Multiple Sclerosis Flashcards
What is multiple sclerosis? (2)
- 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
What is the incidence and prevalence of multiple sclerosis?
Incidence: 7 per 100,000 every year
Prevalence: 120 per 100,000 every year
When is multiple sclerosis most likely to be diagnosed?
- Find out in 30s-50s / 20-40s
2. Signs often start years earlier
What is the female or male ratio of multiple sclerosis?
2:1
Female:male
What is the aetiology of multiple sclerosis? (3)
- 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
Is there a genetic susceptility in multiple sclerosis? (3)
- Increased incidence in certain families
- Presence of human leukocyte antigen allotypes suggest genetic susceptibility
- Class II MHC alleles are associatied
What is the impact of climate on the development of multiple sclerosis? (3)
- 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
Summarise the aetiology of multiple sclerosis
- Immunologic mechanism
- Genetic susceptibility
- Vitamin D
- Smoking increases risk
What causes sensory and motor symptoms?
- Sensory nerves become demyelinated: problems with sensations
- Motor nerves become demyelinated: motor symptoms
What are the 3 most common initial symptoms of multiple sclerosis?
- 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
What are 8 visual disturbances which can occur in multiple sclerosis?
- 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
What are 11 other symptoms of multiple sclerosis?
- 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
What are 4 mild affective disturbances in multiple sclerosis?
- Depression
- Anxiety
- Emotional lability
- Euphoria
What are 2 types of pain which can occur in multiple sclerosis?
- Neuropathic: damage to nervous system eg. stabbing pains in face and sensations in trunk/limbs
- Musculoskeletal: back, neck and joint pain
What are 5 types of mobility problems which can occur in multiple sclerosis?
- Ataxia
- Clumsiness
- Tremor
- Dizziness
- Vertigo
What may exacerbate symptoms of multiple sclerosis?
Excessive heat
Summarise the visual deficits which can occur in multiple sclerosis
- Lose the ability of central vision (looking straight ahead) whilst peripheral (side to side) is less affected
- Internuclear opthalmoplegia
- Optic neuritis
What is internuclear opthalmoplegia? (3)
- 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)
What is optic neuritis? (3)
- Inflammation of the optic nerve
- May partially lose vision in one eye
- Pain when eye moves
What are 3 brainstem symptoms of multiple sclerosis?
- Diplopia
- Vertigo
- Ataxia
What are 3 spinal cord symptoms of multiple sclerosis?
- Numbness
- Rigidity
- Sexual dysfunction
What is the course of multiple sclerosis? (3)
- 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
What is the prognosis of multiple sclerosis? (2)
- Life span is unaffected unless the disorder is very severe
- 75% never need a wheelchair and for about 40% daily activities are not disrupted
How long can remissions last? (2)
- Can last months up to 10 years or more
2. Relapses average about 1 every 2 years
What are the 4 patterns of progression in multiple sclerosis?
- Relapsing-remitting (80%)
- Primary progressive (20%)
- Secondary progressive
- Progressive relapsing pattern
What is the relapsing-remitting pattern? (3)
- Exacerbations alternate with remissions, when partial or full recovery occurs
- Remissions may last months or years
- Relapses can occur spontaneously or trigger by an infection eg. influeza
What is the primary progressive pattern? (2)
- Disease progresses gradually with no remissions
2. May be temporary plateaus of symptoms
What is the secondary progressive pattern? (2)
- Begins with relapses alternating with remissions
2. Followed by gradual progression of the disease
What is the progressive relapsing pattern? (2)
- Disease progresses gradually
- But progression is interrupted by sudden, clear relapses
(Rare)
What 6 symptoms may occur with progression of multiple sclerosis?
- Movements - shaky, irregular and ineffective
- Partial or complete paralysis
- Spasticity of weak muscles
- Speech: slow, slurred and hesitant
- Emotional lability, depression and thinking impaired
- Affects nerves that control urination or bowel movements
What are 5 poor prognostic factors in multiple sclerosis?
- Male sex (more primary progressive MS)
- High relapse rate in early years
- Motor relapses
- Poor recovery from early relapses
- Early accrual of T2 lesions
What investigations are used to diagnose MS? (3)
- Brain and spinal MRI
- Inject gadolinium to distinguish areas of recent demyelination and active inflammation
- Additional testing if MRI and clinical findings are not conclusive
What additional testing can be done to diagnose multiple sclerosis? (4)
- Evoked potentials
- CSF examination
- Blood tests to rule out Lyme disease, AIDS, tropical spastic paraparesis and lupus
- Imaging tests to rule out arthiritis of neck, rupture of spinal disk and syringmyelia
Give 4 ways of treating multiple sclerosis
- Corticosteroids
- Drugs to control immune system attacking myelin sheaths
- Measures to control symptoms
- Plasma exchange sometimes for severe relapses
What are corticosteroids used for?
- Relieve immediate symptoms if interfere with functioning by surpressing the immune system
- May shorten relapses and slow progression
What are 6 side effects of corticosteroids?
- Susceptibility to infection
- Diabetes
- Weight gain
- Fatigue
- Osteoporosis
- Ulcers
Therefore rarely used for long period of time
Give examples of drugs used for symptom control (4)
Muscle relaxants (muscle spasms) Anticonvulsants (pain due to nerve abnormalities) Antidepressants Beta-blocker (tremors) osteoporosis)
What are 4 components of supportive care?
- Regular exercise to condition heart/muscles, reduce spasticity and precent contractures
- Vitamin D supplements (reduce progression and osteoporosis)
- Avoid overwork, fatigue and exposure to excess hear
- Support from MDT to help with rehab