Multiple Sclerosis Flashcards
4 different courses of MS
relapsing remitting
primary progressive
secondary progressive
progressive relapsing
describe the progression of relapsing remitting
bad flare, recover to same or worse, on loop
describe the progression of primary progressive
just steadily getting worse and worse
describe the progression of secondary progressive
initially relapsing remitting but then just gets steadily worse
relapsing progresssive
steadily getting worse with relapses that don’t fully recover
presentation of MS
very varied Optic neuritis motor impairment paraesthesia numbness bladder dysfunction sexual dysfunction cognitive decline vertigo ataxia maaaany many things
how is MS diagnosed
history: 2 or more episodes of 2 or more symptoms in different areas
tests: MRI to see lesions
what tests might your order in MS
MRI - for lesions
LP - for oligoclonal bands (inflammatory markers) in CSF
Bloods - exclude other inflammatory/infection
what is the most common type of MS
relapsing remitting 85%
10-15% of MS is what type
primary progressive
proportion that will need a wheelchair at some point
25%
proportion that MS never affect activities of daily living
25%
who is the prognosis worst for
males, older, those with motor symptoms
true/false a presentation of optic neuritis is associated with a good prognosis
true - as are long relapse intervals and not having many relapses in the first 5 years
when does primary progressive usually present
late - 5th and 6th decade
bladder and spinal symptoms are common in which type
primary progressive
treatment of acute relapse
IV steroids to reduce inflammation (prednisolone)
true/false MS is worse during pregnancy
false - symptoms ease off
MDT that would be involved in MS
OT and physio, MS nurse, SLT, dietician, rehabilitation specialist, psychiatry
general management of MS
MDT, eduacation, tell DVLA, vaccinations
true/false - MS doesn’t always require long term maintanence treatment
true - however there are some disease modifying treatments
when is the risk of relapse highest in pregnancy
3 months post partum
disease modifying drugs in MS
beta-inteferons, glatiramer acetate
how do beta-interferons work
by reducing inflammation
general criteria for disease modifying drugs
able to walk
had >2 relapses in last 2 years
relapsing remitting disease
how does glatiramer acetate work
immunosuppression
how often are disease modifying drugs given
daily –> weekly. intramuscular or subcut
effectiveness of first line drugs
reduce relapse rate by 33%
symptomatic treatments of MS
muscle relaxants analgesia anticholinergics for bladder catheterisation laxatives exercise CBT for depresion anti-tremor stuff memory aids for cognitive decline
