Multiple Sclerosis Flashcards
What is the pathophysiology of multiple sclerosis?
Cell mediated autoimmune demyelination of the white matter CNS. This leads to reduced conduction velocity
Disseminated (over time and space)
What are some poor prognostic signs for MS?
Older patient
Motor signs at onset
Many MRI lesions
What are common first symptoms of MS?
Optic Neuritis - pain on eye movement with greying and blurring of vision
Odd sensations such as wetness or burning
What pathway does MS commonly involve?
Corticospinal path - motor pathway
How does heat affect MS symptoms?
Symptoms worsen
What sensory symptoms are seen in MS?
Dysaesthesia (abnormal unpleasant feeling when touched) Pins and needles Decreased vibration sense Trigeminal neuralgia Lhermitte's syndrome
What motor symptoms are seen in MS?
Spastic weakness
Myelitis
Hyper-reflexia
What GU symptoms are seen in MS?
Erectile dysfunction
Anorgasmia
Urinary frequency
Incontinence
What GI symptoms are seen in MS?
Swallowing difficulty
Constipation/diarrhoea
What eye symptoms are seen in MS?
Diplopia Optic neuritis Nystagmus Opthalmoplegia Uhthoff's Phenomenon
What cerebellar signs are seen in MS?
Trunk/limb ataxia
Intention tremor
Scanning speech (ataxic dysarthria)
What cognitive/visiospatial signs are seen in MS?
Amnesia
Executive dysfunction - emotional and behavioural difficulty
Depression/mood disorders
cognitive impairment
What are some subtypes of MS?
Relapsing-remitting (most common)
Secondary progressive disease
Primary progressive disease
What is relapsing-remitting MS like?
Acute 1-2 month attacks followed by periods of remission
What is secondary progressive disease?
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
What is primary progressive disease?
Progressive deterioration seen from the onset
What is Lhermitte’s syndrome?
electric shocks in limbs on neck flexion
What is Uhthoff’s phenomenon?
Worsening vision following rise in temperature
What lifestyle advice is given for patients with MS?
Regular exercise
Stop smoking
Avoid stressful situations
How are acute relapses managed?
High dose IV methylprednisolone
What criteria have to be met for beta interferon to be used?
Not suitable for primary progressive.
Have to have had 2 relapses in past 2 years.
What is the effect of beta interferon on MS?
Reduce number of relapses and MRI changes
No effect on disability
What disease modifying drugs are used in MS
Interferon-B Glatiramer acetate Dimethyl fumerate Alemtuzumab Natalizumab Fingolimod
How is spasticity in MS controlled?
Baclofen and gabapentin
Physio
How is tremor in MS controlled?
Botulinum toxin
Primidone
How is bladder dysfunction managed?
If significant residual volume - self catheterise
Frequency symptoms - Anticholinergics
How is oscillopsia (visual fields oscillating) managed?
Gabapentin
How is fatigue managed?
Amantadine and CBT
How is MS diagnosed? What are the results of these investigations?
MRI contrast: demyelination plaques (hyperintense plaques in the periventricular region)
Electrophoresis of CSF: oligoclonal bands of IgG
Evoked potentials: prolonged conduction
Differentials for MS
Cervical spondylosis
Fibromyalgia
Stroke
B12 deficiency
