Multiple Sclerosis Flashcards
1
Q
What is multiple sclerosis? (2)
A
- Refers to many areas of scarring (sclerosis) that results from the destruction of the myelin sheath in the brain and spinal cord
- Life long condition that can cause serious disability through remissions and exacerbations
2
Q
What is the incidence and prevalence of multiple sclerosis?
A
Incidence: 7 per 100,000 every year
Prevalence: 120 per 100,000 every year
3
Q
When is multiple sclerosis most likely to be diagnosed?
A
- Find out in 30s-50s / 20-40s
2. Signs often start years earlier
4
Q
What is the female or male ratio of multiple sclerosis?
A
2:1
Female:male
5
Q
What is the aetiology of multiple sclerosis? (3)
A
- Believed to involve an immunologic mechanism
- Likely exposure to a vrisu early in life or an unknown substance which triggers an immune response to attack the body’s tissues
- This results in inflammation, damaging the myelin sheath and underlying nerve fibre
6
Q
Is there a genetic susceptility in multiple sclerosis? (3)
A
- Increased incidence in certain families
- Presence of human leukocyte antigen allotypes suggest genetic susceptibility
- Class II MHC alleles are associatied
7
Q
What is the impact of climate on the development of multiple sclerosis? (3)
A
- More common in people who spend first 15 years of life in temperate climates (1/2000)
- Than those who spend them in the tropics (1/100,000)
- This may be due to lower levels of vitamin D
8
Q
Summarise the aetiology of multiple sclerosis
A
- Immunologic mechanism
- Genetic susceptibility
- Vitamin D
- Smoking increases risk
9
Q
What causes sensory and motor symptoms?
A
- Sensory nerves become demyelinated: problems with sensations
- Motor nerves become demyelinated: motor symptoms
10
Q
What are the 3 most common initial symptoms of multiple sclerosis?
A
- Paresthesias (sensation) in one or more extremities, in the trunk or one side of the face
- Weakness or clumsiness of leg or hand
- Visual disturbances
11
Q
What are 8 visual disturbances which can occur in multiple sclerosis?
A
- Partial loss of vsion and pain in one eye due to retrobulbar optic neuritis
- Diplopia due to internuclear opthalmoplegia
- Scotoma (partial loss of vision or blind spot in otherwise normal visual field)
- Some temporary loss of vision (days to weeks)
- Colour blindness
- Pain
- Flashes of light when moving eye
- Involuntary eye movements
12
Q
What are 11 other symptoms of multiple sclerosis?
A
- Stiffness or fatiguability of a limb
- Minor gait disturbances
- Vertigo
- Mild affective disturbances
- Fatigue
- Bladder/bowel problems
- Problems with attention, thinking, learning and planning (cognitive symptoms)
- Pain
- Mobility problems
- Sexual dysfunction
- Speech and swallowing difficulties
13
Q
What are 4 mild affective disturbances in multiple sclerosis?
A
- Depression
- Anxiety
- Emotional lability
- Euphoria
14
Q
What are 2 types of pain which can occur in multiple sclerosis?
A
- Neuropathic: damage to nervous system eg. stabbing pains in face and sensations in trunk/limbs
- Musculoskeletal: back, neck and joint pain
15
Q
What are 5 types of mobility problems which can occur in multiple sclerosis?
A
- Ataxia
- Clumsiness
- Tremor
- Dizziness
- Vertigo
16
Q
What may exacerbate symptoms of multiple sclerosis?
A
Excessive heat
17
Q
Summarise the visual deficits which can occur in multiple sclerosis
A
- Lose the ability of central vision (looking straight ahead) whilst peripheral (side to side) is less affected
- Internuclear opthalmoplegia
- Optic neuritis
18
Q
What is internuclear opthalmoplegia? (3)
A
- Nerve fibres that co-ordinate the eyes when they move horizontally are damage
- One eye cannot turn inward, causing double vision when looking towards the opposite side of the affected eye
- Unaffected eye may move involuntarily, moving rapidly and repetitively in one direction, then slowly drifting back (nystagmus)
19
Q
What is optic neuritis? (3)
A
- Inflammation of the optic nerve
- May partially lose vision in one eye
- Pain when eye moves
20
Q
What are 3 brainstem symptoms of multiple sclerosis?
A
- Diplopia
- Vertigo
- Ataxia
21
Q
What are 3 spinal cord symptoms of multiple sclerosis?
A
- Numbness
- Rigidity
- Sexual dysfunction
22
Q
What is the course of multiple sclerosis? (3)
A
- Periods of relatively good health (remissions) alternate with episodes of worsening symptoms (relapses)
- Over time, MS gradually worsens
- People who have frequent attacks may become quickly disabled
23
Q
What is the prognosis of multiple sclerosis? (2)
A
- Life span is unaffected unless the disorder is very severe
- 75% never need a wheelchair and for about 40% daily activities are not disrupted
24
Q
How long can remissions last? (2)
A
- Can last months up to 10 years or more
2. Relapses average about 1 every 2 years
25
What are the 4 patterns of progression in multiple sclerosis?
1. Relapsing-remitting (80%)
2. Primary progressive (20%)
3. Secondary progressive
4. Progressive relapsing pattern
26
What is the relapsing-remitting pattern? (3)
1. Exacerbations alternate with remissions, when partial or full recovery occurs
2. Remissions may last months or years
3. Relapses can occur spontaneously or trigger by an infection eg. influeza
27
What is the primary progressive pattern? (2)
1. Disease progresses gradually with no remissions
| 2. May be temporary plateaus of symptoms
28
What is the secondary progressive pattern? (2)
1. Begins with relapses alternating with remissions
| 2. Followed by gradual progression of the disease
29
What is the progressive relapsing pattern? (2)
1. Disease progresses gradually
2. But progression is interrupted by sudden, clear relapses
(Rare)
30
What 6 symptoms may occur with progression of multiple sclerosis?
1. Movements - shaky, irregular and ineffective
2. Partial or complete paralysis
3. Spasticity of weak muscles
4. Speech: slow, slurred and hesitant
5. Emotional lability, depression and thinking impaired
6. Affects nerves that control urination or bowel movements
31
What are 5 poor prognostic factors in multiple sclerosis?
1. Male sex (more primary progressive MS)
2. High relapse rate in early years
3. Motor relapses
4. Poor recovery from early relapses
5. Early accrual of T2 lesions
32
What investigations are used to diagnose MS? (3)
1. Brain and spinal MRI
2. Inject gadolinium to distinguish areas of recent demyelination and active inflammation
3. Additional testing if MRI and clinical findings are not conclusive
33
What additional testing can be done to diagnose multiple sclerosis? (4)
1. Evoked potentials
2. CSF examination
3. Blood tests to rule out Lyme disease, AIDS, tropical spastic paraparesis and lupus
4. Imaging tests to rule out arthiritis of neck, rupture of spinal disk and syringmyelia
34
Give 4 ways of treating multiple sclerosis
1. Corticosteroids
2. Drugs to control immune system attacking myelin sheaths
3. Measures to control symptoms
4. Plasma exchange sometimes for severe relapses
35
What are corticosteroids used for?
1. Relieve immediate symptoms if interfere with functioning by surpressing the immune system
2. May shorten relapses and slow progression
36
What are 6 side effects of corticosteroids?
1. Susceptibility to infection
2. Diabetes
3. Weight gain
4. Fatigue
5. Osteoporosis
6. Ulcers
Therefore rarely used for long period of time
37
Give examples of drugs used for symptom control (4)
```
Muscle relaxants (muscle spasms)
Anticonvulsants (pain due to nerve abnormalities)
Antidepressants
Beta-blocker (tremors)
osteoporosis)
```
38
What are 4 components of supportive care?
1. Regular exercise to condition heart/muscles, reduce spasticity and precent contractures
2. Vitamin D supplements (reduce progression and osteoporosis)
3. Avoid overwork, fatigue and exposure to excess hear
4. Support from MDT to help with rehab
