Multiple Sclerosis Flashcards
What is multiple sclerosis?
Multiple sclerosis (MS) is a progressive, chronic autoimmune disease that involves the immune system and neurological system. It is not very well understood and although it is progressive, patients can remain in one state for a while – remission and relapse are important terms.
What is one of the key physiological signs of MS?
One of the key physiological signs of MS is multifocal areas of demyelination which disrupts the ability of a nerve to conduct electrical impulses. This in turn leads to symptoms; these symptoms can be quite vague as there is a range of symptoms.
What is the age of onset of MS?
20-50.
When do MS symptoms first present?
20-30.
Who is more likely to develop MS, men or women?
Women are twice as likely to develop MS.
How many cases of MS are there in the UK?
100-140 per 100,000.
How many cases of MS are there in NI?
170 per 100,000.
How many cases of MS are there in Scotland?
190 per 100,000
Around the world, how many people are suffering with MS?
2.5 million.
Which racial group has the greater prevalence of MS?
White Caucasians of Northern European Ancestry.
Where in the world is MS more prevalent?
North of the equator.
Describe the genetic component of MS.
There is a genetic component to MS; it is polygenic (more than one gene). There are both MS susceptibility genes and MS-associated genes, which may influence the overall clinical course of MS.
As well as a genetic component, what else is believed to be linked to the development and/or progression of MS?
- Vitamin D3.
- Infection (e.g. viruses, EBV, Chlamydia pnemoniae).
- Environmental factors.
What are the symptoms of MS?
- Vision problems.
- Numbness.
- Difficulty walking.
- Fatigue.
- Depression.
- Emotional changes.
- Vertigo & dizziness.
- Spasticity.
- Sexual dysfunction.
- Coordination problems
- Balance problems.
- Pain.
- Changes in cognitive function.
- Bowel/bladder dysfunction.
Why is MS diagnosis often hard?
One can see from this list that there is no strong link between the symptoms. Because there is no strong link, it is difficult to diagnose patients until they have had MS for a while, diagnosis isn’t early. The symptoms may be thought to be caused by something other than MS.
Describe Lhermitte’s Sign (Barber’s Chair Syndrome).
Lhermitte’s sign or Lhermitte’s syndrome is a sudden sensation resembling an electric shock that passes down the back of the neck and into the spinal column and can radiate out to the fingers and toes.
It is usually triggered by flexing the neck, that is, bending your head down, chin towards chest and is sometimes referred to as barber’s chair syndrome.
Is Lhermitte’s sign often treated? Why?
Lhermitte’s sign is rarely treated as the pain is so sharp and sudden that it does not usually last long enough for pain treatments to take effect.
Describe Uhthoff’s Sign.
Uhthoff’s phenomenon or Uhthoff’s sign is the temporary worsening of symptoms, most often visual symptoms but sometimes motor or sensory - caused by an increase in temperature.
The visual symptoms may present as double vision, sharpness of vision, or black spots in the eyes.
How does MS present clinically?
- Loss or reduction of vision in 1 eye with painful eye movements.
- Double vision.
- Ascending sensory disturbance and/or weakness.
- Problems with balance, unsteadiness or clumsiness.
- Altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte’s symptom).
People with MS present with neurological symptoms or signs, what else is also common?
- Are often aged under 50 and
- May have a history of previous neurological symptoms and
- Have symptoms that have evolved over more than 24 hours and
- Have symptoms that may persist over several days or weeks and then improve.
Before referral to a neurologist for a formal diagnosis, what must be done?
Alternate diagnosis must be ruled out.
One should not routinely suspect MS if a person’s main symptoms are fatigue, depression, or dizziness unless what?
Do not routinely suspect MS if a person’s main symptoms are fatigue, depression or dizziness unless they have a history or evidence of focal neurological symptoms or signs.
What is the key factor preventing MS investigation being done routinely?
It is expensive.
After a patient with suspected MS is referred to a neurologist, what is carried out?
- Medical history.
- Neurological examination.
- Medical investigations, including MRI, to identify areas of sclerosis in the brain or spinal cord (McDonald Criteria 2010).
- Lumbar puncture to test for abnormalities of the CSF.
- Evoked potentials, to measure time taken for nerves to respond to electrical stimulation.
