Multiple Sclerosis

Question 1

What is the pathophysiology of multiple sclerosis?

Answer 1

Cell mediated autoimmune demyelination of the white matter CNS. This leads to reduced conduction velocity
Disseminated (over time and space)

Question 2

What are some poor prognostic signs for MS?

Answer 2

Older patient
Motor signs at onset
Many MRI lesions

Question 3

What are common first symptoms of MS?

Answer 3

Optic Neuritis - pain on eye movement with greying and blurring of vision
Odd sensations such as wetness or burning

Question 4

What pathway does MS commonly involve?

Answer 4

Corticospinal path - motor pathway

Question 5

How does heat affect MS symptoms?

Answer 5

Symptoms worsen

Question 6

What sensory symptoms are seen in MS?

Answer 6

Dysaesthesia (abnormal unpleasant feeling when touched)
Pins and needles
Decreased vibration sense
Trigeminal neuralgia
Lhermitte's syndrome

Question 7

What motor symptoms are seen in MS?

Answer 7

Spastic weakness
Myelitis
Hyper-reflexia

Question 8

What GU symptoms are seen in MS?

Answer 8

Erectile dysfunction
Anorgasmia
Urinary frequency
Incontinence

Question 9

What GI symptoms are seen in MS?

Answer 9

Swallowing difficulty

Constipation/diarrhoea

Question 10

What eye symptoms are seen in MS?

Answer 10

Diplopia
Optic neuritis
Nystagmus
Opthalmoplegia
Uhthoff's Phenomenon

Question 11

What cerebellar signs are seen in MS?

Answer 11

Trunk/limb ataxia
Intention tremor
Scanning speech (ataxic dysarthria)

Question 12

What cognitive/visiospatial signs are seen in MS?

Answer 12

Amnesia
Executive dysfunction - emotional and behavioural difficulty
Depression/mood disorders
cognitive impairment

Question 13

What are some subtypes of MS?

Answer 13

Relapsing-remitting (most common)
Secondary progressive disease
Primary progressive disease

Question 14

What is relapsing-remitting MS like?

Answer 14

Acute 1-2 month attacks followed by periods of remission

Question 15

What is secondary progressive disease?

Answer 15

R-R patients don’t fully remit and over time the disability accumulates (around 65% of R-R patients progress within 15 years)

See gait and bladder problems

Question 16

What is primary progressive disease?

Answer 16

Progressive deterioration seen from the onset

Question 17

What is Lhermitte’s syndrome?

Answer 17

electric shocks in limbs on neck flexion

Question 18

What is Uhthoff’s phenomenon?

Answer 18

Worsening vision following rise in temperature

Question 19

What lifestyle advice is given for patients with MS?

Answer 19

Regular exercise
Stop smoking
Avoid stressful situations

Question 20

How are acute relapses managed?

Answer 20

High dose IV methylprednisolone

Question 21

What criteria have to be met for beta interferon to be used?

Answer 21

Not suitable for primary progressive.

Have to have had 2 relapses in past 2 years.

Question 22

What is the effect of beta interferon on MS?

Answer 22

Reduce number of relapses and MRI changes

No effect on disability

Question 23

What disease modifying drugs are used in MS

Answer 23

Interferon-B
Glatiramer acetate
Dimethyl fumerate
Alemtuzumab
Natalizumab
Fingolimod

Question 24

How is spasticity in MS controlled?

Answer 24

Baclofen and gabapentin

Physio

Question 25

How is tremor in MS controlled?

Answer 25

Botulinum toxin

Primidone

Question 26

How is bladder dysfunction managed?

Answer 26

If significant residual volume - self catheterise

Frequency symptoms - Anticholinergics

Question 27

How is oscillopsia (visual fields oscillating) managed?

Answer 27

Gabapentin

Question 28

How is fatigue managed?

Answer 28

Amantadine and CBT

Question 29

How is MS diagnosed? What are the results of these investigations?

Answer 29

MRI contrast: demyelination plaques (hyperintense plaques in the periventricular region)
Electrophoresis of CSF: oligoclonal bands of IgG
Evoked potentials: prolonged conduction

Question 30

Differentials for MS

Answer 30

Cervical spondylosis
Fibromyalgia
Stroke
B12 deficiency