Multiple Sclerosis Flashcards
What causes MS
Discrete plaques of demylination occurring at multiples CNS sites
Demyelination heals poorly –> causing relapsing and remitting course
Porlonged demylination causes axonal loss –> progressive symptoms
What is the immune response in MS
T cell mediated immune response
What is the average age of onset
20-50
Mean age is 30
Which sex is MS more common in
female
Does it present monosmptomatically or polysymptomatically
Monosymptomatic
What are some of the ways MS presents
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
When may symptoms get worse
in heat or during exercise
How does it progress
early on
As disease progresses remissions are incomplete so disability accumulates
What are the poor prognostic signs associated with MS
Older age Male Many MRI lesions Axonal loss Motor signs at onset Relapses early on in disease
How is it investigated
MRI - t2 weighted
inflamed areas will appear more opaque
LP will show IgG oligoclonal bands
How are acute relapses of MS treated
Steroids - methylprednisolone for 3 days PO
Shortens acute relapses but doesnt alter overall prognosis
How is MS managed
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
What are the side effects of interferon
Flu like symptoms
abortion
Depression
What type of lesions does MS lead to
Upper motor neurone lesions
What are the signs of upper motor neurone lesions
Hypertonia Hyperreflexia Spasticity Positive babinskis sign Muscle mass maintained