Multiple Sclerosis

Question 1

What is MS?

Answer 1

Inflammatory condition characterised by episodic CNS dysfunction caused by plaques which disseminate in time and space

Question 2

What causes MS?

Answer 2

Scar/plaques form in white matter of CNS

Inflammation damages myelin sheath

These plaques disseminate in time and space

Question 3

How does MS present?

Answer 3

Women in 30/40s.

Motor:
Leg cramping/jerking
Spasticity
Gradual onset weakness

Sensory:
Peculiar sensory phenomena
Pain

Ocular:
Optic neuritis
Internuclear opthalmoplegia

Question 4

What is internuclear ophthalmoplegia and what causes it?

Answer 4

Failure of abduction with nystagmus of contralateral eye

Damage to medial longitudinal fasciculus

Question 5

Describe pattern of relapsing-remitting MS (RRMS).

Answer 5

Clearly defined attacks (relapses)

With return to complete recovery afterwards (remission)

Question 6

Describe pattern of progressive relapsing MS (PRMS).

Answer 6

Clearly defined attacks (relapses)

Between relapses, condition slowly worsens (progressive)

Question 7

Describe pattern of primary progressive MS (PPMS).

Answer 7

No relapsing-remitting pattern in early disease (primary)

Condition slowly worsens (progressive)

Question 8

Describe pattern of secondary progressive MS (SPMS).

Answer 8

Relapsing remitting pattern in early disease (secondary)

Condition slowly worsens (progressive)

Question 9

What investigations should you do in suspected MS as what would they show?

Answer 9

MRI: plaques in white matter (which disseminate in time and space)

LP: oligoclonal bands (90% cases)

(Bloods to rule out other causes: negative)

Question 10

What are the diagnostic criteria for MS?

Answer 10

> 2 episodes suggestive of demyelination

Dissemination of plaques in time and space

Not better explained by other cause

Question 11

How do you treat relapsing remitting MS (RRMS)?

Answer 11

First line:
- ß-interferon (copaxone)
or
- tecfidera

Second line:
- fingolimod

Third line:
- Tysabri
or
- Lemtrada

Question 12

What drugs are used third line for relapsing remitting MS? In what scenario may they be prescribed first line?

Answer 12

Tysabri
Lemtrada

Rapidly evolving or severe MS

Question 13

How do you treat primary progressive MS (PPMS)?

Answer 13

Ocrelizumab

Question 14

How do you treat secondary progressive MS (SPMS)?

Answer 14

Prednisolone

Question 15

How do you symptomatically treat motor symptoms in MS?

Answer 15

Antispasmodics (balcofen, botox)

Question 16

How do you symptomatically treat neuralgic pain in MS?

Answer 16

Atypical analgesics (gabapentin, amitriptyline, lignocaine)

Question 17

How do you symptomatically treat urinary tract dysfunction in MS?

Answer 17

Oxybutynin

Question 18

How do you symptomatically treat fatigue in MS?

Answer 18

Amantadine

Question 19

How do you treat a relapse of MS?

Answer 19

Depends on severity

• mild: symptomatic
• moderate: PO steroids
• severe: IV steroids