Multiple Sclerosis

Question 1

Which are 2 common symptoms of MS ?

Answer 1

Pain, experienced by >50% of patients. It can occur anywhere in the body and can change locations over time. Fatigue is experienced by 90% of patients and is the most common reason for work-related disability in MS.

Question 2

Unlike Bell’s Palsy, facial weakness in MS is usually NOT associated with… ?

Answer 2

Ipsilateral loss of taste sensation or retroauricular pain.

Question 3

Describe Internuclear Opthalmoplegia (INO)

Answer 3

INO consists of impaired eye adduction of one eye due to a lesion in the ipsilateral medial longitudinal fasciculus. Prominent nystagmus is often observed in the abducting eye, along with a small skew deviation.

Question 4

Well-established risk factors for MS ?

Answer 4

Genetic predisposition, vitamin D deficinecy, EBV exposure after early childhood, and cigarette smoking.

Question 5

Lesions located where are particularly helpful diagnostically ?

Answer 5

Lesion >6mm located in the corpus callosum, periventricular white matter, brainstem,cerebellum or spinal cord.

Question 6

Disorders possibly mistaken for MS include ?

Answer 6

Neuromyelitis optica, sarcoidosis, vascular disorders (antiphospholipid syndrome and vasculitis), rarely CNS lymphoma, syphilis or Lyme disease.

Question 7

Side effects of short-term glucocorticoid therapy ?

Answer 7

Fluid retention, potassium loss, weight gain, gastric disturbances, acne, emotional lability.

Question 8

Common side effects of IFN-β therapy ?

Answer 8

Flulike symptoms (fevers, chills, myalgias) and mild abnormalities on routine lab evaluation. (elevated LFTs or lymphopenia). Severe hepatotoxicity is rare. Depression, increased spasticity and cognitive changes have been reported.

Question 9

Side effects of glatiramer acetate ?

Answer 9

Injection-site reactions, 15% of patients also experience one or more episodes of flushing, chest tightness, dyspnea, palpitations, and anxiety after injection. Finally, some patients experience lipoatrophy.

Question 10

Important side effects of fingolimod ?

Answer 10

First- and second- degree heart block and bradycardia, disseminated varicella- zoster virus and cryptococcal infections and QT prolongation.

Question 11

Mechanism of action of Dimethyl Fumarate (DMF) ?

Answer 11

Inhibits the ubiquitylation and degradation of nuclear factor E2-related factor (Nrf2)-a transcription factor that binds to the antioxidant response elements (AREs) located on the DNA, thereby inducing the transcription of several antioxidant proteins.

Question 12

Potential risk of DMF ?

Answer 12

Progressive Multifocal encephalopathy. Most patients were lymphopenic, blood monitoring every 6 months is recommended ?

Question 13

A small percentage of patients receiving natalizumab experience ?

Answer 13

Hypersensitivity reactions (including anaphylaxis) and about 6% develop neutralizing antibodies (only half of which persist)

Question 14

Teriflunomide side effects ?

Answer 14

Mild hair thining, GI symptoms, rarely causes toxic epidermal necrolysis or Stevens-Johnson syndrome. possibly teratogenic (pregnancy category X)

Question 15

Mitoxantrone side effects ?

Answer 15

> 40% will experience amenorrhea, which may be permanent. Cardiotoxicity and a risk of leukemia (1.4% lifetime risk).

Question 16

The hallmark of Acute Disseminated Encephalomyelitid (ADEM) is..?

Answer 16

The presence of widely scattered foci of periventricular inflammation and demyelination that can involve both white matter and grey matter lesions typical of MS.

Question 17

Some symptoms that suggest ADEM rather than MS ?

Answer 17

Meningismus, drowsiness, coma, seizures, generally bilateral optic nerve involvement and complete transverse myelopathy.