednisolone
Severe - admit / IV methylprednisolone

Question 8

Management of MS spasticity ?

Answer 8

Baclofen
Tizanidine
Physio

Question 9

Management of MS tremor?

Answer 9

Botulinum toxin

Question 10

Management of MS?

Answer 10

Interferons 
Tecfidera
Monoclonal antibodies
Baclofen 
Botulinum toxin
Gabapentin
Amitriptyline

Question 11

Effect of interferons on MS?

Answer 11

Reduce relapses by 1/3

Reduce severity of relapses

Question 12

Effect of tecfidera on MS?

Answer 12

Reduce relapse rate by 44%

Question 13

Side effects of tecfidera?

Answer 13

Flushing
PML
Liver and bowel problems