Multiple Sclerosis

Question 1

What is the pathology of MS?

Answer 1

CNS white matter demyelination

Autoimmune mediated

• T cells cross BBB and are sensitised to myelin sheath
• Destruction of myelin sheath and then loss of function
• Post infective gliosis may worsen this and lead to axonal loss

Question 2

What is post infective gliosis?

Answer 2

Hyperproliferation of glial cells following damage to surrounding areas

Question 3

What causes are linked to MS?

Answer 3

GENETICS
- HLA-DR2 gene

INFECTION
- EBV

Latitude
- Vitamin D deficiency

Question 4

How do most MS patients present?

Answer 4

With a relapse

Question 5

What is the most common relapse that MS patients present with?

Answer 5

Optic neuritis

Question 6

What are the symptoms of optic neuritis?

Answer 6

Temporary vision loss in one eye from inflammation of the optic nerve

Question 7

What are the other symptoms of MS?

Answer 7

Sensory loss
Limb weakness
Ataxia
Dysarthria

Spinal cord symptoms
- Bladder

Cranial nerve involvement

• Diploplia
• Vertigo
• Nystagmus
• Internuclear opthalmoplegia

Question 8

What is internuclear opthalmoplegia?

Answer 8

Impairment of adduction
Left eye effected for the example
- When trying to look right, the left eye gets stuck in the midline
- The right eye (controlateral) will abduct but there will be nystagmus

Question 9

Signs of MS?

Answer 9

UMN changes in limbs

• Hyperreflexia
• Spacticity

Sensory loss
Weakness
Cerebellar signs
Babinski +

Question 10

DDx of optic neuritis?

Answer 10

Neuromyelitis optica (devics disease)

SLE/Sarcoidosis

Question 11

DDx of MS?

Answer 11

MND

• Some LMN lesions
• Bulbar palsy
• NO SENSORY LOSS

Myasthenia

Tumour
- Paraneoplastic syndrome

Stroke

Question 12

What are the 2 diagnostic criteria for MS?

Answer 12

Poser’s criteria

Macdonald criteria

There must be evidence of more than one episode of demyelination

Question 13

What is Poser’s criteria?

Answer 13

Clinical criteria

• Evidence of 2 seperate attacks at 2 different times in the history

Question 14

What is Macdonald’s criteria?

Answer 14

M for MRI
MRI criteria
- Evidence on MRI of old and young lesions

Question 15

What tests should be done for MS?

Answer 15

MRI (Macdonald’s criteria)

LP

Bloods
- WCC may be raised in relapses

Question 16

What will the LP find?

Answer 16

Oligoclonal bands of IgG on electrophoresis in CSF but NOT IN SERUM

CSF protein <1g/L

Question 17

Surgical management?

Answer 17

Catheterisation

Question 18

What two methods of pharma treatment should be employed?

Answer 18

Symptomatic treatment

Disease modifying treatment

Question 19

What symptomatic treatment should be done?

Answer 19

Spasticity

• Antispasmodics
• Muscle relaxants

Dyasthesia and pain

• Amitriptilline
• Gabapentin

Depression
- Antidepressants

Question 20

What disease modifying treatments can be done?

Answer 20

Beta interferons and glatiramer acetate

• S/C
• I/M

Oral teriflunomide

Amlutuzamab

Question 21

What is glatrimer acetate?

Answer 21

An immunomodulator

Question 22

How should relapses be treated?

Answer 22

Prednisolone

Question 23

What other treatment can be done?

Answer 23

General health
Diet
- Soft?
Laxatives

Question 24

What 2nd line newer treatments can be used?

Answer 24

Monoclonal antibodies

• Amlutuzamab
• Natalizumab

Question 25

What are the big side effects of amlutuzamab?

Answer 25

Autoimmune thyroid disease

Goodpastures syndrome