Multiple sclerosis Flashcards
1
Q
Multiple sclerosis
A
- inflammatory demyelinating disease of the CNS
- leading cause of neurological disability in the UK
- Age of onset 20 - 45 years
- More common in females than males
2
Q
Pathogenesis
A
- activated T lymphocytes which cross the blood-brain-barrier
- T cells initiate as inflammatory cascade resulting in areas of demyelination
- Plaques of demyelination in
- optic nerve
- corpus collosum
- brainstem
- tracts - demyelinated neurons then heals poorly causing relapsing and remitting symptoms
- acute episodes are due to focal inflammation causing myelin damage and conduction block
3
Q
Causes of MS
A
Both genetic and environmental factors play a part
- Multiple genes increase risk of MS - HLA and MHC polymorphisms
- Environmental factors such as viral infections of EBV and HHV
4
Q
Types of MS
A
- relapsing-remitting (80-90%)
- primary progressive (10-20%)
- secondary progressive
5
Q
Clinical features
A
- Optic neuritis - demyelination of the optic nerve
- blurred vision
- reduced visual acuity / reduced colour vision
- optic disc swelling - Brainstem demyelination
- Diplopia
- Vertigo
- Facial numbness/weakness
- Dysarthia/Dysphagia - Spinal chord lesions
- gradually progressive paralysis over days and weeks
- neuropathic pain]
- spasticity
- tingling
- Bladder dysfunction
6
Q
Diagnosis
A
- positive history of symptoms
- MRI of brain.spinal chord - demonstrates area of demyelination
- CSF from an LP shows oligoclonal IgG bands
7
Q
Treating symptoms of MS
A
- Muscle spasticity - anti spastic drugs like Baclofen and Diazepam
- botulin toxin injections into affected muscles - Bladder dysfunction - Anticholinergic drugs e.g. Oxybutynin
- Trigeminal neuralgia - Antiepileptic drugs
- Neuropathic pain and dysaethesia - pain modulating drugs ( amitriptyline + gabapentin)
- Fatigue - Modafinal
- Mood disturbance - Antidepressant
8
Q
Treating acute attacks of MS
A
- Controlled by IV corticosteroids ( methylprednisilone)
2. Monoclonal antibody Alemtuzumab is used to attack T cells
9
Q
Maintainance treatment of MS
A
- Relaspsing remitting MS
- Interferon Beta-1A & Beta-1b
- Glatiramer Acetate
- Mitoxantrone - Progressive MS
- Mitoxantrone - only shown to have positive impact on disease progression
10
Q
Relapsing Remitting form of MS
A
- characterised by clearly defined relapses caused by appearance of new areas of demyelination
- Symptoms develop gradually over days or weeks and resolve over several weeks
- May resolve completely or incompletely
- no disease progression between specific relapses
11
Q
Primary progressive from
A
- slow progression of neurological symptoms and disability
- tends to present at older age
- commonly with paraparesis caused by thoracic spinal chord demyelination
- NO relapsises or remisiions
12
Q
Secondary progressive form
A
- Approximately 75% of those with relapsing-remitting MS go on to develop secondary progressve disease
- slowly progressive disability
- with or without ocurrences of relapses or remissions