Multiple Sclerosis

Question 1

MS is an acquired disorder with immune-mediated destruction of normal CNS ____ with secondary loss of ___.

Answer 1

Myelin; axons

Question 2

Presentation of MS?

Answer 2

Onset between 20-40
F>M (2:1)
Relapsing-remitting course
Optic neuritis (partial or total loss of vision in one eye), sensory or motor deficits in the lower limbs
Lhermitte’s sign (tingling in the spine with neck flexion)

Question 3

Dx MS?

Answer 3

Multiple signs and symptoms disseminated in time and space

MRI with white matter lesions

CSF with oligoclonal bands, increased Ig synthesis

Evoked potentials

Question 4

Rx MS attack?

Answer 4

Rx associated infection and fever control

IV high-dose steroids (methylprednisolone 500-1000 mg/day for 3-5 days +/- oral prednisone taper)

Question 5

Rx MS (long-term)?

Answer 5

Beta-interferon
Glatiramer acetate
Natalizumab
Fingolimod
Teriflunomide
Dimethyl fumarate

Dalfampridine - oral K+ channel blocker that improves walking speed