Multiple Sclerosis

Question 1

What are some potential risk factors for developing Multiple sclerosis?

Answer 1

Epstein-Barr virus
Obesity
Smoking
Vitamin D
Genetics

Question 2

What are the most common demographics afflicted by MS?

Answer 2

Women > Men (3:1)
White
20-40 y/o

Question 3

What are some of the presenting S/Sx of MS?

Answer 3

Numbness / Tingling  (one sided)
Episode of vision loss  (optic neuritis)
Constant spinning vertigo > 24 hrs
FATIGUE
LHEMITTE's SIGN
UHTHOFF's Phenomenon

Question 4

Multiple sclerosis may present with which cranial nerve deficits?

Answer 4

Optic neuritis –> CN II (blurred vision), CN 3, 4, and 6 (Px with EOM)

Question 5

If your PT presents with S/Sx of Optic neuritis during Cranial Nerve examination; what work-up would be indicated?

What are those signs of optic neuritis?

Answer 5

MRI of orbits & brain
OCT
Aquaporin-4
ANA
SSA-SSB

Blurred vision / vision (and/or) color loss
~~Can be unilateral or bilateral~~
Pain with eye movements

Question 6

What is the most common form of Multiple Sclerosis?

Answer 6

Relapse remitting multiple sclerosis (85% of cases)

Question 7

What 4 areas do radiologist look at for lesions to determine if a PT has MS via dissemination in space?

How many different areas do you need for Dx?

Answer 7

Brainstem / Cerebellum
Spinal Cord
Periventricular
Juxtacortical

2 different

Question 8

What lab studies could you order / expect to see in pathology?

Answer 8

CSF studies w/ at least 2 unique oligoclonal bands

Question 9

RULE OF 2’s means what for MS PT’s when it comes to Dx?

Answer 9

2 separate attacks separated by 2 months
New lesions on images (2 months apart)
2 different lesions (dissemination in space)

Question 10

What are some medications you can Rx for a PT with MS?

Answer 10

PO
Teriflunomide (Aubagio)
~~CI in pregnancy (stays in system 2yrs)
Dimethylfumarate (Ticfidera)
Fingolimod (Gilenya) –> S/E: basal cell carcinoma
Mayzent (Siponimod)
Cladribine (Mayvenclad)

Infusion:
Natalizumab (Tysabri)
~~~~PML Progressive multifocal leukoencephalopathy
Ocrelizumab (Ocrevus)
~~~~breast cancer, reactivation Hep C

Question 11

What co-morbid conditions should you manage to ensure your PT’s S/Sx are not further exacerbated?

Answer 11

HTN
Diabetes
Hyperlipidemia
Obesity
Sleep Apnea