Multiple Sclerosis Flashcards
What is Multiple Sclerosis?
A disease involving relapsing episodes of immunologically mediated (T-cell) demyelination in the CNS, leading to neurological degeneration
In what groups does MS most commonly present?
1/1000 UK population
2:1 female preponderance
Age of onset 20-45 years
Genetic predisposition (HLA-DR2)
Where are MS plaques most commonly seen?
Optic nn Angles of lateral ventricles Cerebellar peduncles Brainstem Dorsal/corticospinal tracts
What are the common sx of MS?
Visual disturbance (optic neuritis) UMN deficit Sensory deficit Cerebellar signs Brainstem signs Cognitive impairment
What are the sx/signs of optic neuritis?
Blurring of vision over hrs/days Mild ocular pain, worse on movement Loss of colour vision Diplopia Recovery w/i 2mo
What are the sx/signs of UMN deficit?
Paraparesis
Hemiparesis
Monoparesis
What are the sx/signs of sensory deficit?
Paraesthesia
Proprioceptive loss
L’Hermitte’s sign - tingling sensations down arms/legs on neck flexion (post cervical lesions)
What are the cerebellar signs of MS?
Intention tremor
Nystagmus
Vertigo
Dysarthria
What are the brainstem signs of MS?
Frequency/urgency followed by defecation
Constipation, urgency of defecation
Erectile dysfunction/ejaculatory failure
What is the pattern of cognitive impairment in MS?
Develops late in disease
IQ/language affected
What is the pattern of neurological deficit in MS?
Appear irregularly throughout CNS in terms of site/time
Come on over days/weeks plateau, gradually resolve over wks/months
Recurrence unpredictable
What is Uthoff’s phenomenon?
The fact that sx are worse during a fever/hot weather/after exercise
Central conduction slowed by increased body temperature
What are the different clinical patterns of MS?
Primary progressive MS (10-20%)
Relapsing/remitting MS (80-90%)
Fulminating MS (<10%)
Describe primary progressive MS
No clear cut relapses/remissions
Diagnosed if progressive deterioration over >1 yr
Describe relapsing/remitting MS
Initial episodes resolve completely
Subsequent episodes result in residual disability
Pts eventually develop 2o progressive MS
-steady progression w/o remission
Describe fulminating MS
Debilitating progressive deterioration from early stage
What is required for a diagnosis of MS?
Two characteristic episodes of neurological dysfunction, separated in space/time
MRI evidence of lesions
What investigations are appropriate in suspected MS?
Bloods - FBC, U&Es, LFT, ESR, TFTs, glucose, ca, B12, HIV serology
MRI - multiple plaques (>10 in clinical relapse)
CSF - cell count raised, high protein, oligoclonal IgG bands (electrophoresis)
VER - delayed occipital EEG reactions to visual stimuli
What are the differential diagnoses of MS?
Relapsing-remitting -TIAs -SLE -CNS sarcoidosis Primary progressive -MND -CNS mass -Spinal/cerebellar degenerative diseases (PD, AD, Huntingtons)
What is the management for an acute MS relapse?
Investigate to rule out alternative causes
Consider admission
High dose corticosteroids
-Oral methylprednisolone (0.5g/day for 5/7)
-Start ASAP, may reduce severity
Pt education
What is the general management for MS?
Annual review by MS MDT Lifestyle advice (exercise/smoking cessation) Treat co-existing illness Manage complications Disease-modifying therapy
What disease-modifying therapy is available in MS?
Relapsing/remitting
- Dimethyl fumarate/Teriflunomide
- Natalizumab (>2 relapses in 1yr, decreases relapses by 1/3)
What are the common complications of MS?
Fatigue Spasticity Ataxia/tremor Mobility issues Depression Bladder dysfunction Sexual dysfunction Pressure sores
How are the complications of MS managed?
Fatigue - Amantadine + cognitive approaches
Spasticity - Baclofen + physiotherapy
Ataxia/Mobility/Pressure Sores - Physio/OT
Depression - CBT
Bladder dysfunction - Oxybutinin OR self-catheterisation
Sexual dysfunction - Sildenafil
