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Neurology- Clinical > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS?

A

An inflammatory demyelinating disorder of the CNS

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2
Q

MS in an inflammatory disorder. What mediates this?

A

It is immune mediated by T cells

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3
Q

What characterises MS?

A

Presence of plaques in the CNS, which are disseminated in place and time

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4
Q

CNS plaques in MS can be visualised on what type of imaging?

A

MRI

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5
Q

What is meant by the plaques in MS being ‘disseminated in place and time’?

A

They are seen on MRI in different parts of the nervous system, and they come and go

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6
Q

What is the sex ratio of MS? When is it most likely to present?

A

Affects females 3: 1 / 30s/40s

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7
Q

What is the cause for MS?

A

Individuals have a genetic predisposition, and then are exposed to an environmental stimulus

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8
Q

What is a common theory for what environmental stimulus causes MS? Why is this a theory?

A

Vitamin D deficiency / MS in much more common in countries further from the equator

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9
Q

In MS, demyelination is the hallmark, but disability is actually caused by what?

A

Axonal loss

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10
Q

What type of MS is this describing: episodes of severe disability which either completely or partially resolve, but less fully every time?

A

Relapsing remitting

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11
Q

What type of MS is this describing: a slow and steady progression of disability?

A

Primary progressive

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12
Q

What type of MS is this describing: initially relapsing remitting, followed by a phase of steady progression in disability?

A

Secondary progressive

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13
Q

What type of MS is this describing: episodes of acute deterioration on top of a continuous slow decline?

A

Progressive relapsing

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14
Q

What are the main pyramidal features of MS?

A

Increased tone, spasticity, fast reflexes and weakness

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15
Q

Describe the typical pattern of weakness which is seen in MS?

A

Weak extensors in the upper limbs and weak flexors in the lower limbs

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16
Q

What is a common presenting feature of MS related to the eyes? What will this cause?

A

Optic neuritis / sudden painful visual loss with painful eye movements

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17
Q

What is the timeframe of an acute attack of MS?

A

Usually come on over hours-days and can take days-months to go away

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18
Q

Acute attacks of MS usually occur without warning, but what are some things which can trigger it?

A

Stress or viral infections

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19
Q

Apart from pyramidal and sensory dysfunction, and optic neuritis, what are some other groups of presenting complains which could be seen in MS?

A

Lower urinary tract dysfunction, cerebellar/brainstem dysfunction, cognitive impairment, fatigue

20
Q

When MS affects the brainstem, what two cranial nerves is it likely to affect? What clinical picture does this cause?

A

Oculomotor and facial nerves, causing diplopia and a Bell’s palsy

21
Q

How long does visual loss from optic neuritis usually last for? What is the first aspect of vision to go? What next?

A

1-2 weeks / colour vision / acuity (central scotoma, increased blind spot)

22
Q

Which eye reflex will be abnormal in optic neuritis?

A

There will be a relative afferent pupillary defect / the affected eye will dilate when light is shone in it

23
Q

Aside from optic neuritis, what is another symptom of MS affecting the eyes? What symptoms can this cause?

A

Internuclear ophthalmoplegia / distortion of binocular vision, failure of adduction leading to diplopia and nystagmus

24
Q

What part of the brain is affected to cause internuclear opthalmoplegia? What is its usual function?

A

Medial longitudinal fasciculus / co-ordinating movements between the right and left eyes

25
Q

What is the diagnostic criteria for MS?

A

At least 2 episodes suggestive of demyelination, disseminated in time and place

26
Q

MS is mainly a clinical diagnosis, but what are some investigations that can be done?

A

MRI, LP (for CSF sample), neurophysiology, bloods

27
Q

What will an MRI of MS show?

A

Well defined, ovoid, contrast enhancing lesions in the white matter

28
Q

What will neurophysiology tests show in MS?

A

Decreased axonal conduction velocity

29
Q

What is the CSF sample tested for in MS? How sensitive/specific is this?

A

Oligoclonal bands / very sensitive but not specific

30
Q

What is the treatment for each of the following severities of acute exacerbation of MS: a) mild? b) moderate? c) severe?

A

a) supportive treatment only b) 500mg oral prednisolone for 5 days c) 1g IV prednisolone for 3 days

31
Q

What are some treatment options for the pyramidal dysfunction in MS?

A

Physio and OT, anti-spasmodic agents (e.g. baclofen, Botox)

32
Q

When should Botox only be used for treatment of pyramidal symptoms of MS?

A

If only one muscle is involved

33
Q

What are some treatment options for sensory features of MS?

A

Amitriptyline, gabapentin, TENS, acupuncture, lignocaine infusion

34
Q

What are some treatment options for urinary tract dysfunction in MS?

A

Oxybutynin (anti-cholinergic), desmopressin, catheterisation

35
Q

What are some treatment options for fatigue in MS?

A

Amantadine, modafinil, hyperbaric oxygen

36
Q

When does fatigue tend to occur in MS?

A

Alongside a relapse

37
Q

What investigation is used to assess response to treatment with disease modifying drugs in MS?

A

MRI

38
Q

Interferon beta is a disease modifying drug that can be used in MS. What types of MS can it be used for?

A

Relapsing remitting or secondary progressive

39
Q

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?

A

1st line / self-injectable either SC or IM / increased risk of malignancy over 10-20 years

40
Q

Tecfidera is a disease modifying drug that can be used in MS. What line therapy is this? How is it given?

A

1st line / oral

41
Q

What are the 2nd line disease modifying therapies for MS?

A

Monoclonal antibodies and fingolimod

42
Q

Ocrelizumab is a monoclonal antibody used in MS. It can be used against what types of MS?

A

Relapsing remitting, and also early in primary progressive

43
Q

How is fingolimod given? What is its adverse effect?

A

Oral / causes bradycardia and so heart rate monitoring is needed for 24 hours after the first dose

44
Q

What is the prognosis of MS?

A

Patients generally have a life expectancy 5-10 years less than the general public

45
Q

Describe the fatality of MS?

A

The disease itself is not fatal, though complications such as urinary sepsis or aspiration pneumonia can be

Neurology- Clinical (31 decks)

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