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Y4: Neurology > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

Describe MS?

A
  • Inflammatory demyelinating disease
  • Presence of episodic neurological dysfunction in at least 2 areas of CNS
    • Brain, spinal cord, optic nerve
  • Dissemintated in space/time:
    • ie occuring at multiple sites, with >29 days between attacks
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2
Q

Cause of MS?

A
  • Exact aetiology unknown
    • Genetic factors (>30% concordance in identical twins)
    • Environmental factors (increasing incidence with latitude in the world)
  • Roles of vitamin D and infection
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3
Q

Mean age of onset?

Gender distribution?

A

30yrs average onset

3x more common in women

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4
Q

Describe the presentastion of MS?

A
  • Usually monosymptomatic
    • Unilateral optic neuritis
    • Corticospinal tract and bladder involvement is common
  • Symptoms may worsen with heat (bath/exercise)
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5
Q

What is optic neuritis?

A
  • Inflammation of the optic nerve
    • Pain on eye movement
    • Reduced rapid central vision
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6
Q

Describe the diagnostic criteria for MS

A
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7
Q

Describe the tests for investigation of MS?

A
  • Depends on the presenting symptoms
  • MRI:
    • Sensitive but not specific for plaque detection
    • Can exclude other causes including cord compression
  • CSF:
    • Oligoclonal bands of IgG on electrophoresis that are not present in serum
      • Suggests CNS inflammation
  • Delayed visual, auditory and somatosensory evoked potentials
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8
Q

Describe the progression of MS?

A
  • Relapsing-remitting course
  • With time remission between relapses becomes incomplete -> disability
  • Pregnancy does not alter progression rate
    • May reduce during pregnany then increase for a few months after
    • Then returns to normal course
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9
Q

Name this type of MS?

A

Relapsing remitting

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10
Q

Name this type of MS?

A
  • Secondary progressive
    • Symptoms worse over time, with or without relapses and remissions
    • People progress to this from relapsing remitting
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11
Q

Name this type of MS?

A
  • Primary progressive (PPMS)
    • Slowly worsening symptoms from the beginning
    • No relapses or remissions
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12
Q

Name this type of MS?

A
  • Progressive relapsing (PRMS)
    • Steady decline with relapses inbetween
    • No remissions
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13
Q

Name some lifestyle advice for MS that patients can receive?

A
  • Take multivitamin containing vitamin D
  • Stop smoking
  • Avoiding stress
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14
Q

Approaches to the management of MS?

A
  • Disease-modifying drugs
  • Treating relapses
  • Symptom control
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15
Q

Disease modifying drugs for MS?

A
  • Mild-moderate disease
    • Interferon-β
    • Dimethyl fumarate
  • More severe disease
    • Monoclonal antibodies
      • Alemtuzumab
      • Natalizumab
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16
Q

Treating relapses in MS?

A
  • Methylprednisolone
    • 3-5 day course
    • Shortens length of acute relapses, but does not effect prognosis
    • Should not be used more than twice/year
    • SEs of steroids
17
Q

Name some symptoms that may need controlled in MS?

A
  • Spasticity
  • Tremor
  • Urgnecy/frequency
  • Fatigue
18
Q

How can spasticity be treated in MS?

A
  • 1st line: Baclofen or gabapentin
  • 2nd line: Tizanidine
  • 3rd line: Benzodiazepines
19
Q

How can tremor be treated in MS?

A
  • Botulinum toxin type A injections
    • Improve arm tremor and functioning
20
Q

How can fatigue be treated in MS?

A
  • Amantadine
  • Cognitive based therapy
  • Exercise
21
Q

Clinical features of MS?

A
22
Q

Eponyms of MS?

A
  • Pulfrich effect
  • Lhermitte’s sign
  • Devic’s syndrome
  • Charles Bonnet syndrome
  • Uhthoff’s phenomenom
  • Argyll Robertson pupil
23
Q

Describe Devic’s syndrome?

A
  • (Neuromyelitis optica)
  • MS variant with transverse myelitis
  • Loss of motor, sensory, autonomic, reflex, sphincter function below lesion level
  • Optic atrophy
  • Anti-aquaporin 4 antibodies (698 oxford handbook)
24
Q

Describe Lhermitte’s sign?

A
  • Neck flexion causes electric shocks in trunk/limbs
  • Also present in cervical sponylosis, cord tumours and B12 deficiency
25
Q

Describe Uhthoff’s phenomenom in MS?

A

Worseneing of symptoms with head (bath, exercise)

26
Q

Describe Charles Bonnet syndrome in MS?

A
  • Reduced acuity/temporal blindness
  • +/- complex visual hallucinations of facesm as well as animals, plants and trees
27
Q

Describe Pulfrich effect in MS?

A
  • Unequal eye latencies
  • Causes disoreintation in traffic:
    • Straight trajectories seem curved
    • Distances are misjudged on looking sideways
28
Q

Describe Argyll Robertson pupil in MS?

A
  • Pupil is constrictive and unreactive to light
    • But reacts to accomodation
  • The iris may be patchily atrophied, irregular and depigmented
  • Occurs in MS, neurosyphilis, DM, HIV, sarcoidosis
  • (prostitutes pupil - accomodates but does not react
29
Q

Risk factors for MS?

A
  • Strong
    • Female
    • Northern latitude
  • Weak
    • Genetic factors
    • Smoking
    • Vitamin D deficiency
    • Autoimmune disease
    • Epstain barr virus (EBV)
30
Q

Differentials for MS?

A
  • Fibromyalgia
  • Sleep disorders
  • Vitamin B12 deficiency
  • Peripheral neuropathy
  • Guillain-Barre syndrome
31
Q

Describe the first line investigations into someone with suspected MS?

A
  • MRI brain:
    • Hyperintensities in periventricular white matter
  • MRI spinal cord:
    • Demyelination lesions (especially cervical SC)
  • FBC, TSH, vitamin B12 (all normal in MS)
32
Q

Name some second line tests for investigating someone with MS?

A
  • Anti-neuromyelitis optica antibody
    • Present in Devic syndrome
  • CSF evaluation
    • Glucose, protein, cell count normal
    • Oligoclonal bands and elevated CSF IgG
  • Evoked potentials (most common visual)
    • Prolongation of conduction
    • Asymmetrical prolongation in visual evoked potentials
33
Q

Treatment for acute relapse affecting function in MS?

A

Methylprednisolone + plasma exchange

34
Q

First line treatment for relapsing-remitting MS?

A
  • Immunomodulators
      • lifestyle modifications +/- non-pharmacological treatmeats
35
Q

First line treatment for secondary progressive MS?

A
  • 1st line:
    • Siponimod or methylprednisolone
  • 2nd line:
    • Cladribine

Y4: Neurology (11 decks)

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