Multiple Sclerosis Flashcards
Where in the NS does MS affect?
CNS
White matter tracts
What is the pathology associated with MS?
Demyelination of nerve axons due to autoimmune process causing inflammation of myelin sheath
What scan allows the visualisation of plaques of demyelination?
MRI
What is seen on MRI with axonal loss?
Black holes
Cerebral atrophy
What is the aetiology of MS?
Complex genetic inheritance Associated with other autoimmune conditions F>M Commoner in temperate climates VitD EBV virus
What is the typical age of onset?
20-30s
How will MS usually present?
With a relapse = “Attack of demyelination”
What symptoms are observed in relapse of MS?
Optic neuritis
Sensory symptoms
Limb weakness
Brainstem diplopia, vertigo, ataxia
What is SYMPTOMS are observed with optic neuritis?
Subacute visual loss in one eye
Pain on eye movement
Loss of visual acuity
Swelling of optic disc
What are the differentials for optic neuritis?
Vit B12 deficiency
Wegeners granulomatosis
Local compression
Infection
If the cerebellum is involved in relapse, what likely symptoms will be observed?
Ataxia
Vertigo
Nystagmus
When can myelitis occur in MS?
Demyelination of the spinal cord
What symptoms will be observed with myelitis?
Sensory level (hyperasthesia) Wekness/ upper neuron changes below level Bladder & bowel problems
What are differentials for myelitis?
Tumour
Stroke
Infection
What is clinically isolated syndrome?
No further episodes after initial relapse
What is required for MS diagnosis?
Episodes of demyelination separated in space & time
What symptoms may be observed in relapses of MS?
Sensory loss Optic nerve symptoms Limb weakness Diplopia Vertigo Ataxia Sphincter disturbance
What signs may be observed on examination?
Hyperreflexia Extensor plantars Spasticity Weakness Sensory loss Abnormal eye movements Afferent pupillary defect
How many areas of demyelination equate to 1 relapse?
10 Areas
What other investigations may be done in addition to MRI?
Lumbar puncture - asses for oligoclonal bands in CSF
Bloods - look for inflammatory markers
What are some of the differentials for MS?
Sarcoidosis
Vascultitis
Infection (Lyme Disease)
What are the different types of MS?
Relapsing - remitting (RRMS) -85% Primary progressive (PPMS) Secondary progressive (SPMS)
What are some good prognostic indicators for MS?
Female
Presenting with optic neuritis
Long interval btw 1st & 2nd episodes
Few relapse in first 5 yrs
What are some bad prognostic indicators for MS?
Male
Presenting in older age
Multifocal S & Ss
Motor symptoms
What are the characteristics of PPMS?
Presents in 50s/60s No relapses Spinal symptoms Bladder symptoms Prognosis poor M:F
What diseases are associated with neuromyelitis optic spectrum disorders?
Devics Disease =
Optic neuritis
Myelitis
Aquaporin-4 antibodies
How can you treat acute relapse?
Look for underlying infection
Oral or IV prednisolone
How do you treat further relapses?
Look for underlying viral infection
Vaccine is advised
What is the 1st line therapies for disease modifying meds?
Beta-interferons
Glatiramer - these are all injectable
Teriflunomide
Dimethyl fumarate
What do 1st line therapies prevent?
Reduce relapses by 1/3
No effect on disease progression
What is a 2nd line disease modifying treatment?
Natalizumab
Fingolimod
What are some of the risk factors associated with immunosuppression in MS?
Progressive Multifocal Leukencephalopathy (PML)
Activation of JC virus
What other symptomatic meds bay be given?
Antispasmodics (spasticity) Anticholinergics (urinary) Laxative (constipation) Gabapentin (dysaesthesia) Depression - CBT Cognition - memory aid Speech & swallowing - SALT
