Multiple Sclerosis Flashcards
What is MS?
An inflammatory demyelinating disorder of the CNS
MS in an inflammatory disorder. What mediates this?
It is immune mediated by T cells
What characterises MS?
Presence of plaques in the CNS, which are disseminated in place and time
CNS plaques in MS can be visualised on what type of imaging?
MRI
What is meant by the plaques in MS being ‘disseminated in place and time’?
They are seen on MRI in different parts of the nervous system, and they come and go
What is the sex ratio of MS? When is it most likely to present?
Affects females 3: 1 / 30s/40s
What is the cause for MS?
Individuals have a genetic predisposition, and then are exposed to an environmental stimulus
What is a common theory for what environmental stimulus causes MS? Why is this a theory?
Vitamin D deficiency / MS in much more common in countries further from the equator
In MS, demyelination is the hallmark, but disability is actually caused by what?
Axonal loss
What type of MS is this describing: episodes of severe disability which either completely or partially resolve, but less fully every time?
Relapsing remitting
What type of MS is this describing: a slow and steady progression of disability?
Primary progressive
What type of MS is this describing: initially relapsing remitting, followed by a phase of steady progression in disability?
Secondary progressive
What type of MS is this describing: episodes of acute deterioration on top of a continuous slow decline?
Progressive relapsing
What are the main pyramidal features of MS?
Increased tone, spasticity, fast reflexes and weakness
Describe the typical pattern of weakness which is seen in MS?
Weak extensors in the upper limbs and weak flexors in the lower limbs
What is a common presenting feature of MS related to the eyes? What will this cause?
Optic neuritis / sudden painful visual loss with painful eye movements
What is the timeframe of an acute attack of MS?
Usually come on over hours-days and can take days-months to go away
Acute attacks of MS usually occur without warning, but what are some things which can trigger it?
Stress or viral infections
Apart from pyramidal and sensory dysfunction, and optic neuritis, what are some other groups of presenting complains which could be seen in MS?
Lower urinary tract dysfunction, cerebellar/brainstem dysfunction, cognitive impairment, fatigue
When MS affects the brainstem, what two cranial nerves is it likely to affect? What clinical picture does this cause?
Oculomotor and facial nerves, causing diplopia and a Bell’s palsy
How long does visual loss from optic neuritis usually last for? What is the first aspect of vision to go? What next?
1-2 weeks / colour vision / acuity (central scotoma, increased blind spot)
Which eye reflex will be abnormal in optic neuritis?
There will be a relative afferent pupillary defect / the affected eye will dilate when light is shone in it
Aside from optic neuritis, what is another symptom of MS affecting the eyes? What symptoms can this cause?
Internuclear ophthalmoplegia / distortion of binocular vision, failure of adduction leading to diplopia and nystagmus
What part of the brain is affected to cause internuclear opthalmoplegia? What is its usual function?
Medial longitudinal fasciculus / co-ordinating movements between the right and left eyes
What is the diagnostic criteria for MS?
At least 2 episodes suggestive of demyelination, disseminated in time and place
MS is mainly a clinical diagnosis, but what are some investigations that can be done?
MRI, LP (for CSF sample), neurophysiology, bloods
What will an MRI of MS show?
Well defined, ovoid, contrast enhancing lesions in the white matter
What will neurophysiology tests show in MS?
Decreased axonal conduction velocity
What is the CSF sample tested for in MS? How sensitive/specific is this?
Oligoclonal bands / very sensitive but not specific
What is the treatment for each of the following severities of acute exacerbation of MS: a) mild? b) moderate? c) severe?
a) supportive treatment only b) 500mg oral prednisolone for 5 days c) 1g IV prednisolone for 3 days
What are some treatment options for the pyramidal dysfunction in MS?
Physio and OT, anti-spasmodic agents (e.g. baclofen, Botox)
When should Botox only be used for treatment of pyramidal symptoms of MS?
If only one muscle is involved
What are some treatment options for sensory features of MS?
Amitriptyline, gabapentin, TENS, acupuncture, lignocaine infusion
What are some treatment options for urinary tract dysfunction in MS?
Oxybutynin (anti-cholinergic), desmopressin, catheterisation
What are some treatment options for fatigue in MS?
Amantadine, modafinil, hyperbaric oxygen
When does fatigue tend to occur in MS?
Alongside a relapse
What investigation is used to assess response to treatment with disease modifying drugs in MS?
MRI
Interferon beta is a disease modifying drug that can be used in MS. What types of MS can it be used for?
Relapsing remitting or secondary progressive
Copaxone and interferon beta are disease modifying drugs that can be used in MS. What line therapy are they? How are they given? What is their adverse effect?
1st line / self-injectable either SC or IM / increased risk of malignancy over 10-20 years
Tecfidera is a disease modifying drug that can be used in MS. What line therapy is this? How is it given?
1st line / oral
What are the 2nd line disease modifying therapies for MS?
Monoclonal antibodies and fingolimod
Ocrelizumab is a monoclonal antibody used in MS. It can be used against what types of MS?
Relapsing remitting, and also early in primary progressive
How is fingolimod given? What is its adverse effect?
Oral / causes bradycardia and so heart rate monitoring is needed for 24 hours after the first dose
What is the prognosis of MS?
Patients generally have a life expectancy 5-10 years less than the general public
Describe the fatality of MS?
The disease itself is not fatal, though complications such as urinary sepsis or aspiration pneumonia can be
