Multiple Sclerosis Flashcards

1
Q

What causes MS

A

Discrete plaques of demylination occurring at multiples CNS sites
Demyelination heals poorly –> causing relapsing and remitting course
Porlonged demylination causes axonal loss –> progressive symptoms

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2
Q

What is the immune response in MS

A

T cell mediated immune response

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3
Q

What is the average age of onset

A

20-50

Mean age is 30

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4
Q

Which sex is MS more common in

A

female

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5
Q

Does it present monosmptomatically or polysymptomatically

A

Monosymptomatic

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6
Q

What are some of the ways MS presents

A
Unilateral optic neuritis - pain on eye movements and decrease in central vision 
Numbness/tingling in limbs 
Leg weakness 
Brainstem/cerebellar - ataxia, scanning speech, diplopia, dizziness or vertigo
Visual phenomena on exercise 
Spastic weakness
erectile dysfunction 
urinary retention/incontinence 
Swallowing issues 
Constipation 
Dysaesthesia 
Trigeminal neuralgia 
Loss of sensation
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7
Q

When may symptoms get worse

A

in heat or during exercise

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8
Q

How does it progress

A

early on

As disease progresses remissions are incomplete so disability accumulates

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9
Q

What are the poor prognostic signs associated with MS

A
Older age 
Male 
Many MRI lesions 
Axonal loss 
Motor signs at onset 
Relapses early on in disease
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10
Q

How is it investigated

A

MRI - t2 weighted
inflamed areas will appear more opaque
LP will show IgG oligoclonal bands

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11
Q

How are acute relapses of MS treated

A

Steroids - methylprednisolone for 3 days PO

Shortens acute relapses but doesnt alter overall prognosis

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12
Q

How is MS managed

A

Happy, stress free life
Minimis disability
Vitamin D if poor diet or reduced sun exposure

Interferon - decreases relapses and lesion accumulation –> not recommended by NICE
Dimethyl fumerate
Monoclonal antibodies - Teriflunomide​, Alemtuzumab, Natalizumab
Azathioprine may be just as good as interferon

For spasticity –> baclofen, diazepam, dantrolene
Tremor –> Botulin type A injection
Urgency and frequency - if residual volume more than 100ml teach self catheterisation
Pain control

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13
Q

What are the side effects of interferon

A

Flu like symptoms
abortion
Depression

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14
Q

What type of lesions does MS lead to

A

Upper motor neurone lesions

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15
Q

What are the signs of upper motor neurone lesions

A
Hypertonia 
Hyperreflexia 
Spasticity 
Positive babinskis sign 
Muscle mass maintained
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16
Q

Which viral diseases are thought to contribute to developing MS

A

Epstein Barr virus

Herpes virus 6

17
Q

What is needed for diagnosis

A

2 separate episodes needed in 2 different places at two different times

18
Q

What the different types of MS

A

Relapsing-remitting
Secondary progressive - develops folloing relapsing and remitting
Primary progressive - no relapses or remittance
Progressive relapsing - gradual progression of relapses going back to previous progressive trajectory