Multiple Sclerosis Flashcards
What is multiple sclerosis?
Inflammatory neurodegenerative demyelinating disorder of the white matter in the CNS involving deposition of plaques
Males are more commonly affected by MS than females. True/False?
False
Females 3:1 males
List the 4 classifications of MS (in order of decreasing disability)
Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive
Which classification of MS is the most common?
Relapsing remitting
List clinical features of MS
Pyramidal dysfunction Optic neuritis/ VISUAL SYMPTOMS Sensory dysfunction Lower urinary tract dysfunction Cognitive impairment
List features of pyramidal dysfunction that can occur in MS
Hypertonia (STIFFNESS) WEAKNESS Spasticity Weakness of extensors of upper limbs Weakness of flexors of lower limbs
List features of sensory dysfunction that can occur in MS
Paraesthesia Pain Proprioception and vibration deficit Numbness Trigeminal neuralgia
List features of cerebellar dysfunction that can occur in MS
Ataxia Intention tremor Nystagmus Past pointing Pendular/floppy reflexes Dysdiadokinesis Dysarthria
What is internuclear ophthalmoplegia?
Defect in medial longitudinal fasciculus resulting in nystagmus in an abducting eye + lag/failure in adducting eye (diplopia)
List lower urinary tract features of MS
Frequency Nocturia Urgency Urge incontinence Retention
What therapy can be given for fatigue in MS?
Amantadine
Modafinil if epilepsy or sleepy
What investigations can be done for MS?
MRI with gadolinum contrast
CSF
Neurophysiology
Blood tests
Blood tests are usually normal in MS. True/False? What blood tests should be requested?
True
Plasma viscosity, FBC, CRP, renal liver bone profile, autoantibody screen, borellia, HIV, sypillus serology, B12 and folate
What is the name given to the protein bands present on CSF electrophoresis in MS?
Oligoclonal bands - typically not similar
Outline treatment for acute exacerbation of MS (mild, mod, severe)
Mild: symptom relief
Mod: oral steroid
Sev: IV steroid
What therapy can help spasticity?
Physiotherapy
Anti-spasmodic (baclofen)
Botox
What therapy can help sensory symptoms?
Gabapentin (anticonvulsants) Amitryptiline (antidepressants) TENS Acupuncture Lignocaine (last-resort)
List 1st-line disease-modifying therapy for MS
Interferon-beta (avonex, extavia, rebif, betaseron)
Copaxone
Tecfidira
List 2nd-line disease-modifying therapy for MS
Monoclonal antibody (tysabri, lemtrada, zymbrota) Fingolimod
What age range is the onset of MS most common?
30s - 40s
List features of brainstem dysfunction that can occur in MS
Diplopia (VI palsy) Facial weakness (VII palsy)
List clinical signs of optic neuritis
Painful loss of vision
Blurred vision
Loss of colour vision
RAPD (central scotoma)
What clinical sign on MRI must be present to diagnose MS?
Evidence of dissemination of inflammatory plaques in white matter in time and place (damage at different rates and to different parts of CNS)
In order to diagnose MS, there must be at least ___ episodes suggestive of demyelination
2
