multiple sclerosis

Question 1

where does demyelination occur?

Answer 1

optic nerves - optic neuritis
cerebellar signs
SC - spastic paraparesis or sensory demyelination
medial longitudinal bundle - internuclear ophthalmoplegia

Question 2

multiple sclerosis - investigations

Answer 2

diagnosis mainly clinical - 2 sep attacks affecting diff parts of CNS
MRI - plaques (periventricular + juxtacortical)
CSF - oligoclonal bands

visually evoked potentials - delay in EEG response due to optic neuropathy
somatosensory evoked potentials - delay in EEG response after episode of sensory demyelination

Question 3

multiple sclerosis - treatment of acute attack

Answer 3

if just sensory may not need
3d IV methylpred - reduces duration + severity of attacks but no long term impact (small risk psychosis, DM, AVN fem head)

Question 4

multiple sclerosis - types

Answer 4

relapsing remitting
primary progressive
benign

Question 5

multiple sclerosis - presentation

Answer 5

sensory
optic neuritis
cerebellar/vertigo
internuclear ophthalmoplegia
motor - eg spastic paraparesis

Question 6

indications for disease-modifying drugs in multiple sclerosis

Answer 6

ambulant patient with RRMS

>2 relapses in 2y - or 1 relapse plus radiological progression