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Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Do younger or older people normally get MS?

A

Younger

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2
Q

Is the presentation of MS consistent or variable?

A

Variable

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3
Q

What is MS a disease of?

A

The central nervous system, causing demyelination and inflammation which leads to focal disturbance of function

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4
Q

What is the prevalence of MS?

A

190/100,000 in Scotland

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5
Q

What does MS stand for?

A

Multiple sclerosis

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6
Q

When is the most common age of onset for MS?

A

About late 20s/30

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7
Q

What is the initial presentation of MS?

A

Relapse (demyelination and inflammation)

Gradual onset over days

Stabilises days to week

Gradual resolution

Partial or complete recovery

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8
Q

What is seen during a relapse phase of MS?

A

Optic neuritis

Sensory symptoms

Limb weakness

Brainstem problems (cranial nerve involvement, pons-internuclear ophthalmoplegia, diplopia, vertigo/ataxia, upper motor neurons signs)

Spinal cord problems (bilateral motor and sensory symptoms, bladder involvement)

Myelitis

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9
Q

What is optic neuritis?

A

Subacute visual loss

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10
Q

What are clinical signs of optic neuritis?

A

Pain on moving eye

Colour vision disturbed

Initial swelling optic disc

Optic atrophy seen later

Relative afferent pupillary defect

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11
Q

What is pons-internuclear ophthalmoplegia?

A

Disorder of horizontal occular movement due to a lesion on the brainstem

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12
Q

What is diplopia?

A

Double vision

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13
Q

What is myelitis?

A

Inflammation of the spinal cord

Can be partial or transverse (complete)

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14
Q

What are the 2 different kinds of myelitis?

A

Partial or transverse (complete)

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15
Q

What is the clinical presentation of myelitis?

A

Weakness/upper motor neuron changes below level of demyelination

Bladder and bowel involvement

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16
Q

What is responsible for demyelination in MS?

A

Autoimmune process

Activated T cells cross blood brain barrier causing demyelination

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17
Q

What can demyelination in MS be seen by?

A

Lesions or plaques on MRI scan

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18
Q

What is the process of demyelination in MS?

A

1) Acute inflammation of myelin sheath
2) Loss of function
3) Repair
4) Recovery of function
5) Post inflammatory gliosis
6) May have funcitonal defect

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19
Q

What is gliosis?

A

Non-specific change of glial cells in response to damage to CNS

Usually hypertrophy (growth) or proliferation (increase in numbers) of glial cells

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20
Q

What are the different disease courses of MS?

A

Clinical isolated syndrome

Relapsing-remitting MS

Primary progressive MS

Secondary progressive MS

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21
Q

What is clinical isolated syndrome MS?

A

Refers to first episode of neurologic symptoms that last at least 24 hours

Sometimes no further episodes

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22
Q

What are further relapses of MS usually due to?

A

Underlying infection (25-30%)

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23
Q

What is important for the progression of MS?

A

Axonal loss is important for disease progression and development of persistent disability

24
Q

What are examples of symptoms that can accumulate during the progressive phase?

A

Fatigue

Temperature sensitivity

Sensory symptoms

Stiffness or spasms

Balance problems

Slurred soeech

Bladder and bowel

Diplopia/oscillopsia/visual loss

Swallowing

Cognitive dementia/emotional liability

25
Q

What is oscillopsia?

A

Images are no longer held steady on the retina (vision loss)

26
Q

What do the signs observed in examination due to MS depend on?

A

Where the demyelination has occured and the stage of disease

27
Q

What are some things seen in examination of MS?

A

Afferent pupillary defect

Nystagmus or abnormal eye movements

Cerebellar signs

Sensory signs

Weakness

Spasticity

Hyperreflexia

Plantars extensor

28
Q

What does RRMS stand for?

A

Relapsing remitting MS

29
Q

What does SPMS stand for?

A

Secondary progressive MS

30
Q

What does PPSM stand for?

A

Primary progressive MS

31
Q

What is the most common type of MS?

A

Relapsing remitting MS (RRMS)

85% at outset

32
Q

What is the different between the impairment level of primary and secondary progressive MS?

A
33
Q

When does primary progressive MS usually present?

A

In 5th and 6th decade

34
Q

In what kind of MS do no relapses occur?

A

Primary progressive

35
Q

What are symptoms of primary progressive MS?

A

Spinal and bladder symptoms

36
Q

What is the male to female ratio of primary progressive MS?

A

1:1

37
Q

What is required to make the diagnosis of MS?

A

Evidence of demyelination seperate in time and space

May be clinical or MRI based diagnosis

38
Q

What are the clinical and MRI based diagnostic criteria called?

A

Posers criteria (clinical)

Macdonald criteria (MRI)

39
Q

What chemical can be used with an MRI scan to better show new lesions?

A

With gadolinium new lesions are shown as they uptake it whereas old ones do not

40
Q

What are some conditions including in the differential diagnosis for MS?

A

Acute desseminated encephalomyelitis (ADEM)

Other autoimmune conditions such as SLE

Sarcoidosis

Vasculitis

Infection such as lyme disease

Adrenoleukodystrophy

41
Q

What does ADEM stand for?

A

Acute disseminated encephalomyelitis

42
Q

What is optic neuritis?

A

Inflammation of the optic nerve

43
Q

What are some differentials for optic neuritis?

A

Neurolyelitis optica

Sarcoidosis

Ischaemic optic neuropathy

Toxic/drugs/B12 deficiency

Wegeners granulomatosis

Local compression

Lebers hereditary optic neuropathy

Infection (TB or HIV)

44
Q

What are differentials for myelitis?

A

Inflammation (neuromyelitis optica, SLE, sarcoidosis)

Infection or post infection (HIV, HTLV, HSV, TB)

Tumour

Paraneoplasic process

Stroke

45
Q

Other than MRI, what other investigations can be done for MS?

A

Lumbar puncture (oligoclonal bands present in CSF but not serum)

Visual/somatosenosory evoked response

Bloods to exclude other inflammatory conditions

Chest x-ray

46
Q

MS never affects the activities of daily living (ADL) for how many people with it?

A

25%

47
Q

What percentage of people with MS require a wheel chair at some point?

A

25%

48
Q

What is the female to male ratio for MS?

A

2-3:1

49
Q

What is the general treatment of MS?

A

Treatment of relapse

Disease modifying treatment

General health and diet

Symptomatic treatment

MDT approach

50
Q

What is the treatment for an acute relapse of MS?

A

Look for underlying infection

Exclude worsening of usual symptoms with intercurrent illness

Treatment (oral prednisolone (IV), rehabilitation, symptomatic treatment)

51
Q

What are some 1st line disease modifying treatments for MS?

A

S/C or I/M injections (beta-interferons, glatiramer acetate)

52
Q

What are some 2nd line disease modifying treatments for MS?

A

Natalizumab

Fingolimod

Cladribine

Ocrelizumab

Alemtuzumub

53
Q

What is the function of disease modifying treatments for MS?

A

They are not a cure, they reduce relapse rate, do not slow down progression and have side effects

54
Q

Who can disease modifying treatments for MS give problems to?

A

People who are immunosupressed and can lead to multifocal leukoencephalopathy

55
Q

What are some sympatomatic treatments for MS?

A
  • Spasticity-muscle relaxants/antispasmodics/physiotherapy
  • Dysaesthesia
    • Amitriptyline, gabapentin etc
  • Urinary anticholinergic Rx, bladder stimulator/catheterisation
  • Constipation
    • Laxatives
  • Sexual dysfunction
    • Sildenafil
  • Fatigue
    • Graded exercise, medication
  • Depression
    • CBT, medication
  • Cognitive
    • Memory aids
  • Tremor
    • Aids/medication
  • Vision
    • Carbamazepine
  • Speech/swallowing
    • SALT
  • Motor/sensory impairment
    • MDT
56
Q

Who are some members of the MDT than looks after people with MS?

A

MS nurse

Physiotherapist

Occupational therapist

Soeech and language therapy

Dietician

Rehabilitation specialists

Continence advisor

Psychology/psychiatry

Nervous System (48 decks)

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